HomeMy WebLinkAbout01-13-11 (2)__ _~
COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
,~ • ORPHANS' COURT DIVISION
IN RE: THEODORE SYPHAX
AN INCAPACITATED PERSON
FILLE NO: 21-09-0722
REPORT OF THE GUARDIAN OF THE PERSON
1. INTRODUCTION
Pennsylvania Guardianship Association /Brian D. Brooks was appoint~l the
Limited, _.~ Plenary Guardian of the person by Decree of
Orphan"s Court , Judge Dated: 9/03/09 j
_. (A) This is the Annual Report for the period from to
X (B) This the Final Report for the period from 9/03/09 toy Z~'11/11
and is filed for the following reason:
1. The death of the incapacitated person, Date of Death 8/19
2. The guardianship was terminated by the Court by Decree of
Judge Dazed t
For Final Report, omit sections II through IV. ;'
2. PERSONAL DATA
Age of the incapacitated person Date of Birth
3. LNING ARRANGEMENTS - ~ ' ___
A. Current address of the Incapacitated Pelson:
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B. The Incapacitated Person's residence is: ~ ~ ~ c:,, `~
_ Ward's own home /apartment ~ -~ ~ ..~ `~- . '~
Nursing Home ~ ~~`'~' ~ °_~ ~-~
Boarding Home /Personal Care Home ..~, ~--~+ `•"•'
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Guarclians Home /Apartment
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_Hospital or Medical Facility
Relative's Home (name, relationship and address)
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C. The Incapacitated Person has lived here since:
If the Incapacitated Person has moved since the last report, state the prior addres~ end reason for
move: i
-- _ _
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Estate of: THEODORE SYPHAX , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary care giver:
4. MEDICAL INFORMATION
~~
A. The major medical or mental problems of the Incapacitated Person ark:
B. Specify what if any, social, medical, psychological and supportive ser,~ic~ the
Incapacitated Person is receiving:
ALL SERVICES PROVIDED BY STAFF AND PHYSICIANS AT THE FACIITl~`Y'
5. GUARDIAN'S OPIlVION
A. It is the opinion of the guardian that the guardianship should:
Continue Be modified X Be terminated
The reason for the foregoing opinion is: DEATH OF THE CLIENT
B. During the past year the Guardian of the Person has visited the Inch
4 With an average visit time lasting 15-20 Minutes
The report of a social service organization employed by the Guardian to oversee!
the care of the Incapacitated Person for the period covered by this Report may bye
supplement this Report.
I verity that the foregoing information is true and correct to the best of myl
information and belief; and that this Verification is subject to the penalties
S/S 4904
Date: 1/11/11
Tian D. Brooks
Pennsylvania Gaardianship Association
PO Boa 7295
Lancaster, PA 17604
717 299-4568
Person
coordinate
ached tv
PA. C.S.A.
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