HomeMy WebLinkAbout86-0240~11I_L1-~}C.REPORT OF
GUARDIAN OF THE ESTATE
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of John Chisar, Jr.
No. 86-240
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an Incapacitated Person
I. INTRODUCTION
Christina Sailors
was appointed
~ Plenary ^ Limited Guardian of the Estate by Decree of Kevin A. Hess
dated June 22, 2011 ' J''
/^ A. This is the.,,;-{;~ I Report for the period from June 22 2011
to __ (the "Report Period)
or
^ B. This is the Final Report for the period from
to (the "Report Period"
' ), and is filed
for the following reason:
1. The death of the Incapacitated Person. Date of death:
Name of Personal Representative:
2. The Guardianship was terminated by the Court by Decree of
J., dated
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Page 1 of 5
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~nl~ j -~4L. REPORT OF
GUARDIAN OF THE PERSON
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of John Chisar, Jr.
I. INTRODUCTION
Christina Sailors
No. 86-240
was appointed
^/ Plenary ^Limited Guardian of the Person by Decree of Kevin A. Hess , J.,
dated June 22, 2011
~ A. This is the ,1=~,;-~;~ ~ Report for the period from June 22 2011
to , _ (the "Report Period"); or
^ B. This is the Final Report for the period from _
to . (the "Report Period"), and is filed
for the following reason:
1. The death of the Incapacitated Person. Date of death:
2. The Guardianship was terminated by the Court by Decree of
J., dated
For a Final Report, omit Sections II through IV.
Form G-Oi re r. 10.1 3.06
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an Incapacitated Person
Page 1 of 4
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Estate of John Chisar, Jr.
II. PERSONAL DATA
Age of the Incapacitated Person: 59
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitate~µ Person:
1710 Dighton Street
Camp Hill, PA 17011
an Incapacitated Person
Date of Birth: 2/14/1952
B. T]Ie Incapacitated Person's residence is:
^/ own home /apartment
^ nursing home
^ hoarding 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 keen in the present residence since 1963
. If the Incapacitated Person has moved within the
past year, state prior residence and reason(s) for move:
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Estate of John Chisar, Jr. , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
Christina Sailors
1710 Dighton Street
Camp Hill, PA 17011
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
Marked Mental Retardation, Impaired Glucose Tolerance, Epilepsy
13. Specify what, if any, social, medical, psychological and support services the
hncapacitated Person is receiving:
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
Q continue
^ be modified
^ be terminated
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Estate of John Chisar, Jr. , an Incapacitated Person
The reasons for the foregoing opinion are:
No change in Mr. Chisar's condition.
I3. During the past year, the Guardian of the Person has visited the Incapacitated Person
times with the average visit lasting hours, minutes.
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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. ] ~"
Sigrtntw•e of Guardian of the Person
Dnte
Christina Sailors
Nnrne of Gunrdinn of the Person (type or print)
1710 Dighton Street
address
Camp Hill, PA 17011
City, Strue, zip
717-737-2155
Telephone
Page 4 of 4
Fa•m G-03 rer. 10.13.06