HomeMy WebLinkAbout01-07-08
ANNUAL REPORT OF
GUARDIAN OF THE PERSON
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COURT OF COMMON PLEAS OF
(? U IV) 682 L A tv.D COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of
N f\ NC'J
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, an Incapacitated Person
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I. INTRODUCTION
J) 0 f-.l A t...J) B . S 'U CIC.
o Plenary BLjmited Guardian of the Person by Decree of · <"" d:7 ,q Il- B
dated t - . ~ . ~ V 1 .
pg A. This is the Annual Report for the period from 0),. 0 I.... , "2-007
to ':l..::s , - . 2-0 01- (the "Report Period"); or
, was appointed
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o B. This is the Final Report for the period from
to
(the "Report Period"), and is filed
for the following reason:
1. The death of the Incapacitated Person. Date of death:
2. The Guardianship was terminated by the Court by Decree of
J., dated
For a Final Report, omit Sections II through IV.
Form G-03 rev. 10.13.06
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Estate of
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II. PERSONALDATA
m.
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, an Incapacitated Person
Age of the Incapacitated person:~cn;. Date of Birth: 4 . 'J-7 - 19~-
III. LMNG ARRANGEMENTS
A. Current address of the Incapacitated Person:
\\ OD GO' OW) bU..s Ave. ./t I
L ~ \.f\I\ O(jVl.4C 'Po.. \ I 043
B. The Incapacitated Person's residence is:
o own home / apartment
o nursing home
D boarding home / personal care home
1;1 Guardian's home / apartment
o hospital or medical facility
o relative's home (name, relationship and address)
o other:
C. The Incapacitated Person has been in the present residence since
l\' 0 V e- VVlbCY
t,2D01.
. If the Incapacitated Person has moved within the
past year, state prior residence and reason(s) for move:
Form G-03 rev. 10.13.06
Page 2 of 4
Estate of
NQ,^c-G
N). s~\.Jcl
, an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
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C-- 0\ o \/V) bus I~\ \J e I
rvCA l1043
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
N C>V\ e..
B. Specify what, if any, social, medical, psychological and support services the
Incapacitated Person is receiving:
~Y. JQVltOY)
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V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian ofthe Person that the guardianship should:
9l continue
o be modified
o be terminated
Form G-03 rev. 10.13.06
Page 3 of 4
Estateof~ aY1C~
6)') .
stuc~
. an Incapacitated Person
The reasons for the foregoing opinion are:
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
.-&- times with the average visit lasting 0 '
N}A
hours, -e- minutes.
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 Repor.t. C' L .) ~
r"\\ _ ./"') L -f~. No.\'\~fY). ..:>lUCU-, n
vl\."'( V1'I ,("v~ c.~ I
. t\--, 6 \\\... s. Co"\ 'i i V) CL M H~ mo.le')'} 31 9-- G \JCLU~
1t,~J,. &. I mO"1' ~5"v~ II R.. , 1/ V\- l '7 0 S~ . \l
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. 94904
relative to unsworn falsification to authorities.
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Signature of Guardian of the Person
~<!)OV'lQ \d f). Stucl~
Name of Guardian of the Person (type or print)
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Address
c'''~~OQYlL 'Po<. 1(04-3
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Date
Telephone
t '7 ) 00
KAIne c. DASS 23-2237780
Certified Public AccoUbtant
125 N. EnoJa Dr., Enola, PA 170.;;;
Form G-03 rev. 10.13.06
Page 4 of 4