HomeMy WebLinkAbout10-27-10 (2)i! i~
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ANNUAL REPORT OF
GUARDIAN OF THE PERSON
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
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CLERK OF
ORPH.AN'S COURT
CUMRERL~"~D CO. PA.
Estate of ALAN CHRISTOPHER EPLER , an Incapacitated Person
No. 21-08-0695
I. INTRODUCTION
GYNTHIA EPLER ,was appointed
®Plenary ^Limited Guardian of the Person by Decree of EDGAR B. BAYLEY , J.,
dated AUGUST 14, 2008
® A. This is the Annual Report for the period from
to (the "Report Period"); or
® B. This is the Final Report for the period from SEPTEMBER 1 2009
to JUNE 30 ~ 2010
(the "Report Period"), and is filed
for the following reason:
1. The death of the Incapacitated Person. Date of death: JUNE 22, 2010
2. The Guardianship was terminated by the Court by Decree of
J., dated
For a Final Report, omit Sections II through IY.
Form G-03 rev. 10.13.06 Page 1 of 4 ~,`~
Estate of ALAN CHRISTOPHER EPLER
II. PERSONAL DATA
Age of the Incapacitated Person:
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
an Incapacitated Person
Date of Birth:
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
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 ALAN CHRISTOPHER EPLER
an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
IV. MEDICAL INFORMATION
A. The rmajor 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:
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.os Page 3 of 4
Estate of ~-~ CHRISTOPHER EPLER , an Incapacitated Person
The reasons for the foregoing opinion are:
Death
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
times with the average visit lasting hours, minutes.
Incapacitated Person lived with GuardiP~ during the last year
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.
Date Signa a of Guardian of the Pers
Name of Guardian of the Person (type or print)
Address
City, State, Zip
Telephone
Form G-03 rev. 10.13.Q6 Page 4 of 4