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HomeMy WebLinkAbout08-14-12 ANNUAL REPORT OF GUARDIAN OF THE PERSON COURT iOF COMMON PLEAS OF ~ti~~'~i(1.OI COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ~ G. ~ y . '" ..f t"' ~i ~ ~ ~ ft= r - " {~.+ ~T i -... yyi - ~ F . - ~ ) ©` .rte Q f~ ' ~I `n y i f~~ i`~k~~Gl ~U~~ ~ ~,( Estate of ~~ ~~ Ti2QN k.l ~ ~ si ~'~~i6~e , P~ / ~Di3 , an Incapacitated Person No. ~- ~ _ ~~Q~ I. INTRODUCTION T ~l~n,~lc.~ ~ J~oCkc[-~= ,sflCv~-~~ ,was appointed Plenar ^Limited Guardian of the Person by Decree of , /~'s ~~~~'efiLt ~Li/.r~t_~, J., dated u~u_5~ ~ ~D~G' ~. This is the Annual Report for the period from ~~.~F~ ,~ D/ to g..r~ / y , ~ (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 For a Fina[ Report, omit Sections li through IV. Form G-03 rev. 10. /3.06 J., dated Page 1 of 4 ~~ /~1L,~1,G .~~e,~-~- ~Q~~-~ Estate of _ _g3(~ jnQ~~~~~ S/`- ~,9n/i~~e, y'~ /76~~ , an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person: 02 III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: Date of Birth: ~ ~ , ~ 9 y /' B. The Incapacitated Person's residence is: n home /apartment nursing home boarding home /personal care home Guardian's home /apartment Q hospital or medical facility relative's home (name, relationship and address) other: C. The Incapacitated Person has been in the present residence since ~ ec~n-- S . If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Form G-03 rev. !0.!3.06 Page 2 of 4 ~~~~~~ ~~e~e S~G/~ e Estate of ~' 3 ~ ~ u. ~ f~,,, Si ~ w~~s~~ ~,~ 1 ~~~3 , 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: ~.-~.d~h~ of C!l.h~~cd ,~JG.~-~.~-C Seizun~S L"G4~'~el,~~i~r., tv~i ri1, ~-v~ L~~ ~r~ ~~ti tier C'a ,~~ ~ ,C~ec'e,we Gr.,~l evaluc~lc -~' pp ~ !,v dC~~ nna~~ ohl CGr~n~u.u,`C~~~ c%~~s~~us B. Specify what, if any, social, medical, psychological and support services the ncapacttated Person is receiving:~~M ~u~,po~-L L?. i I' ~a,u,~' ~ ~ ~e /`~/ .~."-,~ S E ~ % ;j utirJa~ ~~~ ~ Su~~/~ ~a~„~ s ~ ~c~ks V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: continue be modified be terminated Farm G-03 rev. 10.13.06 Page 3 of 4 ~~r g~ c~ ~v' e t~e J`~,liUn~ ~ Estate of ~'3~ ~~ /c.l„u 5i l',g~,/,~/Q /p~ ~~,r3 , an Incapacitated Person 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 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. 1 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. Date ~ ignature of Guardian of the Person ~~NCc,h,~ L, - S~~U~e Name of Guardian of the Person (type or print) ~J ~LO ~J(CPA/K(iN ~~ Address Form G-03 rev. /0.13.06 City, State, Zip 7~7~ ash-r7yv Telepho e Page 4 of 4