HomeMy WebLinkAbout02-24-09 (2)ORIGINAL
ANNUAL REPORT OF
GUARDIAN OF THE PERSON
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of Constance M. Meredith _, an Incapacitated Person
No. 06-0294
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I. INTRODUCTION _ ~'' -' -_
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William J. Meredith ;'was appc~ted .~
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^D Plenary [Limited Guardian of the Person by Decree of Edward E. Guido , J•~
dated June 12 2006 and Amended Final Order dated July 20, 2006.
0 A. This is the Annual Report for the period from January 1 2008
to December 31, 2008 (the "Report Period"); or
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
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Estate of Constance M. Meredith , an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: 76 Date of Birth: May 23, 1932
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
South Mountain Restoration Center
10058 South Mountain Road
South Mountain, PA 17261
B. The Incapacitated Person's residence is:
Ql own home /apartment
0 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 March 22, 2007. If
the Incapacitated Person has moved within the past year, state prior residence and reason(s) for
move: She was previously in the Danville State Hospital, 200 State Hospital Drive,
Danville, PA 17821 and was moved to South Mountain Restoration Center.
Form G-03 rev. 10.!3.06 Page 2 of 4
Estate of Constance M. Meredith , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
South Mountain Restoration Center
10058 South Mountain Road
South Mountain, PA 17261
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
Constance M. Meredith suffers from Paranoid Schizophrenia and Organic Brain
Syndrome.
B. Specify what, if any, social, medical, psychological and support services the
Incapacitated Person is receiving: NONE.
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. ~o.~3.n6 Page 3 of 4
Estate of Constance M. Meredith , an Incapacitated Person
The reasons for the foregoing opinion are:
The major medical and mental problems have remained the same.
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
every Saturday, Sunday and holidays with the average visit lasting
1.5 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 18 Pa. C.S.A. § 4904
relative to unsworn falsification to authorities.
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Date
Form G-03 rev. 10.13.06
Signature of Guar an of the Person
William J. Meredith
Name of Guardian of the Person (type or print)
165 Linn Drive
Address
Carlisle PA 17013
City, State, Zip
(717)243-5464
Telephone
Page 4 of 4