HomeMy WebLinkAbout04-0908IN RE: HOPE E. ORRIS
ALLEGED INCAPACITATED
PERSON
· IN THE COURT OF COMMON PLEAS OF
· CUMBERLAND COUNTY, PENNSYLVANIA
: 21-04-908 ORPHANS' COURT
AND NOW, this
ORDER OF COURT
day of October, 2004, a hearing on the petition
for guardianship shall commence at 2:30 p.m., Thursday, October, 21,2004, in
Courtroom Number 2, Cumberland County Courthouse, CarLisle, Pennsylvania.
~te en J. Hogg, Esquire
For Petitioner
By the Court,
IN RE: HOPE E. ORRIS
An alleged iucapacitatcd person
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
:
: NO. 21-2004-0908
IMPORTANT NOTICE
CITATION WITH NOTICE
A petition has been filed with the Court to have yot dcclarcd an Incapacitated Person. If thc
Conrt finds you to be an Incapacitated ?erson, your rights will be affected, including your right to
manage money and property and to make decisions. A copy of the petition xvhich has been filed by
Lester D. Orris is attached.
You arc hereby ordered to appear at a hearing to be held in Court Room No. 2_, Cumberland
County Comshouse, Carlisle, Pennsylvania, on October 21 .200~4, at 2:30 PM. to tell thc
Court why is should not find you to be an incapacitated Person and appoint a Guardian to act on your
behalf.
To be an incapacitated Person means that you are not able to receive and
effectively evaluate intk>mmtion and communicate decisions and that you arc unable to
manage your money and/or other property, or to make necessary decisions about where
you will live, what medical care you will get, or how your money will be spent.
At the hearing, you have the right to appear, to be represented by an attorney, and
to request a jury trial. If you do not have an attorney, you have the right to request the
Court to appoint an attorney to represent you and to have the attorney's fees paid for you
if you cannot affbrd to pay them yoursclt~ You also have thc right to request that thc
Court order that an independent evaluation as to your alleged incapacity.
If the Cotnx decides that you are an Incapacitated person, the Court may appoint a
Guardian for you, based on the nature of any condition or disability and your capacity to
make and communicate decisions. The Guardian will be of your person and/or your
money and other property and will havc either limited of full powers to act for you.
If thc court finds you are totally incapacitated, your legal rights will bc affected
and you will not be able to make a contract or gift of your money to other property. If the
court finds that you are partially incapacitated, your legal rights will also be limited as
directed by the Corn1.
If you do not appear at the hearing (either in person or by an attorney representing you)
the court will still hold the hearing in your absence and may appoint the Guardian requested.
Date: 10- 13-2004 By: J'~
Clerk, Orphans' Court Divisiou
Cumberland County, Carlisle, PA
E pi lStMo day
My Commission x res n ,
January, _2006
LAW OFFICES
STEPHEN J. HOGG
19 S. HANOVER STREET- SUITE 101
CARLISLE, PENNSYLVANIA 17013
(717) 245-2698 · FAX (717) 245-0829
STEPHEN J. HOGG
IN RE: HOPE E. ORRIS
ALLEGED INCAPACITATED
PERSON
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
PENNSYLVANIA
ORPHAN COURT DIVISION
NO.:~t - OI-'~-qO~
AND NOW, this
ORDER
day of
2004, it is ordered and decreed that Hope E. Orris is found to be
incapacitated under Pa. Statute 20 Pa. C.S. §5501 et seq. Lester D.
Orris is appointed Guardianship of her Estate and of her Person.
J.
LAW OFFICES
STEPHEN J. HOGG
19 S. HANOVER STREET- SUITE 101
CARLISLE, PENNSYLVANIA 17013
(717) 245-2698 · FAX (717) 245-0829
STEPHEN J. HOGG
IN RE: HOPE E. ORRIS
ALLEGED INCAPACITATED
PERSON
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
PENNSYLVANIA
ORPHAN COURT DIVISION
NO.:og,.t - O~- qO~
AND NOW, this
ORDER
day of
2004, it is ordered and decreed that Hope E. Orris is found to be
incapacitated under Pa. Statute 20 Pa. C.S. §5501 et seq. Lester D
Orris is appointed Guardianship of her Estate and of her Person.
Glenda Farner Strasbaugh
Register of Wills &
Clerk of the Orphans' Court
(717) 240-6345
FAX (717) 240-7797
One Courthouse Square
Carlisle, Pa. 17013
Marjorie A. Wevodau
First Deputy
Kirk S. Sohonage, Esquire
Solicitor
OFFICES OF
l\egister of Wills anb <!Clerk of tbe ~rpbans' <!Court
Qtountp of Qtumberlanb
November 30, 2005
Lester D. Orris
700 Walnut Bottom Road
Carlisle P A 17013
IN RE: Estate of Hope E. Orris, an incapacitated person
File No. 21-04-0908
Dear Sir/Madam:
It has come to my attention that you have not filed the guardian reports required
by 20 Pa.C.S.A. S5521(c) in the above captioned guardianship. Enclosed you will find
the suggested formes).
Please mail those reports, along with a check in the amount of$15, payable to
the Clerk of Orphans' Court, to the following address within (30) days:
Clerk of Orphans' Court
One Courthouse Square
Carlisle, P A 17013
If you have any questions, please contact your attorney.
Respectfully,
~e=~~
Clerk of the Orphans' Court
CC: Stephen J. Hogg, Esquire
.
Clerk of Orphans' Court of Cumberland County
INRE: ;/IJP& If: 0 ,,~JS:
/ An Incapacitated Person
Docket No.~ I tJ 'I <J (I 7"
(
ANNUAL REPORT OF GUARDIAN OF THE ESTATE
I, !- eiJe~ '~[). to')! .,,1 ' S'
appointed plenary guardian(s) of the estate of --ib. pe C-. eJ ~}"\-r I S
by Decree of the Honorable Judee 11y{ B'Y II} ,ated <fJi{; ;"/....071 This is my annual
report for the period from Dc) ~/-~'fo II - 3 ().-6. ~"The Report Period").
, was /were
-- '\
I SUl\1MARY
c:rCIN J ~ n- >>rr
A. Value of principal assets at the beginning of the Report Period? $/9tJ t,.9?, 1'?
;.Ie p~ - ~~;I)? f:u ' 'i C fP/l ~j.PaL. .
A E-iTG>P. ~ II, l{1'f. Cf &f:.\ 'j.-l 't1,/Al(.'>k.
LV p A~E (&n--A. f?d>T/I~~ b
Total amount of all expenditures made for care and maintenance of the
C. incapacitated person during the Report Period?
B. Total amount of income earned during the report period?
1. Principal
$ q~ S-1 (; ~ y 3'
$ '3 ~ ;;rJ-. ~ tf
C!2Lcv-AINc{j ~O
$ APP ~)( . '"' -:-:
~),(!> ?TIll Jg,q 5 A1-,--~I~
Cl~~~'e5 /fT t!) oR/hr"f;
;~\5f1 f}rJ i . f'2
. ~:.: c:2'-
$:.-:. <:'. .
.,,' 1 .'
p-$~; C, 7~ J.../:1' 2-
J C.J
(.......::'
I. From principal
2. From income
D. Total amount spent for all other purposes during the Report Period?
E. Total amounts remaining at the end of the Report Period?
2. Income
Total Income and Principal
{2t-
#
II. ADDITIONAL INFORMATION
A. Principal:
1. Total amount remaining at the end of the Report Period?
$/00.1)" 'B,Db
I
2. How is principal currently invested?
t::: J.{/'1t:.E R# AN /ltVAlI' . r X' fi M()C' ..0 "'; Tc' ~;>,~ -,,-rO
. / (
.Ax 11 I~"r; Ii ,T,&,;/ E.. uJ hIe ~ I Po ,.,,// 'TAf:e AJV ~/A,j"P
~ a /"
ERoAIJ1 ~.xC!.epr-.r}.tl'lf::::.> fa'771 ?otJo;~~ PAY/} Y31} ji:i
/ AJRfls'lrpMK
3. Have there been any expenditures from principal during the Report
Period? jf'Yes 0 No
If you answered YES, was there Court approval for all expenditures
from principal? 0 Y e~ No
4. Did you receIve any principal assets dunng the report period wtnch
were not included on the inventory or a prior report filed for the estate? 0 Yes)( No
If you answered YES, did you receive Court approval prior to receiving
additional principal? 0 Yes 0 No
5. State the sources and amounts of the additional principal you received:
$
$
B. Income:
1. State sources and amounts of income received during the Report Period (i.e., social
security, pension, rents, etc.):
7R. $1 ~ 50 H (J Gi~o {.' '?
7X>., $ /7 J i..J /1 J tj 6 (p~~
,>'R, $ "'.3f7,';{ Y OfW"S
Total Income received during Report Period $ 3;<'.s- g>~ ~ () '/
2. How is income currently invested? (Please specify, restricted bank accounts, client care
account, etc.)
50s- r~/-? J:-lr.' P tf_ ORtR.te
$' 5 Fb Y< }.... C5'.5,' () f?;~ Ii:
fel'(~JC>;';' ptJ/f J-.&~ O~~l ~
#
3, Specify what payments were made for the care and maintenance of the incapacitated
person (i.e., clothing, nursing home, medicine, support, etc.).
II '
4. Specify what other payments were made during the R
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. 94904 relative to
unsworn falsification to authorities.
/~ - ~ -tfjr
Date
"zfL /L-G
* FILING FEE $15 MUST ACCOMPANY THIS FILING.
V'
,. .
'-
~ .
Clerk of Orphans' Court of Cumberland County
IN RE: /-10 P (! & lOr r- I 5'
An Incapacitated Person
Docket No.:JJ CJ f l' b 2""
ANNUAL REPORT OF GUARDIAN OF THE PERSON
I, L e ~7e.~ 'V () r- ')-1' 5 Cij/were appointed
plenary guardian(s) of the person of /I D pp f I 0"1'''''''' ~. by Decree ofthe
Honorable Judge tJ>C fI R 81( / ~d tOcp J.....J ~ 0 'f. This is my annual report for
the period from Oc T A ( _ 0 i to /1.- 3 D-- () ~ , ("Th..: Report Period").
1.
Present age of the incapacitated person:
7 9 Yrs.
2. Current address of the incapacitated person
Fb"" e>d r=J91" Ie /-1 e,4 )... 'r A C ~IYTe <~
'7CJo WA J.....N.U/<73Q-,r;/Vl 9D/l-..D
CA)--t..)~ Ie ~/YNfi, /'7cJ/3-3C;9y
)
3. The incapacitated person's residence is:
CJ own home/apartment
~ nursing home
CJ boarding home/personal care home
CJ guardian's home/apartment
CJ hospital or medical facility
CJ relative's home
r:'-'I
-)
. : '",,)
C,,')
<-'J
(Name and relationship)
CJ other: (describe)
4. The incapacitated person has been in the present residence since :J;) J y 7- D i If
/
the incapacitated person has moved within the past year, state change and reason(s) for
, .
-
. .
change:
5. Name and address of the incapacitated person's primary care giver:
;::;'~r@sT~ ~J< i'/<2fi/TA C~,yte)-
~ . ,
---7q-~ WM~~ 1_~~772J~~ort~_
Q~/2t..'s'/t"1 p,#, 170/:1-3'7
6. The major medical or mental problems of the incapacitated person are as follows:
1-1" eels / it -r J.. €> 3t- 1) SIJi Eo;:
F! "- ~ 1/ e/ /Vl e 'r- ~ C /l N /94 T 1fi.LJ< I S'
. I J
1 ,
Ct1 N' e.; 7l; uJh@e JJAs
--PiA.:! /VtJ5ElJ '8Y II~R MM I) Y 'O~ /JR J Ii/ Ie; 99.
Spe~-what, if any, soe1'al, medical, psychologic.d' and support services the incapacitated
7.
8.
person IS receIvmg:
I
~ I? ,.j!U({S / N r 9'46 M e" r~DV!'bE~ CAre> f"6 ....
. lie ''J-. .!' 'f J,.,,<.J R s ;tL bt? /" "5~ @ 1 S se ~) AI' rf' er I /J ~ I Y
Ey' Adcc/CJ,f!, ~~-vy;~r-)F /ye~~ ~-J rf,;JTj)oC!'~1
It is our opinion as guardian of the person that the guardianship should: (check one)
,g[ continue, 0 be modified, 0 be terminated. (Briefly explain your response)
"51-., e UJ l il /K~.:b 02-1 ^ R c /JI? e j-=C),f 'rI. e '(2 e?r
6 r rJ e "J.., rE:.- IN.T4 P /y uj/f51 N r #~ IYl ~
9. During the past year, I have visited the incapacitated person 3 C"c) times with the
a\/erage v"isit lasting
.
-.:t::" CJ . ~:>..-, .
(State num r ofhours/ml!1utes, etc.)
~ WI}./r~'f'#
D/1Y
s '----C;;e70 BI'9P W 6l/?,4t>J-...
uJA 1Jt~R 1-2- h Rs /J
, '
The repOli 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. 94904 relative to
unsworn falsification to authorities.
/0/ tb JOY--
Date /
--i:~L /),[id
Signature of Guardian
* FILING FEE $15 MUST ACCOMPANY THIS FILING.
-
.Mr, Lester Orris
Mo,"",i, View Vlg, I ';)..- &:, - C 0---
4182 Elk Ct., Apt. 115
Mecbaeicsburg, P A 1]050-7659 · ~.
. 1:=;'( f' )./11 N ,1l770;;/ & F 140 P e cJ.. L SJi I G>ff c?RA I:> FrT-f'I. IE
. /)J h@I'/T w;45 -p<'9J(hM11~e 'b 'jh;rJ rJo Prt uJflS -ra 12-l>
TO fORE>,---f1I aJ.? ;.Ie-/9) rA. c~I'1? 1:> u f (0.A J.. 7='fIE ~
41Yl> h.D<:5 ",PArt;) "7 -TO u.M L-I</ 'f3G'CAu sJil1 cop" h> 7i~"
7}:J1< e el4 & E Df?;.I~ P, ~:; ~~ p <<tpl':> 'f>~p ^ f h 1< Ca Rf J
~ 11 I / ,_..1 - - }
1/1 r /1 'f't'?t) F E~fC /VAl PI'1l! J '~I 5.'ne W ~1V"7'1 ~
r"'2; f'TJ. ;l..~~'f', .
\ :- .4f;'pL.e.e it> C(jM'Ih~R/fi){J> e"uN7j'I'7.>si:;J-IIIlat:.
\ t)j-PI C f.., fa ~ M <!' ~ J~A' t:> Fo R ;./6 f f!. -r+.? ~7i-1('h11-
\ #<"p () v"q,~ tJ F '" "p 0, fp 0? ' 'i 'II lAY} 5 T7J ~ fJRo;(ErI
i.J::o wJy" //5 Fb II {j /II S t-lo p y,s- ,,;)lI'1R e"lf' en. Eft, H' fi "'"P
\ .M I :r hV/1< ef '1;" '-(r; 6 , ~ ;r tV .,....P~~ c' 7 ~ S-P~~ b
: ~..v ~ H ~R 5" h II~ E "819 Fe R f!. sh 8:'#1 /IS rJ.J.1 ~)9fJ1.:.
. \ ~I": NI e"", C/lt i. 70 PA j fO ~ h (<> R. C:~~E-:' :D'f~ IH
! -r I~... .., K f) ~ t3$'::> if) P -PAC/' N f ThAT' so flit? ,-1'1' R ell!?€!-
if h a-I!.B: h J<I ~ c!'c> <;7-4 q 0 5'"3fi> ,'f J ' A P IP~ /}'" f.( J!> 10
, J ,. '
i <<> v A r.,; T,4Te IS> F I 9o} r. "'1 ''I'' (pi rz $ / AI -;;7C C! KS c..J~(1'. J.
\ I '.
!,AR E ,4 L t.... S"P '- '? tP F~ ro R.. cA ~ft. ,A el?f!. · (jJ' u R /"" de ,iV, J;.
! ~ ~
\ F'" "'I f30 IA ~ F v S" 1 $ so c:r. J S i!"C t' ~ I Ty (" j.. '" S' ;"J
\ ~M/J/ J PM';:'; 1'1(.' , :r fl~ wh\"~ , .;4'tD q. '17 RPR N/M71,
i ;e- /1M /f/ <> T' }.. Ii' E j-/ <> /ft.; -, '" /l H";- 1</ bR ,). r?
\ Reif t$r -rAIP 9,:f1~7:4~SI,~I:S Lt'^j r/.l.J~iro
\ 7 A;s E>t p/",ooy/l' 7ft> AI ' N" {-'€- ,:1. ~:s fi')<ee IIAN!-
\ (};-l/~ fi. ,/l/ F'" l?t [)" FJ4 RK /l /V P \lb.' 11 I '8r;,"I), 6' RP
i ~. R/3 ",T' '" I" HeR j.../ F€-, ,T 1-1.. e e.'t j, I (; I .i
. ' ,Ii HI2LP TD /<!J L', J'r T,AM .h'c!'C?D~O r;r<.
HAl .fT/.u....j/E't.. HE t I" /VI/!)' /l e T />II ~ C A/ .MIl! ttJ;J..- Ph.iI/1!
,/7 -35'0- b '1'15- AS I /7~ tJ,.:rA)."Jt,c) ~ ,.,4e.i!> M/vl,F/i.
---f?" ~....& . Iii; 8. Q1uJ..
ANNUAL REPORT OF
GUARDIAN OF THE ESTATE
COURT OF COMMON PLEAS OF
COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of
flcJ p J:. & ~ ()42i<< IS
No.~/- tf L(- '7~F
, an Incapacitated Person
I.
INTRODUCTION
L, EsTER Vf
c:
CJIfI?/ S
OPlenary OLimited Guardian of the Estate by Decree of 2D (fAt
dated D~__ T: J-/ - }..pCJ f
, was appointed
fl~Ylv5Y ,J.,
o A. This is the Annual Report for the period from
to (the "Report Period"); or
B B. This is the Final Report for the period from ~,y J ~ () ~'
to ryJ /flII Jl~ __ a L/_ tJ h (the "Report Period"), and is filed
for the following reason:
1. The death of the Incapacitated Person. Date of death: / J - ;..1- :J....06 (,
Name of Personal Representative: I-I=-5TFtZ, /1. C9 /(t:{J 6"
2. The Guardianship was terminated by the Court by Decree of
J., dated
.i>.ciciO /.,.)
:10 )iUJ1J
I ~ :ZI Wd 92 J30 gfiaZ
;.! ',';,';
Farm G-02 f,e';, JO,l3.06:
-'(1 :f':'.u-, n-'i'U -,i~"-' i
-'~ ....vl,jjU uj.JuUJ,Jd
Page 1 of 5
~
Estate of HoP Ei-
f;.- OftRI 5"
, An Incapacitated Person
II. SUMMARY
A. State the value of the estate reported on the Inventory
1/ t; ~.~
B. State the value(s) of principal assets at the beginning of
the Report Period. (Same as Inventory if first Report,
otherwise, ending balance from last Report.)
$ 6
C. What is the total amount of income earned during the
Report Period?
D. What is the total amount of income and principal
spent for all purposes during the Report Period?
$ 7} r Y s: S-O- .53.
$ or ffql F~
I
E. What are the balances remaining at the end of the Report
Period?
1. Principal $
2. Income $
3. Total of Principal and Income
$ 1 0 1 ~.. 0.00
III. ADDITIONAL INFORMATION
(If more space is needed, please attach additional pages.)
A. Principal
1. How is the principal balance listed above currently
invested? (Please specify, e.g., real estate,
certificates of dep 0 s!!> re~nk accou~, etc~ J) ~ ~
~~U<-U L>>2trJ1-fJ~ tf
/P;! ~~ ~ fj;1;;!:,-k1l~ PI
~~ lA/.d/
2. Have there been any expenditures from the principal
during the Report Period? ............................ \~'Y es 0 No
If yes:
a. Have all expenditures from the principal been for
the sole benefit of the Incapacitated Person? . . . . . . .. "sYes 0 No
Form G-02 rev. 10.13.06
Page 2 of5
Estate of H tY PEt=:. tf),r Rl ~
b. LiJlurpose and amount of expenditures:
. EFU> Sfa>/Y E" FbrR tJ.1<A-~ff-
/VlEil;" /.) I fcsp ~u:~~1'
r/lA,/25!' PJll~K J.I~ ~ C!.7R...
, An Incapacitated Person
$ / (J tJ !f-!!-
$~3 , 1 b
$ 1> J./ b, ~y
$
c. Was Court approval received prior to
expending the principal? ....................... 0 Yes gNo
3. Were additional principal assets received during the
Report Period which were not included in the
Inventory or a prior Report filed for the Estate? ........... 0 Yes ~o
If yes:
a. Was Court approval requested prior to
receiving the additional principal? . . . . . . . . . . . . . . .. 0 Yes 0 No
b. State the sources and amounts of the
additional principal received:
B. Income
1. State sources and amounts of income received
during the Report Period (e.g., Social Security,
pension, ret,lts, etc.): ("
J I.M()S' j :5 df3 i J'J _ S prJ I.r'R, ~t;;
,
Total income received during Report Period:
Form G-02 rev. 10.13.06
$
$
$
$
$
$ -{ Lj %:f'.. S"o
I
$
$
$
$
$
$ ~ If'P J:.!J-dJ.OO
Page 3 of 5
Estate of .J-J 0 PEE () I? ;e } s'
I'
, An Incapacitated Person
2. How is income currently invested? (Please ,
specify, e.g., restricted bank accounts, client __ . r ~L <?;.....,-eD
;;J::r::etc~C(J~C'A/IUJlTh h8:>j~R y 6J"Iftfo ~
//6 FA!Z""r..{'l ~ f'~.oJ2!!.J)~~~j...j.~
/"'l";:i CIfY'<-'L~' ---fI.~fi ~f' /J<A^(X"-NiJ-O .
~V rn''t r-u.+ \ ~ W ~
c.
D. Other Expenditures
Specify what other expenditures were made during the Report
Period. (Do not include any items stated in response to
question C above.)
/71~
E. Guardian's Commissions
List amounts of compensation paid as Guardian's commission
and state how amount was determined:
Amount
Method of Determination
Court
Approval Obtained
()
()
DYes DNo
DYes DNo
Form G-02 rev. 10.13.06
Page 4 of5
Estate of 1-1- C) P E f:.. /,) R f< f .g'
I
, An Incapacitated Person
F. Counsel Fee
List amounts paid as counsel fee, and indicate whether Court approval was obtained.
Amount
Court
Approval Obtained
8
DYes D No
DYes DNo
B
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. S 4904
relative to unsworn falsification to authorities.
/j. - ~J- - CJ ~
Date
~~57i'R P. CJRRI:S
Name of Guardian of the Estate (type or print)
tf I ?;1. t= /-..1< er r1 rr:: JI J-
Address
/11 t?C ,,;.ptC- si/3U,e
City, State, Zip
'7(7- 7.3.;L-~? 2- ~Me
Telephone
~e II -p: 7(7-- 3.s-d- t9 'I'Ir-
Form G-02 rev. 10.13.06
Page 5 of 5
ANNUAL REPORT OF
GUARDIAN OF THE PERSON
COURT OF COMMON PLEAS OF
COUNTY, PENNSYL VANIA
ORPHANS' COURT DIVISION
Estate of tf 0 PEtE- 0 f(f( \ S
No.:ZJ -D f ~ 9tJ?
, an Incapacitated Person
.(.yt~ cb
-. !~_)C-I
~. \. ~) ~~) :!!
,~~s appo~ed
. .~ \.)
J~ *.,.
o Plen"", 0 Limited Guardian of the Person by Decree OfF!>! A ~ ~/1Y / 7 ~ J.,
dated QO r ,. J.- .,) 60 ;J . / '
/
"a A. This is the Annual Report for the period fro
to A/~ V Of. Y , tJc,
D
:,'-'0
<{~~Q
,",.
g:~~
--.;
I.
INTRODUCTION
LfsTj:~ u.
CJ~f() S.
,?J.F"
"Report Period"); or
o 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-03 rev. /0./3.06
Page 1 of 4
\
Cf
Estate of
Ii 0 P ~
E
f
t)~ A-) S
, an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person:
gc,
Date of Birth: '7 -- J- 3 - ;L. t.
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
&flJ;5! fAI'?K J-J eAf.-Th C5N7BR
7DD Li.//!{d() 7 [jo71O/v1 ~/1b
<::::: /if? 1.../ 5" 'E- I ~$/Y,.y /T. - 17 (j I 3 -3'(;, 7> a
B. The Incapacitated Person's residence is: /
o own home I apartment
~ nursing home
o boarding home I personal care home
o Guardian's home I apartment
o hospital or medical facility
o relative's home (name, relationship and address)
o other:
C. The Incapacitated Person has been in the present residence since J V /7- R - 0 jL
/ '
. Ifthe Incapacitated Person has moved within the
past year, state prior residence and reason(s) for move:
Form G-03 rev. 10.13.06
Page 2 of 4
Estate of JI () pee O/PRI tr
, an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
~t'I?t? 9/ /f};ft2k ;.1,,;1411/; ceNIPf?
you u) A,I All;! ~~O)./) 1if;,Af,t
C/9-~/./~ he --pb/VA//7. (70 13 -.3t. ?9-
, /
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
}/pPE 15 /-
e-fi tfNCJ /w,!fJJt
~ 5'Rn
'S,.7fr.e.e FRf-M),pbcti R 14
B. Specify what, if any, social, medical, psychological and support services the
Incapacitated Person is receiving:
..
rA~AlV~5IAf! fI~Me- rn6vJPEs.~t.f#~ cMe Pr;q{! HeR,
;5 he IS- 1(1'-' I;J: sp-p: r:yA b7::Ji! 11 l7CN-7id oA{]J
A Foo / .. '()G~ N')::> d dre5't::. .
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should: ~
. . _ ' fO~ 7:A..'f-- Rf" J I
.B-contmue 75hE /VEe4> ~C{ j.{tt-errlZ C~Rr$.- jJr 1.11 J./b/Ylli
o F rll3'l2.. AI FE. / H trl e. AI Ut'I:".;:.1 /
o be modified
o be terminated
Form G-03 rev. /0.13.06
Page 3 of 4
Estate of Ao P E 12
t)f?~J 6:
, an Incapacitated Person
The r('(.cas~ns for the foregoing opinion are: # r':h ~ ~ ~ #~ tV Ie 5'i7k
,#~ fiP relEt::> /.fte,qse(7, ,;5. P {" fii:?D ?3L /Yt5 co If
!f1 . 4 AI' tJ~ >~ olfJ AN 'A 1- 't:> , 7/Jt?,;Y A~ fZ-~Al,lE- fY )
-rAJi/ :5'"~P-~/JN s-w;-9-I)6 tV ;I~e fhoD oJ. ~J:;f!f~//I( I
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
-3 b t times with the average visit .lasting :J..., hours, . 3 0 minujes. ('
:J: _q () A'"/ Htf?~ ^ (.J If C' h It ~ n/YJ::> ~t;: 'P frI!?R /11 5 -:shE) 6"
ft'otliJ /Nc~1JA(j' ~ ,&~ ~/,y71r: )fhF/IE:r 1-; /Y~76fi Re, Th f3.
The report of a social service organizatzon employ~f>b0h~tf;uardfan to ove~l;(/and
coordinate the care of the Incapacitated Person for the period covered by this Report may be
attached to supplement this Report.
,
ftl~
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. S 4904 relative to
unsworn falsification to authorities.
eJ/.eo, tlC}- Dj
Date
Name a/Guardian of the Person (type or print)
Address 'I / ~ ~ c).../{ C!. Ti .A- PT, / ( r
MechMc..S \3,,-,1{9 CPA. IToS'6
City, State, Zip ( l
7/7 -'73:2. -~ ?P2~
Telephone . :2 r'O _ (; d' lL 5
~c/I it- 7/7 - I,N /' T'
Form G-03 rev. 10.13.06
Page 4 of 4