HomeMy WebLinkAbout01-04-12
ANNUAL REPORT OF
GUARDIAN OF THE PERSON ?~~ :_j _r _~~
r? c~ ~.
' ': r:r i i
COURT OF COMMON PLEAS OF -
~~ ~b ~r' ~ Q h c~. COUNTY, PENNSYLVANIA '' ~ _...
ORPHANS' COURT DIVISION ~ , -'' ~ _,;~
-:n
Estate of ~- o h i ~ /~ a ~ ~ i '~N1 e r , an Incapacitated Person
No. oZ(-G7-o937
I. INTRODUCTION
~ / a r e ~ c c ~/, ~/~/ i ~"i+t c r aad ~ t'~Y ~~ ~,~1 r -+'r~ c ~ was appointed
Plenary OLimited Guardian of the Person by Decree of ~d w ~tI'c~ E. Guido , J.,
dated N o yer-~b er /,3. a 007 .
[,~ A. This is the Annual Report for the period from -San u ai-~ 1 a o /I
to I~ e c e ntib e ~ 3! , 02 ~ -1 (the "Report Period"); or
Q 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
For a Final Report, omit Sections II through Ii!
Form G-03 rev. !0.13.06
J., dated
Page 1 of 4
Estate of L o n i ~ ~ ~~ W ~ ~"m e r , an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: S b
Date of Birth: Decentbe; ,?7, /Qss
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
cc,Y, l~ er (and. V i s ta-
/073 York RoQ~
!~ r`lls hu~y , P~ l701 9
B. The Incapacitated Person's residence is:
own home /apartment
nursing home
[boarding home /personal care home
Guardian's home /apartment
[~ hospital or medical facility
['relative's home (name, relationship and address)
Q other:
C. The Incapacitated Person has been in the present residence since Sept"e,,.ber ,Z OG6
v
. If the Incapacitated Person has moved within the
past year, state prior residence and reason(s) for move:
Form G-03 rev. 10. /3.06
Page 2 of 4
Estate of L ohi ~- /'Z ay (,(Jr f'rn cr , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
C Jo~ren ce ~- r3e ~7 (di -f'mcr (-I'1~~ou~k Curn6en~an~ Uis1'~~
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
Lo~n~e Wi-/'m~r f~as ~enf`0.~ aid ~I~ySiL.cI ~isab; l~f-ies ~'el.~t<<I, f-o
and
brain eLa..na~e-• Ifc is una~b~e. ~ t+14n=-'` his -f-i~Q~c1R( ct~;rs
Pr-ol,cr`1~r, ffc has l~`n.i-~d rarnr~~~~c~~-ion sk~11s. /fe is un4bl~
-i-p bra/9er~y care- ~~ hrI-1S'~I~ f/i~oc~'f cLStis'~nc~ W1-~
wc/~ aS ,~a'~in ba~r'oor4 heedS~ and
pet'So.~xc-~ ~yg ~ end S ,9 ~
loc. ~onA~ 9 rovm~h~,
B. Specify what, if any, social, medical, psychological and support services the
Incapacitated Person is receiving:
~~~ Strvlces awe /r~~'o'~~ ~ his persan~~ sere homes ter'
are, re ferrc-e~ ,6y 6c~a~io!'a ~ Car'e sf0.`~
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
[continue
~ be modified
~ be terminated
Form G-03 rev. /0.13.06 Page 3 of 4
,a
Estate of L on i ~- Ray W i 'f "/~t c r , an Incapacitated Person
The reasons for the foregoing opinion are:
,~~ ~Q~a~;~y df
L o,. , e W i -j'rn cr has ~'1, ~- ~ ~n
,Z or 3 year- alb. ~e- has 1: ad. me,~~J GtiSa~:~i'Ties
,s t` n c c .b i /' ~ cu i'i {~ n o e ~P e c -t" cL '~-i an s -{ter i ~P /'o v e sn cn "~
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
~_ times with the average visit lasting '~ ~ hours, minutes.
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 infonmation 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. C~ v ~jj/~,~„L,~
> a- 3 r- r r ~Gt/.~-u
Date Signnttve ojG d' the Person
~-~tf .~% ~t(/ i firn er Car en «
Nome ojGuardian ojthe Person (type or print)
3 b ~{ J11 a~t~ Qr,'v ~
Address
_ ~r eertcQs~ le ~ ~f~ /~~ZaS'
City, State, Zip
~i7 -r97 oa 37
Telephone
Form G-03 rev. 10.13.06
Page 4 of 4
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