HomeMy WebLinkAbout12-17-08 (2)ANNUAL REPORT OF GUARDIAN
OF THE PERSON
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA ~ ~
ORPHANS' COURT DIVISION =~ ~? ~,~
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Estate of Howard J. Taylor , an Incapacitated Person ,`. ~ ` ' - `'
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No. 21-06-043, ~ --
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I. INTRODUCTION
Keystone Guardianship Services was appointed
~~Plenary ~ Limited Guardian of the Person by Decree of M.L. Ebert, Jr. , J.,
dated 10/9/07.
_i This is the Annual Report for the period from
to (the "Report Period"); or
~B. This is the Final Report for the period from October 10, 2007
to , April 14 2008 (the "Report Period"), and is filed
for the for the following reason:
1. The death of the Incapacitated Person. Date of death: 4/14/2008
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 Howard J. Taylor , an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: Date of Birth:
II[I. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
B. The Incapacitated Person's residence is:
I ;own home /apartment
f ;nursing home
boarding home /personal care home
Ci Guardian's home /apartment
~:~ hospital or medical facility
i relative's home (name, relationship and address)
~l 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:
r~u,-m ~~-~~3 r~~. ~r~. ~3. nh Page 2 0£ 4
Estate of Howard J. Taylor , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
I'V. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person areas 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
Dorm G-03 ccv. 70.13.OG
Page 3 of 4
Estate of Howard J. Taylor , an Incapacitated Person
The reasons for the foregoing opinion are:
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
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
t~~ 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.
~,
Date Signature of Guardian of the Estate
Constance E. Stoneroad
Name of Guardian of the Estate (type or print)
512. Market Street
Address
Millersburg, Pa 17061
City, State, Zip
717-692-2345 OR 717-692-1320
'Telephone
Form G-03 rev. 10.13.06 Page 4 Of 4