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Home My WebLink About11-19-12 (5) ' " n `~ ~ r ~ 1 ~r c ANNUAL REPORT OF ~ ' D "o ~ c1 (_ L ' "~ ; ~ ~J, GUARDIAN OF THE PERSON ' ~ -. ~~ ; s ; .`"- ~:~ "~ N i r r '`_. ~~ COURT OF COMMON PLEAS OF y .- Cumberland COUNTY, PENNSYLVATdIA c..~ ORPHANS' COURT DIVISION Estate of Inez H. Davis No. 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 2010 to Julyl l 2011 (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 2. The Guardianship was terminated by the Court by Decree of J., dated For a Final Report, omit Sections II through IV. Fo.mc-os ~ev.tars.n6 Page 1 of4 Estate of inez_ H• Davis II. PERSONAL DATA Age of the Incapacitated Person: 81 III. LIVING ARRANGEMENTS an Incapacitated Person Date of Birth: 6/i/30 A. Current address of the Incapacitated Person: Golden Living Centex, 770 Poplar Church Road, Camp Hill, PA 17011 B. The Incapacitated Person's residence is: [J 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 12/2/0_ b _ . If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: n/a Page 2 of 4 Form G-03 rer. 10.13.06 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. [t is the opinion of the Guardian of the Person that the guardianship should: ~ continue ®be modified ~ be terminated Fo.,n c-na .e,. io ~s.oe Page 3 of 4 Estate of Inez H. Davis , an Incapacitated Person The reasons for the foregoing opinion are: 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 ~~ times with the average visit lasting 2 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. t verify that the foregoing information is correct to the best of my knowledge, inforn~ation and belief; and that this Verification is subject to the penalties of 18 Pa. C.S.A. § 4904 relative to unsworn falsification to authorities. ~k~iJ /~L, fill /~. pare S/gno are ojGunrdian of~he ei nn Gloria J. Banks ;tiame of Gmrdinn of fhe Person (type or print) 5776 Catherine St. Address Harrisburg, PA 17112 cry, s,a~e, zip (717)545-4816 Telephone Farm c-o3 rev. ]0./3.06 Page 4 of 4