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HomeMy WebLinkAbout06-27-11 (2)~r~~an~ A11fN~JAU REPORT OF . GiTARDIAN OF THE PERSON ~ , K ,, ~ _ {/~ "d COURT OF MMON PLEAS OF COUN ~~jo ~~ x~ TY, PENNSYLVANIA t7RPHANS' COURT DIVISION ~ ~ e', c.: Estate of ~T[~X f~ ~c ~^~ • ~n Incapacitated Person No. ~ O<5 0 - y ~~ I. INTRODUCTION --// _~~r,,~i' a.c.xa c~1Y~1 V- C~ Z was a~ainted LYFlenary ®Limited Cnu~rdian of the Persan by Decree of J., datai (~-r ~Z ~ _•,, n. Thi$ is the Ann~I Report far ~ period. firm _ to (the "R+epnrt Period"; ar 1q B. This is the P'in~at Report far the triad fram ~ - 3, to ~ ~ ~-1 ~ (the "Report Period', and is filed far the fallowing reason: l . The death of the Incapacitated Person. Date of death:.~,,,(Q„~ „~ ~,,,,,,_, 2. The Gfuardianslup was terminated by dae Court try Decree of J., dated For a Final 8eparP, omit Sections 11'tMRrorrgti I v. ~_ C 5'7 i "3'i J C;, ~` r~. ~~ Fora o-03 .er. rGI, ~1 Q6 Page I of 4 of i-CY~CCti~P p XX.(~~, an Incapacit~tl Pin II. PERSONAL DATA Age of the Incspacitatexi Pelson: ~ D.3 lII. LIVING ARRAI~fGEMEIVTS A. Curt address ofthe Incapacitated Person: B. The Incapacitated Person's residence is: Date of Birth'-r=-~-~ - ~ q y `~ Q own home ! apartment Q nwrsing borne Q boarding homy /personal care home Q Ciaardian's home /apartment ®hospital or medical facility ®relative's home (name, relationship and address) (other: C. The Incapacitated Person has been in the present residue ~ncc . If tla' Incapaciffited Paxson has moved within flat past year, state prior residence and reasan{s) for move: Foy. c~ ,r. ~a~3 a6 Page 2 of 4 Estate of ~ t' an Inca~citated Person D. Name and address of the Incapacitated Fersan's primary caregiver. IV. MEDICAL INFORMATION A. 1Le major medical ar mental problems of the Incapacitated Person are as follows: B. Specify what, if any, social, n~cal, psychological and support aervicxs die 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 modif ed b41 be te~ninated Fa,. o-o,~ ,:. ~a.raoa Page 3 of 4 Bstabe of ~ an Incapacitated Person The reasons for the foregoing opinion arc: B. During the past year, the Guardian of the Person has visited the Incapaeitaied Persal tirr~s with the average visit lasting hours, ~ minutes.. T ire report of a soetat a~ervice ergareizaatYo>t em~rtrryed by the Guardian to ©versee acrd coordinate the cars of the Incapacitated Person for the period covered by this Report may be attached to supptement this Report. I verify that the foregoing, information is correct to the best of my lcrrrowkdge, information and beliefy and, chat this Verification is subje~'ct~, to t~~he,penalties of 18 Pa C,S.A. § 4904 relative to tmswom falsification to authorities. ~N`~ ~ tJ~s ~- S r~ak Prrmn C ~~ 134~T 1:0.11Q1i [ 1'J90 r,ANC/t$'1'F11, YA 17iq-x913 Nm~ro ~G~wuefMn e~Jthe Pan (ryyt orprfmJ CfiY, Ste. ~i~-3gz-2175 u~. 22_( ~G-03 rn: rar~.oa Page 4 of 4