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HomeMy WebLinkAbout04-0661 LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 IN RE: SHIRLEY E. FLANAGAN ALLEGED INCAPACITATED PERSON : COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : ORPHAN COURT DIVISION ~ NO.: Z 1- ()4 -lol.t> ,_ PETITION FOR GUARDIANSHIP c , , The undersigned brings this Petition through his Attorney, .'::;:, Stephen J. Hogg, Esquire, seeking appointment for Guardianship of Shirley E. Flanagan alleging the following: 1. The alleged incapacitated person is Shirley E. Flanagan born October 24, 1932 and whose last known address is 1513 Carlisle Road, Camp Hill, PA 17011. 2. The alleged incapacitated person is married to Terence J. Flanagan petitioner herein. The alleged incapacitated person has no natural or adopted children. 3. The alleged incapacitated person is currently being treated by Dr. G. Robert Little, 1900 Bridge Street, New Cumberland, Pennsylvania 17070. 4. The Petitioner is Terence J. Flanagan, residing at 1513 Carlisle Road, Camp Hill, Pennsylvania. The Petitioner has no interest adverse to the alleged incapacitated person and seeks appointment of Guardianship to ensure the alleged LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE lOl CARLISLE, PA 17013 . , incapacitated person's continued physical and mental health treatment. 5. The alleged incapacitated person has been diagnosed by Dr. G. Robert Little as having Alzheimers Disease. 6. The Petitioner alleges that the alleged incapacitated person has shown herself to be unable to adequately care for her own needs and would likely not pursue any physical or mental health treatment as prescribed by Dr. G. Robert Little. 7. The Petitioner requests that he be appointed Guardianship of the alleged incapacitated person to assure continued needed physical and mental health treatment and over the estate of the alleged incapacitated person to ensure that the alleged incapacitated person does not waste or squander her estate. 8. The Petitioner alleges that he is the most qualified individual to be appointed Guardianship of the alleged incapacitated person having her best interests in mind. 9. The Petitioner seeks appointment of Guardianship of the alleged incapacitated person only so long as the alleged incapacitated person is determined by her treating doctor, Dr. G. Robert Little, to be unable to take care of her own needs. 10. The Petitioner estimates that the gross value of the alleged incapacitated person's estate is $18,000.00 and her current income is $900.00 Social Security pension, $400.00 from an LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 . . " IRA, $500.00 from a family trust and $160.00 pension totaling $1960.00 a month. 11. Petitioner seeks appointment of guardianship of the alleged incapacitated person's estate and of her person. Respectfully Submitted, Date: ~ IN RE: SHIRLEY E. FLANAGAN, AN ALLEGED INCAPACITATED PERSON IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION NO. 21-04-661 ORPHANS' COURT ORDER OF COURT AND NOW, this 16th day of July, 2004, upon consideration of the Petition for Appointment of Guardianship, a hearing is scheduled for Monday, August 9, 2004, at 2:30 p.m., in Courtroom No.1, Cumberland County Courthouse, Carlisle, Pennsylvania. BY THE COURT, Stephen J. Hogg, Esq. Suite 10 1 19 S. Hanover Street Carlisle, PA 17013 _ /td,;1d _ Attorney for Petitioner ~ ?/tflo<{ A-., :rc -...: IN RE: Shirley E. Flanagan An alleged incapacitated person IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-04-661 IMPORTANT NOTICE CITATION WITH NOTICE A petition has been filed with the Court to have you declared an Incapacitated Person. If the Court finds you to be an Incapacitated Person, your rights will be affected, including your right to manage money and property and to make decisions. A copy ofthe petition which has been filed by Terrence J Flanagan is attached. You are hereby ordered to appear at a hearing to be held in Court Room No. I. Cumberland County Courthouse, Carlisle, Pennsylvania, on Mondav. August 9 , 2004, at 2:30 12M. to tell the Court why is should not find you to be an incapacitated Person and appoint a Guardian to act on your behalf. To be an incapacitated Person means that you are not able to receive and effectively evaluate information and communicate decisions and that you are unable to manage your money and/or other property, or to make necessary decisions about where you will live, what medical care you will get, or how your money will be spent. At the hearing, you have the right to appear, to be represented by an attorney, and to request a jury trial. If you do not have an attorney, you have the right to request the Court to appoint an attorney to represent you and to have the attorney's fees paid for you if you cannot afford to pay them yourself. You also have the right to request that the Court order that an independent evaluation as to your alleged incapacity. If the Court decides that you are an Incapacitated person, the Court may appoint a Guardian for you, based on the nature of any condition or disability and your capacity to make and communicate decisions. The Guardian will be of your person and/or your money and other property and will have either limited of full powers to act for you. Ifthe court finds you are totally incapacitated, your legal rights will be affected and you will not be able to make a contract or gift of your money to other property. If the court finds that you are partially incapacitated, your legal rights will also be limited as directed by the Court. If you do not appear at the hearing (either in person or by an attorney representing you) the court will still hold the hearing in your absence and may appoint the Guardian requested. By: lerk, Orphans' Court Divisio reo- Cumberland County, Carlisle, PA My Commission Expires 1 sl Monday, January, 2006 IN R~, gHIRL~Y~. FLANACAN, AN ALLEGED INCAPACITATED PERSON IN TH~ COURT OF COBBON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 2l~04-66l ORPHANS' COURT IN RE: PETITION FOR GUARDIANSHIP BEFORE OLER, J. ORDER OF COURT AND NOW, this 9th day of August, 2004, upon consideration of the Petition for Guardianship in the above-captioned matter, and following a hearing at which the allegedly incapacitated person, Shirley E. Flanagan, was present, as were Petitioner, Terence J. Flanagan, and his counsel, Stephen J. Hogg, Esquire, and the Court finding that Ms. Flanagan is totally incapacitated for purposes both of her person and estate, she is so adjudicated, and Terence J. Flanagan is appointed plenary guardian of her person and estate. The guardian is directed to file reports in accordance with the provisions of the Probate, Estates and Fiduciaries Code applicable to such guardianships. No bond shall be required of the guardian in this case. BY THE COURT, ~j , //I,~ V Wesley,BI J. ;.-_.- ~:3 IN RE: SHIRLEY E. FLANAGAN, AN ALLEGED INCAPACITATED PERSON TN 'rH1='. rmlPl' ("iF rllMMIlN PT.l"IIc; Ill" CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-04-661 ORPHANS' COURT IN RE: PETITION FOR GUARDIANSHIP BEFORE OLER, J. OPINION and ORDER OF COURT OLER, J., August 9, 2004. At issue in the present case is whether Shirley E. Flanagan should be adjudicated an incapacitated person, and, if so, whether her husband, Terence J. Flanagan, Petitioner herein, should be appointed plenary guardian of her person and estate. A hearing was held in this matter on Monday, August 9, 2004, before the undersigned judge. Based upon the evidence presented at the hearing, the following Findings of Fact, Discussion and Order of Court are made and entered: FINDINGS OF FACT 1. The allegedly incapacitated person is Shirley E. Flanagan (date of birth, October 24, 1932), a domiciliary of Cumberland County residing at 1513 Carlisle Road, Camp Hill, Cumberland County, Pennsylvania, 17011. 2. Petitioner is Terence J. Flanagan, an adult individual and husband of the allegedly incapacitated person, who also resides at 1513 Carlisle Road, Camp Hill, Cumberland County, Pennsylvania, 17011. 3. The allegedly incapacitated person, Shirley E. Fla~aqan, suffers from dementia-Alzhcimer's Type 0, a condi~ion which was first diagnosed on August 18, 1999. 4. As a result of the aforesaid condition, Ms. Flanagan is an adult individual whose ability to receive and evallla.te informrl.t.~orJ ('ffpctlveiy and comm1.1n1.rritp r1prl.slollS lS impaired to such a significant extent that she ~s totally unable ~o manage her financial resources and totally unable to meet essential requirements for her physical health and safety. 5. The aforesaid condition may be irreversible. 6. Based upon the aforesaid condition, the Court finds ~t necessary to establish plenary guardianships with respect to the estate and person of Ms. Flanagan. 7. In view of the absence of a more favorable prognosis at this time, the duration of the guardianships required must be said to be indefinite, pending further Order of Court. 8. Terence J. Flanagan, spouse of the allegedly ~ncapacitated person, ~s found to be a person qualified under 28 Pa. C.S. Section 5511(f) to serve as plenary guardian of Ms. Flanagan's person and estate. 9. 'rhe foregoing Findings of Fact are made on the basis of clear and convincing evidence. DISCUSSION The provlslons respecting an adJudication of incapacity are contained in 20 Pa. C.S. Section 5501 et seq. Petitioner has substantially complied with these provisions, and based upon the foregoing Findings of Fact the following Order of Court will be entered: ORDER OF COURT AND NO~J, this 9th day of August, 2004, upon consideration of the Petition for Guardianship in the above-captioned matter, and following a hearing at which the allegedly incapacitated person, Shirley E. Flanagan, was present, as were Pecicioner, Terence J. Flanagan, and his counsel, Stpphpn J_ Hogg, Esquire, and the Court finding th~t Ms. 1='l~n~opn is totally incapacitated fo~ purposes both of her person and estate, she is so adjudicated, and Terence J. Flanagan is appointed plenary guardian of her person and estate. The guardian is directed to file reports In accordance wi~h the provisions of the Probate, Es~ates and Fiduciaries Code applicable to such guardianships. No bond shall be required of the guardian in this case. BY THE COURT, /s/ J. Wesley Oler, Jr. J. Wesley Oler, Jr., J. Stephen J. Hogg, Esquire 19 South Hanover Street Suite 101 Carlisle, PA 17013 For the Petitioner :~ae Marjorie A. Wevodau First Deputy One Courthouse Square Carlisle, Pa. 17013 Glenda Farner Strasbaugh Register of Wills & Clerk of the Orphans' Court Kirk S. Sohonage, Esquire Solicitor (717) 240-6345 FAX (717) 240-7797 OFFICES OF lRegister of Wins anb <!Clerk of toe <!E)rpoans' <!Court <tount!' of <tumberlanb November 30, 2005 Terence J. Flanagan 1513 Carlisle Road Carlisle P A 17013 IN RE: Estate of Shirley E. Flanagan, an incapacitated person File No. 21-04-661 Dear Sir/Madam: It has come to my attention that you have not filed the guardian reports required by 20 Pa.C.S.A. 95521(c) in the above captioned guardianship. Enclosed you will find the suggested formes). Please mail those reports, along with a check in the amount of $15, payable to the Clerk of Orphans' Court, to the following address within (30) days: Clerk of Orphans' Court One Courthouse Square Carlisle, P A 17013 If you have any questions, please contact your attorney. Respectfully, ~~Ff~ Clerk of the Orphans' Court CC: Stephen Hogg, Esquire " ~~ - \:\:. \, Clerk of Orphans' Court of Cumberland County IN RE: 51111~ L I: ~ E. Fc-/J. pJ/~ t; Irlv' Docket No. An Incapacitated Person ANNUAL REPORT OF GUARDIAN OF THE ESTATE r,..') .. (, !..-.,1 ----; r ^) . ,'1 l ') r"~-) -' c-...... -"'C.~ -:--..J (.) .....--: .-r --- I, l fiR Ii Jf/ C-1~ J I-l,..../+ III ,A-C; A- 1\/ , was /were appointed plenary guardian( I) of the estate of 5A: I Y Ie: 7 &-. ;::( c- )t, d 1 cl.... by Decree of the Honorable Judge J. W~:J~.., Old. Dated I1-vf Cf} d-oo'fu. This is my annual , } (J report for the period from (\-~J el) 201)'" to D<2l:: '2...0 d-.b 01{" , ("The Report Period"). I. SUMMARY A. Value of principal assets at the beginning of the Report Period? B. Total amount of income earned during the report period? 0 {' Ibfr'lO~1h> ;1-.<--J f,0Y-V>~" 2..-0, Total amount of all expenditures made for care and maintenance of the C. incapacitated person during the Report Period? 1. From principal 2. From income D. Total amount spent for all other purposes during the Report Period? E. Total amounts remaining at the end of the Report Period? 1. Principal 2. Income Total Income and Principal I .,.he-I(' f cl l 6> 0 II11'rJ" I I AYl7 el--trd- (I'1.COj1.-t.e. / re Md.-I ~3 the fl".'....I.<f& $ / 1 ?f-o c) J , $ ~.f) b c () u $ $ /9 ;).00 . I $ '3 (j() . $ jq,4C>o , $ b)d-DD $ ~~ bDo pf II. ADDITIONAL INFORMATION A. Principal: 1. Total amount remaining at the end of the Report Period? $J~/bOO 2. How is principal currently invested? 5~~k L-er tt &- l L J~f-te~ ?>t Dc;)o"7({ , / () , o-o-<J , f ~ / fe, o-t)-Cl ~ - 3. Have there been any expenditures from principal dunng the Report Period? 0 Yes I2l.No If you answered YES, was there Court approval for all expenditures from principal? 0 Yes 0 No 4. Did you receive any principal assets during the repolt period which were not included on the inventory or a prior report filed for the estate? 0 Yes,Z1 No If you answered YES, did you receive Court approval prior to receiving additional principal? 0 Yes 0 No 5. State the sources and amounts of the additional principal you received: Sur<. P L v.5 - I' ~~ $ 'I 2-- (:> () $ B. Income: I. State sources and amounts of income received during the Report Period (i.e., social security, pension, rents, etc.): I ~ j'YI'lo J"- 't k-5 5, $Ize.. 1(:)0(;, .ritl .::> !b~ $ I~, 036 s'" <.. S ~<:: It, (lo.,.,....~ /L > i R.. I}. J..f:u> I"t~ !6~ ~, 0 ~" 1: /<,/:\ fb hL-e VI rk. s ;11fT l(b/"lU /& 4t,.6/ $ ~ ?lIb M+r p~ , , $ Total Income received during Report Period $ ~3 ~ (1'z,. 2. How is income currently invested? (Please specify, restricted bank accounts, client care account, etc.) ( l~~~k d c. C O....IA t) /l-rt d- CO 5 5 IJ-j/(t..Ji.:'f rtri 5 Il!-O T J) 1<-1 V I::; /1.. A c" flr/1?. -n-tt rz L~9/ t-w 0 'i ti- It. ~s / It-..v/J () {??-f IV t r I'J A- ~,~. It.. t-- ( c tz. "-/ ;; E To IJ R I II F 1'1f ( f{ 0--:; y I~ /l/fJ T ( f Ii- V .5 13 Ij ": "-'~ 5 If Id-IL I A/ 't.- ,-:::: ^ ,fl/~ 11/5/;'-5' ? pol<.. Tt(-6 J.-/~5T 2-( '{t'iA-a.r /l-f'v'r'J I W(t.-(..- IVt)T /J-t-/.A)I(/ / f- c t{ TV v ~ 17 /f )c/'-t 0 (~ I t (~~ P d>..t ItJ c ( P /rf (..; 3. Specify what payments were made for the care and maintenance of the incapacitated person (i.e., clothing, nursing home, medicine, support, etc.). ~ 1'1) Lf- 0 c> Lev GIl 5 (" tJ-t,/P n. ri ~ "f fJ1. r d { C I Il....c fv." II ( 2-/\ -e (#I{ 'U' ~ o flotlCvt t (q d- "" J /)61' k.~ '!:> () ~-> fLv 5 /~ 5f r ..5TA-1t/ t:(: l~oR Fool1 Jrw'i) P Ji--A--':::>o Ar 4-& E /c. P 6 ,v 5 12 r 4. Specify what other payments were made during the Report Period. f1~c.e 55 d r 7 d, (~ L,it If/ A- C:; k'- , , f.... K-l"~ 50/'" I 'r I '-C 'f 5 / /1cc:de <.! IILC-/vdt ~. Iv b 5> h ~ ,) (..0'1- f ;/',d v f';/ -- ( (:;/? t;/Vc~ T ~I C- {( h (//-o')~ ,ntd,'11 ~F'- 6'-<-C< I 11t!-~~A A-LL Cp.-R. (il<(J/itlJ5IiI / rj(tiP.A{~?.-r I FDOP Jrflt/l) f/lil<.->tJ'v.+t.. u5i? , I / 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. D ec....- :L.o , d--btl? , Date CJ J I~-~e~ JJ .:- Signature of Guard' I * FILING FEE $15 MUST ACCOMPANY TIDS FILING. ~\.\ - ~ \. \. Clerk of Orphans' Court of Cumberland County () IN RE: 2/1 { fC L /2 If c F LI/-tV A e IJ tV Docket No. An Incapacitated Person ! \_1 j .'",-~ ANNUAL REPORT OF GUARDIAN OF THE PERSON 1-" -.-', -, I, 7& f<. ,; {f/ CI~ :) F '- A- N At G /rt /l/ ~: appointe~) plenary guardian(t) of the person of S Ifr !(t...Ji '( e, r::L/<f-)f/ IJ c..(d-f'/ by Decree of the Honorable Judge 1. We.,> I e d 0 it!- {' , dated If- v;; q" i 0 0 '( . This is my annual report for the p:;:riod from -A"*J q Lo~~_ ~o __Occ:.. ~Ol ~()5/, ("ThE' RE'oo~ Penon") 1 ol'1/J,...'{ t?.fic...;-,I/~W 7',1\1~ Jt/pTfL':'" 01'1/ F12liJlJ.-y 12--//"..05 _ _ /::/l Ll ~,; /. IV JI.<o'f' r:J..- ~ f) ~t; '>> I){:-C.II-(/S,~ 0,- I+~ _''<ft-IJ''-, ..... '-v "',J Present age of the incapacitated person: 1. 73 Yrs, :2. Current address of the incapacitated person I ~I 3 (' fl f?, Ll';,Lt= 1<-0/1 cJ C /1- H P /f I .t:..L.-, ~ A. /7 tP tI , 3. The incapacitated person's residence is: )( QpaFimen( D nursing home D boarding home/personal care home /---~ 9< guardian's hom~~pamnent D hospital or medical facility relative'shome5f(~!?, t,5 '!"'f Lvi te Q\vd 5h.e (Nameandrelationship) '5 A-A/ OIV<-'( ~ Cl+I't.J other: \JJ t2. W tZ t\' Ii .M It <R. tQ ''lit) /11/ I~ f.:- t3 ~ () I HL 'f I q 'ij/t.cribe) D D 4. The incapacitated person has been in the present residence since Ie; 'iJ'D . If the incapacitated person has moved within the past year, state change and reason(s) for pt change: h C-v ..e vt.o q- bee v. d b I ~ h J 11.( her ro I(. Tf1tf 1-/L5T (:::: e w {"to ;vTr!-> / ~J r r d~, jd... Co..t-'\/ Ii L,5/d-lIo IV' w, t-'k d .L ~ h.e'" ;:; p{:..(~t-- '{If-rr'T l f Stt-€'" IS f"'-' Ill//~ /t-oil-\l-;' -.5/~;Z ~~ e~~'~- .) . 1 -h If &5 si<- rld5 /le 5-.J.-~1 t'f ;:::"A..ceyjif- JMYj'eLf ~ /J.-<J wit .( I )0 5h<.. lS d.", ()^ Lj <.h41~ - n... hl',;;rh<('.> or 5/5 HV'( 5. Name and address of the incapacitated person's primary care giver: WII../.- --- It:' ((6-IVc:..,; T F '- A- N Ia- t: ftiV .- !-tv s t3 Jr /t/ pi I - (:3 j c.. II" It- L( 5 L /"i l~fJ C# /l1 P It-( L '- 5/J./f(,; /J-(),JR.fi'55 d-~ r-k (NU-l-P~C 1 T/l-rl;{ f>GR5o,v w i7.. 'It l~ 0E. q vt/ L..4. (/ / we th::: R Ii t=-oR. 1... I Y € -+11.-5' 6. The major medical or mental problems of the incapacitated person are as follows: S If r p. L/; V IT If <) If- L 2- tfli r /11. E IL {, 0 I at ri IV n Ii- /f-IV I) P 1;"1<./<'" t tV .5 0 III 's P 15 G/'->/~ 5/z'l- 1)d-5 if/tO Tl-t'-='5ti- Mt;.IIIT~t- f~o8LIi.I'-t ( F<?I<.... .4-t3t'V( 2 Yc://...N.I' 7. Specify what, if any, social, medical, psychological and support services the incapacitated person IS receIvmg: 5/I-ItZ/-Ii If 5 0 oc (71( (5 J J j) t/IV j(f,z. Y3 1i ~ Cfi J... , p. 0, o-{ f/I-JMI '-'{ PlfV~/<:' (/l...Als A 5PP, TkC I y 1>0 131'11 f<= ~ , q NclA/ LV' I'Vt hE?r!~ hJ}-;//I- Phor1-'(! (7/7/ 77*- 20 if 8. It is our opinion as guardian of the person that the guardianship should: (check one) ~ continue, 0 be modified, 0 be terminated. (Briefly explain your response) Dr 0 v"'- ).d.e- ~)'Cv-J-ev d-JV(S~J v1tt,e d.--- home 6R. -rfr-I~IZ.. t:.-/j...A/~ OF {f/;R. -- During the past year, I have visited the incapacitated person fz t:J t/V he t/' (I"\. II , :J 4 -7 < I c-~ /) se r-u-c: jJ fe'- 9. u""v'erage "'vTisit lasting times with the ): frl1( Ihf/Z.. 1-("'.>13.&#>> If-NI) u./li. L( l/I~ rp Ce"-t';.ntE'- (State number of hours/minutes, etc.) ( . -n I <;. .If () tU? ,:; ~ S Fo ~ r Ihi (/ A L.,- l- t11iL-/JT&t!JA/9-N/p jt..T I~/ ,- t ,,7 r ~'3 u '1 /.l.. L.. I- { h~- ~ Jt1 E (.J t c/ #' ,! ,lrJl/ jj C; (V Ii 1ft 13 H TZJ D or D vJ fA her 'l....e / J I'\. d See h I ~ F/21:.- & U li;L/ T LV "Tlf '2 D, 19.. Ii ( rr t) IV 0 ,:;, It fI c- /.v ~ f,.--b v I A.) C. L(I3A ;'--1 Ifr.:-I( uP;J E€ .. # The repOli 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. 94904 relative to unsworn falsification to authorities. \J e '- Date ~, " tloo5 ~f~ '-"'-- * FILING FEE $15 MUST ACCOMPANY THIS FILING. Family Physician Associates, Inc. of New Cumberland G. R. Little, M.D. . .-- J. J. Dunkelberger, D.O.-- M. J. Ameigh, M.D. e. A. Williams, e.R.N.P. 1900 Bridge Street, New Cumberland, P A 17070 Phone: 717-774-7041 .. , , Clerk of Orphans' Court of Cumberland County INRE: Docket No. it I -,;: tJ 'f ~ (~ ~ I 0 -" ~lli,.,-w ~ ~AL REPORT OF GUARDIAN OF THE PERSON . !, /p,>-,,~~ ~, --;J ~ "'-- " ,was/"""",appomted plenary guardian ( s) of,le person of "', FE :it... -\1.1 t, ~"<':'K",=.bY Decree of the Honorable Judge () L f 1(, $, W,cd.it~d ~t.;. 7, 2- () or. This IS my annual report for the period from {;U{1~ '1%; () C; to ?&1Aj. vv#- 1%1 , ("The Report Period"). 4 0 07 1. Present age of the incapacitated person: 1 't Yrs. 2. Current address Of~ed person / f) I ~ . . R~rJ [~~ l~ , PA-. Cl ) 170 IJ 1'--.,'" 3. The incapacitated person's residence is: <iJ own home/apartment 0 nursing home 0 boarding home/personal care home 0 guardian's home/ ~partment 0 hospital or medical facility 0 relative's home 0 other: ......~- ~ (Name and relationship) (describe) 4. The incapacitated person has been in the present residence since /9? V , . If the incapacitated person has moved within the past year, state change and reason(s) for ~ ... , " change: 5. Name and address of the incapacitated person's primary care giver: ;5 A- ~ 1S 6. The major medical or mental problems of the incapacitated person are as follows: ~~'AA L~J!~---> LvJ, P ~ J r.v,J .9""", !.jf;'-JJ;; A~ L~ ~.~~ .Ri.!4.-fjd ~,~V~ ~ 7. Specify what, if any, social, medical, psychological and suppon services the incapacitated person IS recelvmg: ~<A''/ tl, (2,.J ~ .~ ;, l~ ~ ~ W~ ~~dtlf /?,P,n,r;~f (~ 8. It is our opinion as guardian of the person that the guardianship should: ( check one) ):t continue, 0 be modified, 0 be terminated. (Briefly explain your response) dL ~~~% ;;f;pU J <YL ~ ~ ~ ~7~ d~~" 1L~ ~~LJ ~~ ~.~,~ during'ihe patt year, I have visited the incapacitated person ~./.~ tirfi'es with the average visit lasting ~ 9. (State number of hours/minutes, etc.) ,; 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. 94904 relative to unsworn falsification to authorities. CcA Date d tl> ) ').OD~ ;(ZR~' J Signa~ure of Guardia . 1Q~ "- * FILING FEE $15 MUST ACCOMPANY THIS FILING. RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Orphans Court One Courthouse Square Carlisle, PA 17013-3387 Recetpt Date: Recelpt Time: Recelpt No. : 8/11/2006 13:02:34 1031058 ... .... -j FLANAGAN SHIRLEY E File Number: Paid By Remarks: 2004-00661 TERENCE J FLANAGAN AJW Fee/Tax Description ANNUAL RPT GRD PER Check# 870 Total Received......... Receipt Distribution ------------------------ Payment Amount Payee Name 15.00 CUMBERLAND COUNTY GENERAL FUN $15.00 $15.00 - ~-3 .... .. .. . .... -..... .... .