HomeMy WebLinkAbout04-11-11COURT OF COMMON PLEAS CUMBE AND COUNTY, PENNSYLVANIA
ORPHANS' COUR DIVISION
IN RE: LOUISE CARL , AN I CAPACITATED PERSON
FILLE NO: 2109-0459
ANNUAL REPORT OF THE GU~RDIAN OF THE PERSON
1. INTRODUCTION
Pennsylvania Guardianship Association /Bran D. Brooks was appointed the
Limited, X Plenary Guardian oft e person by Decree of
ORPHANS COURT Jude Dated: 3/30/10
X (A) This is the Annual Report for
(B) This the Final Report for the pf
and is filed for the following reason:
1. The death of the incapacitated pe
2. The guardianship was terminated
For Final Report, omit sections II through IV.
period from 3/30/10 to 3/30/11
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n, Date of Death '~~
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the Court by Decree of " ~ L~ __
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2. PERSONAL DATA
Age of the incapacitated person 74
3. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Pers n:
FOREST PARK NURSING HOME, 700 WALNUT B~
B. The Incapacitated Person's residence is:
_ Ward's own home /apartment
X Nursing Home
_ Boarding Home /Personal Care
_ Guardians Home /Apartment
_ Hospital or Medical Facility
Relative's Home (name, relation
C. The Incapacitated Person has lived here
If the Incapacitated Person has moved since the last ~
move:
of Birth 2/28/37
RD., CARLISLE, PA 17013
and address)
8/22/08
state the prior address and reason for
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Estate of: LOUISE CARL
D. Name and address of the Incapacitated
FOREST PARK NURSING HOME
's primary care giver:
4. MEDICAL INFORMATION
A. The major medical or mental problems o the Incapacitated Person are:
MENTAL RETARDATION, CVA, FAILURE TO HRIVE, CELLULITIS, OSTEOPOROSIS
B. Specify what if any, social, medical, I
Incapacitated Person is receiving:
ALL SERVICES PROVIDED BY STAFF AND
and supportive services the
S AT THE FACILITY
5. GUARDIAN'S OPINION
A. It is the opinion of the guardian that the
p should:
X Continue Be modified Be terminated
The reason for the foregoing opinion is: T'he
B. During the past year the Guardian of the
4 With an average visit time lasting 15-
for the guardian continues
has visited the Incapacitated Person
The report of a social service organization employe by the Guardian to oversee and coordinate
the care of the Incapacitated Person for the period c vered by this Report may be attached to
supplement this Report.
I verify that the foregoing information is true a
information and belief; and that this Verificati
S/S 4904.
,' ~
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Bria .Brooks
Pennsylvania Guardianship Association
PO Box 7295
Lancaster, PA 17604
717-299-4568
~ correct to the best of my knowledge,
is subject to the penalties in 18 PA. C.S.A.
Date: /