HomeMy WebLinkAbout01-10-12 (2).... .
ANNUAL REPORT - .
G1UAR~~ ®l~ T~ pLRSON
.;-,
COURT OF COMMON PLEAS OF ~'
,CUMBERLAND ~-'~~-'
_ COTJNTZ', PENNSYLVANIA __ p ~ _..
ORPHANS' COURT DIVISION f= ':. `=;
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NANCY M . STUCK --°--°------------- an Incapacitated Person
Estate of
,~
~. ~ INTROD1rTCTION
DONALD B'. STl1CK-----=--------t~~°-°---- -was appointed
J.,
' ~ Plenary~•L~t~ Guardian of the Person by Decree of •
dated
O1-Ol= I 1
A. ~~ e Waal Report for the period from~e"Report Period"); or
to ~ ~ I .. .
B, This is the Final Report for the period from '
- ~_ (the "Report Period"), and is filed
to -
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 ~1'~Iirougli £V.
Page 1 of 4
Form G-03 rev. 10.13.06
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Estate of - ~1~ C~11~•C •~~ ~ ~ ~ C~ I~l~ •• ~ an Incapacitated Person
IL F +1~SGNAL DATA
Age of the Incapacitated Person:,,,, ~~ L' C'Q~ S Date of Birth: ~ • ~~ " ~ ~ ~ ~~
III. LIVIl~G AItRAl\TGEMENTS
.A. Current address of the In~~apacitated Person:
~~ 5 ~ ~~~~~ ~~l~w (~~A~~
LLi~. ~12d~L, ~~ ~~~~
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)
®other:
C. The Incapacitated Person has been in the present residence since ~C ~ U ~~_~~
?~ I 2~ (~, . If the Incapacitated Person has moved within the
r
past gear, state prior residence and reason(s) for move:
Form G-03 rev. 10.13.06 Page 2 of 4
.. _
Estate of ~ .C` ... . - - - : -- ~ ~ - LI-C-- .. - --~~ an Incapacitated Person -._ .. --
D. Name and address of the Incapacitated Person's primary caregiver:
1 ~ 1 'Y . ~~.J G V1 C~.1 G~ ~ . ~ ~1.A ~ ~L
IV MEDICAL INFORI~ZATTON
A. The major medical or mental problems of the Incapacitated Person are as follows:
~ov~ ~
B. Specify what, if any, social;~medical, psychological and support services the
Incapacitated Person is receiving:
GOES TO -DR . DOM I N I C MI RARCH I, D . 0-., OF I NTERN-i STS OF CENTRAL PA
108 LOWTHER STREET, LEMOYNE, PA 17043, ON REGULAR BASIS..
V. GUARDIAN'S OPIll~ON
A. It is the opinion of the Guardian of the Person that the guardianship should:
continue
be modified
Q be terminated
Form G-03 rev. 10.13.06 Page 3 Of 4
C - - .... ~ 1--- .. -~~.~.i~'. • ~ . _ ..._.. _ . an ~~capacitated Person......... .
Estate of ~~1
The reasons for the foregoing opinion are:
B. During the past year, the Guardian of the Person has ;visited the Incapacitated Person
--~- times with the average visit Ias+ing '~~ hours, ~_ minutes.
. ~~
The report of a social servfce organ- ization employed by the Cruardian to oversee and
coordinate the care of the Incapacitated Person for the period covered by this Report may be
attached to supplement this Report.
DURING WEEK DAYS, NANCY .M. STUCK, STAYS WITH MS. DANDRA E. WIRTH
AT 1429 RAVEN HILL ROAD, MECHANICSBURG PA 17055 FOR NURSING AND
DAY CARE. ~~ ~ •
• 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. ~ ~ ~---
~~ ~~ tit ~tGt 'y c ~ ~ Z C;~ t~ ?~
Date
KARTIC C. t}I~'SS"#23-2231180
CERTIFIED PUBLIC ACCOUNTANT
125 N. ENOLA DR. ENOLA, PA 17025
Form G-03 rev. 10.13.06
~--
Signrtture of Gumdian ofthe Person
1 o v~~ l d ~. ~~t c ~~
Name of Gum'dian of the Person (type or print)
Address
city, State. Zip
'7 3 ~ ~- o ~- ~ ~
Telephone
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