HomeMy WebLinkAbout01-09-08 (3)
ANNUAL REPORT OF
GUARDIAN OF THE PERSON
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COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY PENNSYLVANIA
,
ORPHANS' COURT DIVISION
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Estate of
LONIE RAY WITMER
, an Incapacitated Person
No. 21-07-0937
I. INTRODUCTION
Clarence Victor Witmer and Betty Jane Witmer
, was appointed
IZjPlenaryDLimited Guardian of the Person by Decree of Edward E. Guido
dated November 13,2007
, J.,
IZj A. This is the Annual Report for the period from January 1 2007
to December 31 2007 (the "Report Period"); or
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
Page 1 of 4
o
Estate of
LONIE RAY WITMER
, an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: 51
Date of Birth: December 27, 1955
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
Cumberland Vista
1073 York Road
Dillsburg, P A 17019
B. The Incapacitated Person's residence is:
D own home / apartment
D nursing home
lZl boarding home / personal care home
D Guardian's home / apartment
D hospital or medical facility
D relative's home (name, relationship and address)
D other:
C. The Incapacitated Person has been in the present residence since September 2006
. 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
LONIE RAY WITMER
, an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
Betty and Clarence Witmer*
364 Nova Drive
Greencastle, P A 17225
*through: Cumberland Vista, Attn: Barbara Royer
1 073 York Road, Dillsburg, P A 17019
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
Mental and physical disabilities related to brain damage. Unable to manage
financial affairs and property. Limited communications skills. Unable to properly
care for himself without assistance with personal hygiene such as bathing, bathroom
needs, and personal grooming.
B. Specify what, if any, social, medical, psychological and support services the
Incapacitated Person is receiving:
All services through personal care home or referred by behavioral care staff.
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
III continue
o be modified
o be terminated
Form G-03 rev. 10.13.06
Page 3 of 4
Estate of
LONIE RAY WITMER
, an Incapacitated Person
The reasons for the foregoing opinion are:
Mental capacity of 2 or 3 year old. Mental disabilities since childhood with no
improvements expected.
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
9
times with the average visit lasting 72
hours,
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 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. S 4904
relative to unsworn falsification to authorities.
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Signature of artf of the Person
13eitt ..JAne. Wi'T.n1('.;
Name ofGuar !an of the Person (type or print)
Date
Address
City, State, Zip
Telephone
Form G-03 rev, 10,13.06
Page 4 of 4
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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. ~ 4904
relative to unsworn falsification to authorities.
/,1- 11-07
Date
Form G-03 rev. 10.13.06
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Signature of Guardian of the Person
(I t{r <" (~ V/, fbr IN,' +111 rr
Name of Guardian of the Person (type or print)
Address
City, State, Zip
Telephone
Page.4'of$