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HomeMy WebLinkAbout07-06-10~UAR.~~A~ ~~ ~~~ .~F~~ CURT (JF_ CQION PLEA S C)F Cp ~ C7 :~?~m _~ ~-- -:~ ~: _ '~ ~_~ -,b-~ '~ -c} `-~ .v N ~_ c_._ C r-' i c~ -v c..~ O 5.~~.1a~~.-._.~. cocrnrTY, PENNSYLVANIA ORPI-IANS' CdU:CiT DIVISIC3N Estate of _ ~ ~ ~~ , an. Incapacitated Person No, ~~~o - ~a S I. INTRODUCTION was appointed :~ ~i_ _. .._ :~ 1C> .., Plenary QLi,mited Guardian afthe Persoa~ by Decree of , J., dated - 12 - ~A. This is the Annum Report far the period from ~ XL~ ~ 2- , .2 GZ~"j to 31 ZG (U __ (the "Report Period"); car B. 1`Iris is the Final Report far lYe period from to (the "Report Period"), and is Bled for the following reason: 1. The death afthe Incapacitated Person. Bate of death:: 2. The Guardianship was terminated try the Court. by Decree of Fvr a ,i<inul,itepnrts emit Sectiaras II tlrrauht~ IV. 3., dated Page l of 4 L Estate of rl~r ~ (Jt , an Izcapaetat~d Person I1. :pERSQNAL DA'T'A ale of tl~e Incapacitated Perspz~:__ ~ o Z Dente of Birth; ~ - Z ~~~ ~ ~7 TIT. LTVINtz ARRANGT~~MCNTS A. Current address of the incapacitated Person: ~Ylaunor Cax-rz Cca.~t~~sLe. Cc~.rL~~5~1~ , ~~ ~~~ ~ 3 B. The Incapacitated Person°s residence is. a Home / apartment nursing home boarding home 1 personal. case home Guardian's home 1 apaxtznent hospital ar medical facility relative's Name (name, relationship and address} father: ~. Tlie incapacitated Person has been in the present residence since ~ ~ D -1 ! . if the Incapacitated Person has moved within the past year, state prior residence and reasons} far move: Page 2 of 4 Form ~-t~3 rev. 1 t~.13.Q6 Estate of r , an incapacitated Person D. Name and address of the Incapacitated Person's prin~a~y caec river: ~c~~~ Ccu~r.-e~ I'V. MEDICAL INFORMATIAN A. `Che n;a}car medical cr mental problems ref the Incapacitates! Person are.. as fc~liows: ~~~ B, Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: ~Jc. Sp Cif t,UC?~~i ~~~ ~~ c S S ~~'1 ,~ ~~;~ S~ Cam- 17'1 c~ ~'c~.u-~_ ~t.e V. cuAxDlAlv's ©rlNloly A. It is tl~e opinion of the Guardian of the Person that tl~e guardianship should: ~nti nue be modified be terminated Fa~rt~ G-U3 ret~. l~1.13.06 Pa~',S ~ of ~ I;st<~te of , an Incapacitated Persan The reasons far the foregoing op»ian ar+~: ~~ t s i ~l C~..QGt Cc `~-fi-e B. I7urixig the past year, the Gltardia~a of the Person has visited. the Incapacitated. Person times with the average visit lasting Ilo~.lrs, ~ ~ tnimttes. I'he report of a sACx~l.~et7lice c~rgarrzzrriavrt emplr~yeca't~y ~h~ (iarardfan to oversee crncl cvr~rdin~te the cnr"e ©f the InCap+acitcllet~' PGrro» for the period co?tired h}~ tTitc Report` trrct~ b~ attocher~ to sa~pplement this ne~ort. I verify that the foregoing information is correct to the best of my knawtedge, infarmation and belief; algid that this Verifzcation is sabject to the penalties of 18~ S.A. § 4904 relative to unsworn falsification to authorities. ~,~;~ ~ti~J .~.~a - 2 ~ - I O ~ c~-2rvt ~ S ~,~~ Srgncrrure of lturd/arr otr~ 1'er:srur rVrxrrr~ ref ~r+nrdrnn of rire Prrxcsr {'r3yx or pr~F+r~) ~QigpggpOD SB,RVICES ~ ~~g pRIIVCE STREET LANCASTER' PA 1160E-1593 rlrtrtr~as ~r"~j; State, Zi~r 7 (~ - 3 R z ~Z ~ `~ 5 j(-~-. 22 Ter~~hure r~rr c-o3 ~e~r. ra ~s.o~ Page 4 of 4