HomeMy WebLinkAbout10-15-080
Clerk of Orphans' Court of Cumberland County
IN RE: ~) d Y, h N v~- I~ I Docket No. Z E D ~, ' d G~ Y Cl
An Incapacitated Person
ANNUAL REPORT OF GUARDIAN OF THE PERSON
I, ~~y~ ,rw ~ 6`ru- o ,~~i{{`//h J f v.by P,~~as /were appointed
plenary gua ian~ of e person of ~ ~ ~-~ I~ye ~ ~~ by Decree of the
Honorable Judge (71 e ~ ,dated -~ ~ ~~ ~ a f Z~~ ~. This is my annual report for
the period from to ,(''`The Report Period").
1. Present age of the incapacitated person: ,~3 Yrs.
2. Current address of the incapacitated person
__ ~ ti~
-, ~,
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3. The incapacitated person's residence is: `.- ~~"
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^ own home/apartment "- - -n
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^ nursing home ,~ -~'
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lC7
^ boarding home/personal care home
guardian's kit/apartment
^ hospital or m/~e-dical facility
relative's h~et~ ~~`'~j ~4i/~ ~~ L' (/~O ~`/ t' Y" ~ (Name and relationship)
^ Other: (describe)
4. The incapacitated person has been in the present residence since _ r.` ~ OUP . If
the incapacitated person has moved within the past year, state chaaige and reason{s) for
change:
5. Name and address of the incapacitated person's primary care giver:
~~i~~ mss /r D - Z
6. The major medical or mental problems of the incapacitated person are as follows:
Specify what, if any, social, medical, psychological and support services the incapacitated
7.
person is receiving:
c:,E :' ~ q p .e s ~0 71`iR- ~i'~.S Gh S, ~e //a c~ (~P~h~T"~P ~- ~~-
It is our opinion as guardian of the person that the guardianship should: (check one)
8.
Q continue, ^ be modified, O be terminated. (Briefly explain your response)
9. During the past year, I have visited the incapacitated person `-" times with the
average visit lasting
(State number of hours/minutes, etc.) /J
.S h rs_ cf a/4 ~y /?~~iJ, Y~'i r o ~r / ~/ ~~ cc~ /~.e.,_. ~ t . S C~q~ pG~T.
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 maybe attached to
supplement this report.
1 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.
'~ ~y
ate Signa re o a~n__.
~__..~
* FILING FEE $15 MUST ACCOMPANY THIS FILING.