Loading...
HomeMy WebLinkAbout12-21-09 (2) ANNUAL REPORT OF ~ a r.a ~ - ;-~ ;~'- GUARDIAN OF THE PERSON ~ ~ -~ ~ ~ Q N ~ ~~~ r ,~ ~ r , ~``-, -~ ,:; COURT OF COMMON PLEAS OF ~ ~ -,~ N ~ ~~ =.- -_. ~u mb e~ I an ~- COUNTY, PENNSYLVANIA ''' ~ `'~' `=r; ORPHANS' COURT DIVISION Estate of Lonie ,~ay (,~i ~rncr I. INTRODUCTION No. ~1-07-0937 an Incapacitated Person Clarence U ~/if"rncr and. l3e~fy f I/yitmcr,wasappointed Plenary Limited Guardian of the Person by Decree of ~d ward E, (~u id o , J., dated /1/u /~ l 3 X 0 0 7 ~A. This is the Annual Report for the period from San • / o? 0 a to D e ~ • 3 / 0 0 (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: I . The death of the Incapacitated Person. Date of death: 2. The Guardianship was terminated by the Court by Decree of For a Final Report, omit Sections II through IV. J., dated Form G-03 rev. /0.13.06 Page 1 of 4 Estate of L- o n ~ ~ l~ 0.y ~ i f m c ~ , an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person: S3 III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: ~urnber and. ~//sfia- /073 York ~d, p; lI s 6 ur~ , P~4 / ~ 0 19 B. The Incapacitated Person's residence is: own home /apartment nursing home boarding home /personal care home Guazdian's home /apartment Q hospital or medical facility Date of Birth: A e ~. a7 7~ l 9SS relative's home (name, relationship and address) other: C. The Incapacitated Person has been in the present residence since a pt. ,2 0 0 6 . If the Incapacitated Person has moved within the past yeaz, state prior residence and reason(s) for move: Form G-03 rev. 10.13.06 Page 2 of 4 Estate of Lon ; ~ ~ Qy VV i trh c C , an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: Cf a.r cncc an a. Qe'~"y Wifimer' 36`J Nova.. Or, Grcencccs'r'l~, ~/g 17~~-~ ~. f- person a-~ C arc f~~n c C,u fjnn c. ~'reec~ / 0 73 1(o r kPi4 d'~ 7 0/ 9 D % its b ar9 IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: 'i'Mcr ha.s /~'Jtn~~~ and p~yslca~ dl is0..~i1%-F~~s r'el.~f"~~ L. on i c I,tJ i 4-~F'4~rs, -r-v brain ~„,.~9e, ffc is c.~na_blL -~o maKCt9e_ his ~r-~`naicc~a_( ~ has limifc~ comn~un~car~'~'n Skills, ~~ CRrt '~+r I{i/rtSe~f I.~Il~vuf G~sSiS/ancC is u„ abler fio Properly wi1'Jt Person0.l /~y9ie~tc sK~~( Qs .bafi"~t%-y, ,ba~"l~r~on~ ncGA.r aid P erS~nal 9 r6omin 4~ B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: ~ ors ~ a ~ ~ ~J~ services arm- ~r~~~~- his Perso"~I c_Q~~ Cumdcr-la~d~/Per~r Co~ent~'~s /Hc,~'~'+~ ( /ictard4~f-io.~ S'er/ICeS, V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: [~ continue be modified ©be terminated Fonre G-03 rev. 10.13.06 Page 3 of 4 Estate of L- 6ni ¢- ~ ay ~) r~~r~i cr , an Incapacitated Person The reasons for the foregoing opinion are: Loni~ I.<Ji'fmcr {tas ttic rnc.,-~a) c~a4r;fY of a- a or 3 Yr. old, f/t has h~d~ r,e-~~ disab; li "hes S~y~ce cl-~jdA~a~ wi'f-h qo ex~~~~tat';cns ~r im~~!'overne~t. B. During the past year, the Guazdian of the Person has visited the Incapacitated Person _~ times with the average visit lasting 702 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~- /7 - aoo9 Date Signature of d' f the Person ~e~y S• 1Nif mcr Name of Guardian of the Person (type or print) 3b`l /~l ova ~/'~ v~ Address City, State, Zip 7/7 S 97 Oat 37 Telephone Form G-03 rev. 10.13.06 Page 4 of 4 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. is-i~-~g Date Signattve ojGuaidim~ ojdx Person C l a c c.~ ~ e. r/. W i try c /" Name of Gumdian ojthe Person (type or pant) 3 6 ~/ /~l a r/ ~- D /- r" y ~ Address Gfce~c~s t~~ P~ ~7o?o?-S" Ctry, State Zip 7i7 s97 0~3~ Te/~phone ~~