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ANlvu� �poRT oF � � �.
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GUARDIAN OF THE PERSON �c ° � �? �
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C�URT OF COMMt)l�t PLEAS Q�' a � o -ca n �
Cumberland � �,
COUNTY,PENNSYLVAN�A � � �`' ,-..• � M
�R.PHANS' COURT DIVISION ! -� �`'' r
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Estate of JeffreY A. Betiard ,an Incapacitated Person
No. 21-12-�153
I. INTRODUCTION
i�elly A. Landis .was appointed
�Plenary OL'united �'ruardian af the Person by Decree of Thomas A. Placey ,J.�
�ated January 7,2013
� A. This is the Annual Report for the period from_ ,
.,�
to . (.the"Report Per�od");or
❑ B. This is the Final Report for the period from ,
____.�
to . (the"Report�eriod"),and is filed
for the following reason:
1. The death of the Incapacita.ted Person. Date of death:
2. The Guardianship was terminated.by the Court by Decree of
J.,dated .
For a F'inal Re�ort,amit Sectio»s II through IY.
Form G-03 rev 10.13.Ob Page 1 of 4
Estate of Jeffrey A. Bedard ,an Incapacita.ted Person
II. PERSONAL DATA
Age of the Incapac�ta.ted Person: � Date of Birth: �ecember 5, i�67
III. LIVING A►�t]RANGEMENTS
A. Cutrent address of the In�apacitated Person:
227 Pine Itoad
Mount Holly Springs,PA i 7065
B. The Inca.pacita.ted Person's residence is:
❑own home/apartment
Q nursing home
❑boardi.ng home/personal care home
0 Guardian's home/apartment
❑hospitai or medical facility
�relative's home(name,relationship and address)
Joseph and Barbara Bedard
2�'1 Pine Road,Mount Holiy Springs,PA 17065 �
❑other:
C. The Incapacitated Person has been in the present residence since June 2006
. if the Incapacita.ted Person has moved within the
past year, state prior residence and reason{s)for move:
Form G-03 rev.10.13,a6 Page 2 of 4
Estate of Jeffrey A. Bedard , ,an incapacitated Person
D. Name and ad.dress of the Incapacitated Person's primary cazegiver:
Kelly A.Landis
423 Main Street
York Springs,PA 17372
IV. MEDICAL INFORMATION
A. The major medical or mental problems of tlie Incapacita.ted Person a�re as follows:
Mental Retardation
B. Specify what,if any, social,medi�cal,psychological and support services the
Incapacitated Person is receiving:
Job coaching, special olympics
V. GUARI)IAN'S OPII�TION
A. It is the opuuon of the Guardian of the Person that the guardianship should:
�continue
❑be modified
❑be t�minated
Form G-03 rev.10.13.06 Page 3 of 4
.
, ,
Estate of Jeffrey A. Bedard , ,an Incapacitated Person
The reasons for the foregoing opinion are:
3'her�has been no change in his mental acuity.
B. During the past year,the Guardian of the Person has visited the Incapacitated Person
35�times with the a.verage visit�asting 1 haurs, 3� minutes.
?'�ie report of a social service organization employed by the Guardian to oversee and
coordir�ate the c�e of the��tca�acitated�ersv�for the perivd covered by this Report may be
attached to supplement this Report.
I verify that the foregoing informa�ion is conect to the best of my knowledge,
informarion and belief;and that tliis Verification is subject to the penalt�es of 18 Pa.�.S.A. §4904
relative to unsworn falsification to authorities.
Januaxy 3,2014 '
Date Signahve of of the ers
Kelly A. Landis
Name of Guardtan of tHe Person(type or pri�t)
4�3 Main S�reet
Address
Yorl�Springs,PA 17372
c�r�,s�,z�n ,
71?-528�7357
Telephone
Fa�m G-03 rev.10.13.06 Page 4 of 4