HomeMy WebLinkAbout06-25-13 (2) t Clerk of Orphans' Court of Cumberland County
IN RE: r)o6\ Nye, III Docket No. 7,oc)6 - CG 9l6
An Incapacitated P rson
ANNUAL REPORT OF GUARDIAN OF THE PERSON
I, -5,ez&t-4L �� ji e��prr,?;n� �h� ➢rrr wjy&er appointed
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plenary guardian(s)of the person of c�o 11r, Nye ) l I by Decree of the
Honorable Judge e r ,dated 3iAVN . gOf20()b.This is my annual report for
the period from A to ("The Report Period").
I. Present age of the incapacitated person:
Z. Current address of the incapacitated person
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3. The incapacitated person's residence is: m
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❑ own home/apartment Ca -o z to =
rn C� j a
Tyr- ry r.rm
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13 nursing home a U, o
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❑ boarding home/personal care home
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❑ guardian's home.'apartment a N
p hospital or medical facility
(3 relative's home (Name and relationship)
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p/ other: "r yvV/u//1r" r, describe)— f�J Sfax
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4. The incapacitated person has been in the present residence since fkL,S 012 0%0 . if
the incapacitated person has moved within the past year,state change and reason(s) for
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change:
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5. Name and address of the incapacitated person's primary care giver:
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�t�%•�-s I�Olz'�.e.. �7dcii^�5` "'^ j+%/s..se- c2a'
6. The major medical or mental problems of the incapacitated person are as follows:
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7 Specify what, if any, social,medical,psychological and support services the incapacitated
person is receiving:
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g It is our opinion as guardian of the person that the guardianship should: (check one)
ltd continue,0 be modified,O be terminated.(arieny explain your respnx)
9. During the past year, I have visited the incapacitated person times with the
average visit lasting
(State'number othourstm nutes.ere.)
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
unworn falsification to authorities.
Date gigriature of uardian
* FILING FEE $15 MUST ACCOMPANY THIS FILING.
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