HomeMy WebLinkAbout01-27-10 (2) C7 `~ ..
'
C Q ,
_~..' ~
~
r1 r.
~ -? C~
ANNUAL REPORT OF
~
?'' ' "' ' ~ ~~
..
..<y ~ ..,.,
...
GUARDIAN OF THE PERSON ` ~ ~:f ~~'~ ~ ~ '
_,
-= .~. ~ -
~ -.,
COURT OF COMMON PLEAS OF . ~,~
~ ~ ~, _
~ ' ''
;
. ,
CUMBERLAND COUNTY, PENNSYLVANIA "'
ORPHANS' COURT DIVISION
Estate of Constance M. Meredith , an Incapacitated Person
No. 06-0294
I. INTRODUCTION
William J. Meredith ,was appointed
OPlenary ^Limited Guardian of the Person by Decree of Edward E. Guido , J,,
dated June 12, 2006 and Amended Final Order dated July 20, 2006.
A. This is the Annual Report for the period from Janu 1 2009
to December 31, 2009 (the "Report Period"); or
^ B. This is the Final Report for the period from
to
for the following reason:
(the "Report Period"), and is filed
1. 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 IY.
J., dated
( Form G-03 rev. 10.13.06 Page 1 of 4
V~'w /
/V
Estate of Constance M. Meredith , an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: 77 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:
^ own home /apartment
~ 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:
Form G-03 rev. 10.13.06 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:
All social, medical, psychological and support services are provided by or
coordinated through South Mountain Restoration Center.
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. 10.13.06 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
:.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.
/~-1q-~
Date
Form G-03 rev. 10.13.06
Signature of Gtld-dian 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