HomeMy WebLinkAbout06-07-13 . ' � Or�iG� iYl�,t.Q-
ANNUAL REPORT OF
GUARDIAN OF THE PERSON
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� COURT 0 COMMON PI.EAS OF � � � � � �
LiilYI�FX Il,".F��:� COUNTY, PENNSYLVAI��? ;� �
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ORPHANS' COURT DIVISION � " �? � ='
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Estate of_ 1''s�(� 1 �.S �����'L , an Incapacitated Person
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�vo. 2 I ` l2 -C' i'�ly
I. INTRODUCTION
�1P3�i���)'"�rYli?�l� ��X\/I,i � � , was appointed
�Plenary�Limited Guardian of the Person by Decree of J,
dated I�-- ��y - �� � � ' '
�,A. This is the Annual Report for the period from �I -� `� �Z ,
to �j-�I - I '� , (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 deatb of the Incapacitated Person. Date of death:
2. The Guardianship was terminated by the Court by Decree of
J., dated
For a Fznal Report, omU Sectioiss II t/zrough IV.
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Estate of_ ��� (,fi k�l �J � ���X ��.� , an Incapacitated Person
II. PERSONAL DATA
Ag� of tbe Incapacitated Person: � � Date of Birth:_ ��� - ��� - ��- �
III. LIVING f`.RRANGEMENTS
A. Cunent address of the Incapacitated Person:
!-I �� �r��rG'� �1��
(�����,,�; �-h � j , '(� 17 C)i (
B. The Incapacitated Person's residence is:
�own home / apartment
�nursing home
�boarding home/personal care home
0 Guardian's home /apartment
0 hospital or medical facility
�relative's home (name, relationship and address)
�other:
� ��
C. 'The Incapacitated Person has been in the present residence since � ���-�J J
. If the Incapacitated Person has moved within the
past yeaz, state prior residence and reason(s) for move:
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� Estate of �' �i�'�C���� � ����( �p � , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
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�,t(.� �:r��:1 k���,
C��,�{"? ( �-r 1 � � �Y�
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
i-•,��,�,� �����-�Y�er �n����L�f��z;�XV��, G,���St� G���hc���, �
�:;'1�,�"n e��t'i,fi Cr �;' bP_1'X'��n��c�,� c:1.iS�tir r r.��.t�� �t.r� t�� � ri�'�,rrr_�r�;
� � t,h�IXl ���l� i ��i��L, ���JI`Y-l��i�� � CO1"UY1('I(���CA �"V"It 'Y"U`�-�u�(�`�i� ���(>�1 � '-�"�k,
I lii�F���7 � `�GCI t'�o�YltrF_.Y\�C1 i C��feS`�� V_C� C���S(x��L'4; � (�ir1t ��i�"t-�`� ,
i 4�,�(�vx 1����C�, ���tt—��� '��I�r I Ic��hG1 ; Cc�����1 ���� ���
B. Specify what, if any, social, medical,psychological and support services the
[ncapacitated Person is receiving:
1�-1 ho�.,�r ��� ll��l I�l�rs�nc� C'a�: �
��
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
�continue
�be modified
�be terminated
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Estate of_ �� (�l �.��� �� �(� ��-�' � , an Incapacitated Person
J
The reasons for the foregoing opinion are:
��1C�l�j� �"�rru�,r>> �:r�cr��.:��� tr��r���� .
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 servrce organization employed by the Guardian to oversee and
coordinate the care of the Incapacitated Person far the period covered by this Report may be
attaehed 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 sub'ect to the penalties of 18 Pa. C.S.A. § 4904
relative to unswom falsification to authorities. — �'�, � �^�� ��
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�� - � - � 3 N�-�qt�rxr-��,�°x�cC _�er���.�c���_
Date � Signature ojGuardian of the Person � J
�D���C� Nqme of Guardian of[he Person(type or prin(J
�fi1GH114
;34 SOUTH PRINCE STREET
�,>,p,BOX 1593
� 4NCASTERpA �7608-1593
Address
. City,Stale.Zip
( � � ''� G-<:1 ��J X`�- G.U�
Telephone
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