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HomeMy WebLinkAbout97-0168 ANNUAL REPORT OF GUARDIAN OF THE PERSON ("") C::;o .~ :7J ;-'-0 :-~C) ,J.~~53 cr.' ;:x: :3~~~ :-0 j> . r--.) ,~ = ex:> !:;; ::;0 COURT OF COMMON PLEAS OF Cumberla.nd COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION -0 :x - - (~ --, I .~.::: (_~ .J fT'j - .. Estate of tf\\\t-ov\ \Y\Cl~D No.-'ZJ - Cf'1- III ~ , an Incapacitated Person I. INTRODUCTION t--\-e-tfj\\bo rhcc::cJ ~V\L-eS , was appointed DPlenary~imited Guardian of the Person by Decree of G-e.Dn~ H0 ff-e-r , J., dated '0-5-- q ~ . ~ A. This is the Annual Report for the Eeriod from rn Ct-l.,: I.. , ~ OO~ -'\ . to lY\~ 15 , <!00\..P (the "Repo 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 ~ Estate of m ,\+01'\ m~O , an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person: ~~ Date ofBirth:~-7- \Cf'2 t-J III. LIVING ARRANGEMENTS A. c~~~;e~~~ap~ ~n:(Mr\d ~e hab 770 POp\Cl( C\'\vrGh P1d CCUI'\P \-hl\ I PA I-Yol \ B. The Incapacitated Person's residence is: o own home / apartment t)(nursing home o boarding home / personal care home o Guardian's home / apartment o hospital or medical facility o relative's home (name, relationship and address) D other: c. The Incapacitated Person has been in the present residence since _l 2 - \- \9'6~ . If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: t\\~ Form G-03 rev. 10.13.06 Page 2 of 4 Estateof m(\-to(\ \Yl~o , an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: West Sh O~ \-teQ\ th and ruz..hCl b IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: Dexnenh'{).; ~~ Feu: \ Lre ~ 'S'c-\tVzop I", fenio..: CerVltrcl S pondy I OS\S ~ \ fl cm.:k\ O.eA'\..t..JL QX. t\ t1'\--€ 5 ,. at- c\.<;~ \Vr: re.SpdL:\'eJ c{(s1f'e~s J Skl'\ bVRCCVl -ctctLV) CLV~ UTI:; cLwV1?S'5\ot\ B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: l-t~ UV-eS (n Cl \'~lY\S .fo.c-\. h~ I L0Le.x--e '(QCuV.eS "2. Y he Co. r..e- V\.v V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: ~ontinue D be modified D be terminated Form G-03 rev. 10.13.06 Page 3 of 4 Estate of _\1\ '\ \'m n m fuJ6 , an Incapacitated Person The reasons for the foregoing opinion are: , m r. m (LeYl I'S t'1'\ CGt \Xl C dQ t--ed B. During the past year, the Guardian of the Person has visited the Incapacitated Person 20 times with the average visit lasting hours, I 5 minutes. The report of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Personfor 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. ~ 4904 relative to unsworn falsification to authorities. ~ l~ mv 3 -20 -01J '\ bO\\'\ood Servl'CQ S Date Signature ofG rdian of the Person 1'\eiS1h}xy-hcOC( Servl 'CQ ~ Name ofGu ian of the Person (type or print) NElGBBOBBOOD SERVICES 134 SOUTH pRINCE STREET ~O. BOX 1593 LANCASTER, PA 17608-1599 Address City, State, Zip ~lJ7-509- \22 \ Telephone Form G-03 rev. 10,13.06 Page 4 of 4 ANNUAL REPORT OF GUARDIAN OF THE PERSON ,...", <:::::> = a::> :::;:... -'0 ::::0 o c::-:o '--; ::LJ I=EO ; ~~:; ~ .,;;~~ (~JC) ~2'-Tl t..._ ::f:J -V-l :;;.. -0 :z COURT OF COMMON PLEAS OF C" xY\ hQ~,,\Cl ncl COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of ----.1D i \ -mY\ m CLtjO No. -2) -9~- L12<6 , an Incapacitated Person I. INTRODUCTION Ne('Cj h \2-x-hood Sex-v l(OS ' was appointed o Plenary.lt{imited Guardian of the Person by Decree of (JE'Dn:y _ l-\off~r ,1., dated \L~r 5 - CJ r-; . \-, L. This is the Annual Re ort for the period from 'Zoo l.p ~n. to , '2IX:f7 (the "Report o B. This is the Final 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. TI r-<'1 '::-) .~-) ~':) \,~ r:::; "J '1'1 :.: :~~ ':: :n '=:) " , Form G-03 rev. 10,13,06 Page 1 of4 ~ Estate of -ill l 1m VI y}J t1~ 0 , an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person:~9 Date of Birth:-.3 -7 - ICf2 '7 III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: tD~st Sh~ ~o.\+11\ O-/\C( Y1cYRb 770 PO?\etY"' C\r)~x'ch 'P-Jd CAwt~ lilt HI PA I ~o {\ B. The Incapacitated Person's residence is: o own home I apartment ~urSing 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) o other: C. The Incapacitated Person has been in the present residence since l1 ~ \ ~ ,g 35 . If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: .~ \ 0-r Form G-03 rev. 10.13.06 Page 2 of 4 Estate oem i \ +on \1\ Cl..lfJ , an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: ~\jes1-- 'Shcr~ rt-eCt \ 11,\ ~ Pw- hw~ IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: \\enoS ,&llVIQ I Uy\nCt~ (neon -hJ~) SC Iru 2Ci ph re ~( a 1 ~ I, CerViCc'll <;~VY\lj \ oSIS I aSSIC', tailu ~cteci Lvi ADL'S I PusVl -FbI UTJ:'S B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: f-t.e. Q U(Ws 2 Lj h r \) LX'; I nJ (lax'.e.... v. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: ~continue D be modified D be terminated Form G-03 rev. 10.13.06 Page 3 of 4 Estate oeib ( ( -\--on 101 {iiJ~ , an Incapacitated Person The reasons for the foregoing opinion are: (f\C Cl ~c~'t-at--Qc( B. During the past year, the Guardian of the Person has visited the Incapacitated Person \Y times with the average visit lasting hours, 1 ~ minutes. The report of a social service organization employed by the Guardian to oversee and coordinate the care of the Incapacitated Personfor 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. f ~ lU~. -, ", . to r. 3-'2.0- 0'6 Neil C~ 'dJo( ~D2:S Date Signature of rdian of the Person t=tK' hcoc( v\Cef; NEIGHBORHOOD SERVICES 134 SOUTH pRINCE STREET ~O. BOX 1593 LANCASTER, PA 17608-1500 Address City, State, Zip '(It{ -IJOg-/2'2 J Telephone Form G-03 rev. 10.13.06 Page 4 of 4 t Ohl ('i-l{,,^:~ ()R f'. J`?•• ~^!.~. ~ ` L. I f fi 1f; > P.. ., .. i i V "~:L ?.,.. 208 JUI. - I PM 1 ~ { 6 ANNUAL REPORT OF CLERK OF ORPHAid S COUI~i' GUARDIAN OF THE PERSON C~E'~~'~"~fl ~° PA COURT OF COMMON PLEAS OF C U i'Y\ Ir1 f'r I C~.~1 C~ COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of __ ~ ~ ~ ~ti ~ ~~~ ~ 1 ~ , an Incapacitated Person No. Z I -q 7- I ~.(? I. .INTRODUCTION was appointed _ f ~~lenary Limited Guardian of the Person by Decree of ~~ l"~~ J•, dated _ ~ -~-~ .7 A. This is the Annual Report for the period from _ to (the "Report Period"); or B. This is the Final Report for the period from ~InQ.~,l~~ 2~~ \\ to C~, 2 7 2-0~~ (the "Report Period"), and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: ~ - ~ 7 ~~ ~ 2. The Guardianship was terminated by the Court by Decree of For a Final Report, omit Sections II through IV. Form G-03 rev. 10.13.06 J., dated P e u~~ ag 1 of 4 Estate of ~ ~ ~ I II. PERSONAL DATA Age of the Incapacitated Person: Iti. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: an Incapacitated Person Date of Birth: B. The Incapacitated Person's residence is: ® own home /apartment ® nursing home boarding home /personal care home ® Guardian's home /apartment ® hospital or medical facility ~ relative's home (name, relationship and address) ®other: C. The Incapacitated Person has been in the present residence since . 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 i Estate of ~ ~ I ~U ~ , an Inca acitated Person P D. Name and address of the Incapacitated Person's primary caregiver: N. MEDICAL II\TFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: ® continue be modified 'be terminated Form G-03 rev. 10.13.06 Page 3 of 4 Estate of , an Incapacitated Person The reasons for the foregoing opinion are: m ~. ~~~y©~ c~ssecf c~~~~-~' B. During the past year, the Guardian of the Person has visited the Incapacitated Person 2~_ hours, minutes. _~ times with the average visit lasting 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. § 4904 _....... relative to unsworn falsification to authorities. ~? ' ~~~ ~~ ti ~ ~ ~ " C~~ r' ,r1~tc~cf ~ ~. S Date Signature of Gua ian of the Person 1x34 5` OU H~PRIND E STREET P.O. BOX 1593 LANCASTER, PA 1760&1593 Name ojGuardian of the Person. (type or print) Address City, State, Zip 717 ~ ~!~ 2 -2175 ~x t- 22 l Telephone Forme-03 rev. ID.I3.06 Page 4 of 4