HomeMy WebLinkAbout09-10-13 (2) F-,-- i
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ANNUAL REPORT OF o �;
GUARDIAN OF THE PERSON C.0 r
C.
r
O
COURT OF COMMON PLEAS OF
LAM 4 4--i a4-al—COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of l S2 i&ck an Incapacitated Person
No. 'ZH 2_—Lfq2--
L INTRODUCTION f _
t(} Y( 1? 2CX9t ?tt°CU C f S was appointed
PIenanOLimited Guardian of the Person by Decree of
A. This is the A nuaI Report for the period from
to l9 - (the"Report Period';or
El 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
J.,dated
For a Final Report, ondt Sections H through IV.
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Estate of _ �i 1 t }�� .,� _ an Incapacitated Person
LI. PERSONAL DATA
Age of the Incapaoitated Person: ^ Date of Birth:
M. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
&td-e,n C V 1
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
If the Incapacitated Person has moved within the
past year, state prior residence and reason(s)for move:
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Estate ofS��C�a t4P,tA } an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
Csolde bvir�
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
jt
B. Specify what,if any,social,medical,psychological and support services the
Incapacitated Person is receiving:
V. GuARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
]continue
Obe modified
F-]be terminated
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17Estateof &rJ&. an Incapacitated Person
The reasons for the foregoing opinion are.
13. During the past year,the Guardian of the Person has visited the Incapacitated Person
Utimes with the average visit lasting hours,15 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. §4404
relative to unworn falsification to authorities.
Dare Signature ofGaar&an ofae Person
Name ofGaardtan ofd w Perron(type orprinO
34SSUgEiOO11SERVICES Addrrsa
PRINCE STREET
r.o.BOX 1593 PA 1760S.t593
I,ANCASTERr City,State,Zp
-71-7-3 i Z-217:
reteptwir
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