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HomeMy WebLinkAbout11-19-12 (3) ANNUAL REPORT OF ~ u ~ ,~ ~~: ,^~ r -~, r,~~ ;-,~ ,__ GUARDIAN OF THE PERSON ~'1 - ~~ r.- - - <- ~ r; ~ _, ~_. r-,~-, COURT OF COMMON PLEAS OF n ~~ "~ Cumberland COUNTY, PENNSYLVANIA _ o-' T~ ORPHANS' COURT DIVISION Estate of Inez H. Davis 21-07-0200 I. INTRODUCTION Gloria J. Banks an Incapacitated Person was appointed ~Plenary~Limited Guardian of the Person by Decree of Oler, J. J dated 4/12/07 ~ A. This is the Annual Report for the period from July 12 2009 to Julyl l 2010 (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: l . The death of the Incapacitated Person. Date of death: 2. The Guardianship was terminated by the Court by Decree of L, dated For a Final Report, omit Sections II through IV Fomc-or rev. ro.ta.ne Page 1 of4 Estate of Inez H. Davis II. PERSONAL DATA an Incapacitated Person Age of the Incapacitated Person: 80 Date of Birth„ 6/1/30 III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: Golden Living Center, 770 Poplar Church Road, Camp Hill, PA 17011 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 12/2/06 If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: n/a Form G-o3 rein. 10.13.06 Page 2 of 4 Estate of Inez H. Davis an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: Golden Living Care Center -Alzheimer's Unit 770 Poplar Church Road, Camp Hill, PA 17011 IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: Alzheimer's Disease B. Specify what, if any, social, medical, psychological and support services the Incapacitated Person is receiving: Social, dental, nursing, ophthalmology and pharmaceutical care; V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: continue 0 be modified ©be term mated Norm G-03 re~~. lO. 13.06 Page 3 of 4 Estate of Inez H. Davis The reasons for the foregoing opinion are: an Incapacitated Person There has been not improvement in the Incapacitated Person's condition. B. During the past year, the Guardian of the Person has visited the Incapacitated Person ~5 Mmes with the average visit lasting ~_ hours, 3~ 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 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. ~_/ ~ aa~a Date ~~~ Signnnme of Gaiardinn the Perso~ Gloria J. Banks Nome ojGnardian ojthe Person (type nr print) 5776 Catherine St. Address Harrisburg, PA 17112 QN, Slate, Tp (717)545-4816 Telephone Form G-03 rev. /p, )3,06 Page 4 of 4