HomeMy WebLinkAbout03-04-10 (2)ANNUAL REPORT OF GUARDIAN OF THE PERSON
THE COURT OF COMMON PLEAS OF CUMBERLAND CO., PENNSYLVANIA
ORPHANS' COURT DIVISION r-> o
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Estate of• , an incapacitated person "_~ ~~ r
FILE NO:
I. INTRODUCTION
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PENNSYLVANIA GUARDIANSHIP ASSOC. / BRIAN D. BROOKS,
appointed Limited X Plenary Guardian of the Person by Decree of
ORPHANS' COURT ,Judge. Dated 1/22/09
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A. This is the Annual Report for the period from to
X B. This is the Final Report for the period from 10/22/09 to 1/24/10
and is filed for the following reason:
1. The death of the Incapacitated Person. Date of death 1/24/10
2. The Guardianship was terminated by the Court by Decree of
,Judge, Dated
For a Final Report, omit Sections II through IV.
II. PERSONAL DATA
Age of the Incapacitated Person Date of Birth,
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
B. The Incapacitated Person's residence is:
ward's 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)
C. The Incapacitated Person has been in the present residence since
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If the Incapacitated Person has moved within the past year, state prior residence
and reason for move:
Estate of: ROSE E. COLBERT , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as
follows:
B. Specify what if any ,social, medical, psychological and support services
the Incapacitated Person is receiving: ALL PSYCH AND SOCIAL
SERVICES PROVIDED BY STAFF AND PHYSICIANS AT THE FACILITY
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship
should
Continue be modified X be terminated
The reasons for the foregoing opinion are: DEATH OF WARD
B. During the past year, the Guardian of the Person has visited the
Incapacitated Person 2 times with average visit lasting
Hours, 15-20 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 correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties if 18 Pa.
C.S.A. S/S 4904 ,~
Date• `.
Sign re of the Guardian of the Person
Brian D. Brooks
Name of Guardian of the Person (type or print)
PENNSYLVANIA GUARDIANSHIP ASSOC.
PO BOX 7295
LANCASTER, PA 17604
Telephone 717-299-4568