HomeMy WebLinkAbout10-23-07 (2)
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. Clerk of Orphans' Court of Cumberland County
INRE: ~ 0 hY\ Nye- 11/
An Incapacitated Person
Docket No.
ZOOb - 06 Lj~6
ANNUAL REPORT OF GUARDIAN OF THE PERSON
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r r 4/ A--e.. /1/ t e- U , ~ /were appointed
J 6 hn rJye 1 \I by Decree of the
, dated .J V\ v\e.. S ~I 1DD {O. This is my annual report for
to , ("The Report Period").
I,
the period from
1.
Present age of the incapacitated person:
S / Yrs.
2. Current address of the incapacitated person
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3.
The incapacitated person's residence is:
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C)
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D own home/apartment
r'J
w
o nursing home
--'.
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D boarding home/personal care home
~
en
~ guardian's lMMe/,apartment
o hospital or medical facility
~ relative's home Sltrq 3QJu- lYy-€-(!J1(}~ '(NameandrelaliOnShiP)
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D other:
(describe)
4.
The incapacitated person has been in the present residence since Apy/! ;2002 . If
the incapacitated person has moved within the past year, state change and reason(s) for
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change:
5. Name and address of the incapacitated person's primary care giver:
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6. The major medical or mental problems of the incapacitated person are as follows:
5euer!p 1?~h/J~ d
7.
Specify what, if any, social, medical, psychological and suppon services the incapacitated
person IS receIvmg:
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It is our opinion as guardian of the person that the guardianship should: (check one)
~ntinue, 0 be modified, Cl be terminated. (Briefly explain your response)
8.
9. During the past year, I have visited the incapacitated person ----- times with the
average visit lasting
-:Ji. c I, , 'C. ,. S tv / h'JL 7 d.
(State number ofhourslminutes, etc.)
5hrs,ada>>- mPlJ, +hrv
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The report of a social service organization employed by the guardian to oversee and coordinate
the care of the incapacitated person for the period covered by this report may be attached to
supplement this report.
I verify that the foregoing information is correct to the best of my knowledge, information and
belief; and that this verification is subject to the penalties of 18 Pa. C.S.A. g4904 relative to
unsworn falsification to authorities.
/0/;2.3/07
Date
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Signature Gu Ian
* FILING FEE $15 MUST ACCOMPANY THIS FILING.