Loading...
HomeMy WebLinkAbout09-02-08 N ~ C7O °w'; 'm)'F~t~~ ~j. i~~ . ~~ . ANNUAL REPORT OF 't7 ~' ~'`- a Cam? GUARDIAN OF THE PERSON cn tV ~~' c,-; ~, © ~ -v s --~, ~: N t i~n i _ ~ ,"~ COMMON P EAS OF COURT OF ,jam \ r(~~ ~~0.r1 ~ COUNTY, PENNSYLVANIA ORPHANS' COURT DI ISION Estate of L , an Incapacitated Person No. -" I. INTRODUCTION was appointed Plenary Limited Guardian of the Person by Decree of ~ ~, ~ ~'" , J., dated ~ 31 Ode ~~ A. This is the nnual Report for the period om ~ ~ , s~~ to ~ r,~, l (the "Report Period"); or © B. This is the Final Report for the period fro~i , 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 t~'y the Court by Decree of dated For a Final Report, omit Sections II through IY. Form G-03 rev. 10.13.06 Page 1 of 4 D Estate of ~~ ~ ~t7 \ ~_ ~ \~~ CLL , an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person:~0 ~ Date of Birth: f ~ III. LIVING ARRANGEMENTS A. Current address of the Inca acitated Person: °1 ~ ~ d a~~.a, ~~ Co~c-\~s1e ` p°A 1-1015 B. The Incapacitated Person's residence is: ~rW~h ~ PA ~ ~'l3 ~ Z ~ own home /apartment ~ nursing home Q 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. l~~q 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 ~ ~ G ~ l ~. 'C'~ `A.~GL~ , an Incapacitated Person D. Name and address of the Incapacitated Person' primary caregiver: M,er\rno`~~ ~.1rv~ ~ ~I `~ IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: ~J a.r~ ac.~ d ve ~ ~ ~.~., a ~~~ . B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: w` V is p~e.~ ~ ~ t'~l~~ ~ 1 ~~-~c~Q , (~ 5~C}ld ~t~\ C~ j ~.~s~ ca..Q ~~1ec~o.p ~ ~ ° c~ `' P~-~r~-Q -~c~e~P uJ , -~-he~P~ c~.~ J~b -~~~~~r~oJ ~~~LS ~ r~ c~ccc~darce vJ~ he ~- ' ~~? as ~~}4ec~ 1r~~ `N~~mac-kar~~ c~Qp~aJec~'~,b".~ ~c~er~S/Co-oJ~ac~~artS V. GUARDIAN'S OPINION Qr~c~ ~rf~~lr,~ei~~r~val\~~~X~~oa~ ~S'~c`lc~ A. It is the opinion of the Guardian of the Person hat the guardianship should: continue I~~' ®be modified I', ®be terminated Form e-03 rev.10.~3.06 ', Page 3 of 4 Estate of ~, l C~ ~~ "t'-~ \ CJ~ y Q C , an Incapacitated Person The reasons for the foregoing opinion are: '~~ co\~ ~S ma~~ ~~esS on hem- \~1 al~~S by-~t-- ~s s~~` ~Y,A.`"~\e.. ~ ~rc~~ hey- a~Jt~ c-~~~c-s . ~1 icra l~ c-~em~a~ nS ~e(~rc~et~- or1 cs~cs hoc- hoc- ~c~., B D ~ie`pas y r; the Guardian of the Person has visited the Incapacitated Person ~_ times with the average visit lasting ,~_ 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 I8 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. ~I~~ iog Date Signature of Guardian of the Person Name of Guardian of t~vhie Person (type or print)~~"~ ~~(N ~ 11V Address C~~L~S~ . ~~ \~~~5 City, State, Zip ~-, ~-,~ asps- ~ ~ c~ Telephone Form G-03 rev. 10.13.06 Page 4 of 4 Supplement to Annual Report of Guardian of the Person Person: Nicole Hlavac; Docket', Nbr: 06-0608 Following are the details regarding visits to Niki during the September 1, 2007 to August 31, 2008 timeframe. Trip Visit Visit Duration Notes ' Number Start End , 1 9/28/07 9/30/07 52 Home Vi it; Picked Niki up in Philly about 5 .m. and eturned back to Phill about 9 .m. 2 11/11/07 11/11/7 3 Visit wi Niki on way home from Swim Meet; 3- .m. 3 11 /21 /07 11 /26/07 121 Niki ho a for Thanksgiving; Picked Niki up in Philly bout 6 p.m. and returned back to Phill a ut 7 .m. 4 12/21 /07 12/26/07 131.5 Niki ho a for Christmas; Picked Niki up in Philly ab ut 7 p.m. and returned back to Phill a ut 12:30 .m. 5 3/21/08 3/23/08 50 Niki homle for Spring Break ; Picked Niki up in Philly bout 5 p.m. and returned back to Phill a ut 7 .m. 6 6/21/08 6/21/08 8 Visit Nik~i in Philly for the day; arrived about 10 a.m. d left about 6 .m. 7 7/30108 7/30/08 1 Visited iki after attending Transition Conferencce at Melmark (conference 8 a.m. to 3 .m., visited Niki about 1 hour) Total visits = 7 Total hours = 366.5 Average Per Visit: 52 hrs and 21 minutes