HomeMy WebLinkAbout11-28-11 (2)ANNUAL REPORT OF
GUARDIAN OF THE PERSON
COURT OF COMMON PLEAS OF
Cumberland COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of Robert C. Wallower
No. 21-09-1044
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an Incapacitated Person
I. INTRODUCTION ~
Q R ~ .~ . y1/~/l a ~,~~~ ,~ ~
,was appointed
Plenary ~1Limited Guardian of the Person by Decree of ~~ ~~"~ J~ ~~- ~~ F y
dated ,~ ~ ~ /~ ~--G D 9 , J.,
~ A. This is the Annual Report for the perio from ~~ Y ,, ~4 /~ aG /~
to _ n C.7~ ~ ,
' ~ ,~ (the "Report Period"); or
[j 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 I i~
Form G-03 rev. 10.13.06
Page 1 of 4
Estate of Robert C. Wallower
II. PERSONAL DATA
Age of the Incapacitated Person: `~~
III. LIVING ARRANGEMENTS
an Incapacitated Person
Date of Birth: f ~ l / ~ ~`~~~
A. Current address of the Incapacitated Person:
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~~ ~~~
B. The Incapacitated Person's residence is:
own home /apartment
nursing home
boarding home I personal care home
0 Guardian's home /apartment
hospital or medical facility
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relative's home (name, relationship and address) s7'~`/'
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other: f ~. ~ ~ ~ ° ~ ~ ~ ~
C. The Incapacitated Person has been in the present residence since ~ ~ ~
. If the Incapacitated Person has moved within the
past year, state prior residence and reason(s) for move:
Form G-03 rev. 10.13.06
Page 2 of 4
Estate of Robert C. Wallower , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
B. Specify what, if any, social, medical, psychological and support services the
Incapacitated Person is receiving: ~, ~,~ l /~.'~~,e ~
y~ p -~ i~`~~l
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V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
continue
~ be modified
0 be terminated
Form G-o3 rev. 10.13.06 Page 3 of 4
Estate of Robert C. Wallower
an Incapacitated Person
The reasons for the foregoing opinion are: o T. ~ l- ~ SS 1.~~ ~(J
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
a ~- a 1~~~~,~s ~'~~ ~~
times with the average visit lasting hours, minutes.
~~ j ~7`,q. ljs 2 X2;3 1c~~,~ks ~}i ~`/~ .~~ y/,/~1~~ .,Z~'II a Z / i~ES /fir'' ~ S f:- G 7- ~.~r` lP F ~ ~ h`G'~l,I~
.~- !'S ~'%'R 7`~ 6 ~ ~ ~ 1 />til~ ! ~ ~ .~I USI= ~ l= ,S ~ ~ ~ ~~ ft ~l2 d .~1/ ~'`~
The report o a ocia service org nization 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 sworn falsification to authorities.
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Date Signature of Guar an of the Person
Name of Guardian of the Person (type or print)
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Address
Crty, State, Zip
Telephone ~~
Form G-03 rev. 10.13.06 Page 4 of 4