HomeMy WebLinkAbout03-11-08 (2)
ANNUAL REPORT OF
GUARDIAN OF THE PERSON
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COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DMSION
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Estate of
REGINALD WALLER
, an Incapacitated Person
No. 2007-214
I. INTRODUCfION
FAITH, HOPE AND LOVE GUARDIANSHIP SERVICES, me . was appointed
IlIPlenaryDLimited Guardian of the Person by Decree of M.L. EBERT
dated ApriJ23.2007
. J.,
o A. This is the Annual Report for the period from
to (the "Report Period"); or
III B. This is the Final Report for the period from Apri123, 2007
to present
(the "Report Period"). and is filed
for the following reason:
J. The death of the Incapacitated Person. Date of death: January 8. 2008
2. The Guardianship was terminated by the Court by Decree of
J.. dated
For a FUUIl Report, omit Sections n tIIl'ouglt w.
Form G-O) ~. 10.13.06
Page I of4
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Estate of
REGINALD WALLER
. an Incapacitated Person
ll. PERSONAL DATA
Age of the Incapacitated Person: 67
Date of Birth: January 29, 1940
m. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
N/A
B. The Incapacitated Person's residence is:
o own home I apartment
o nursing home
o boarding home I personal care home
o Guardian's home I apartment
o hospital or medical facility
o relative's home (name, relationship and address)
(lJother:
C. The Incapacitated Person has been in the present residence since April 26, 2004
. If the Incapacitated Person has moved within the
past year, state prior residence and reason(s) for move:
N/A
Form (j.()j rev. /0.13.06
Page 2 of 4
Estate of
REGINALD WALLER
~ an lncapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
N/A
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
N/A
B. Specify what., if any, social, medical, psychological and support services the
Incapacitated Person is receiving:
N/A
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
o continue
o be modified
1lI be terminated
Fonrr G-lJ3 ~. /0./3.06
Page 3 of4
Estate of
REGINALD WALLER
. an Incapacitated Person
The reasons for the foregoing opinion are:
Mr. Waller is deceased
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
18
times with the average visit lasting
hours, 30
minutes.
The report of a social service organization employed by the Guardian to oversee and
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attached to supplement this Report.
[ verify that the foregoing information is correct to the best of my knowledge,
information and belief; and that this Verification is ~ to the -!li 'es of] 8 Pa. C.S.A. ~ 4904
relative to unsworn falsification to authorities. ( ) J
March 11, 2008 . {N"'< ?;.I ;1.,,..
"C 5",\ J,'-(.
Date
Faith, Hope & Love Guardianship Sves. Ine
N_qf~qf.P~(typeorprint)
P.O. Box 2027
Adchss
Harrisbwg, P A 17104
City, S1ote, Zip
(717) 233-5698
Telephone
Form 0-03 rev. /0.13.06
Page 4 of 4