HomeMy WebLinkAbout01-10-14 (2) a •
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ANNUAL REPORT OF �° � � � ; � ���
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GUARDIAN OF THE PERSON � � �
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COURT OF COMMON PLEAS OF � t� � "'� �
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Gumberland COLJNT�,P�NNSYLVANiA � `:;
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ORPHANS' COURT DIVISION
Estate of Jay W.Bedard ,an Incapacitated Person
No, 2�-12-1154
I. INTRODUCTION
Kelly A.Landis , .was appointed
�Plenary OLinuted Guardian of the Person by Decree of Thomas A. Placey ,J.�
dated January 7,2013
� A. This is the Annual Report for the period from
to , (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 death:
2. The Guardianslup was terminated by the Court by Decree of
J.,dated .
For a Final Report,o�»it Sections II thrnugh IY.
Form G-03 rev.10.13.06 Page 1 of 4
e
Estate of JaY w• $�'d � ,an Incapacita.ted Person
� II. PERSONAL DATA
Age of the Incapacitated Persnn: `�6 Date of Birt1�: ���'�� 1967
III. LIVII�TG A►RRANGEMENTS
A. Current address of the Incapacitated Person:
227 Pine Road �
1Vlount Holly Springs,PA 17065
B. The Incapacitated Persan's residence is:
❑own home/apartment
❑nursing home
❑board�ng home/personal care home
❑Guardian's home/aparbment
❑hospital o�medicai facility
�relative's home(nazne,relationship and address)
Joseph a�c�Barbara Bedard
227 Pine Road,Mount Hoiiy Springs,PA 17fl65
❑other:
C. The Incapacitated Person has been in the present residence since June 2006
. If the Incapacita#ed Person has moved within�he
past year,state prior residence and reason(s)for move:
Fornt G-03 rev 10.13.06 Page 2 of 4
Estate of Jay W.Bedard ,an Incapacita.ted Person
D. Name and address of the Incapacitated Person's primary caregiver:
Kelly�. Landis
423 Main Street
York Springs,PA 17372
IV. MEDICAI.INFORMATIaN
A. The major medical or mental prablems of the Incapacitated Persan are as follows:
Mentai Retardation
B. Specify what, if any,social,medical,psychological and support services the
Incapacita.ted Person is receiving:
Jo��oa�hing,specia�oiympics
V. GUARDIAN'��PIl�It3N
A. It is the opinion of the Guarclian of the Person that tlie guardiat�ship should:
�continue
❑be modified
❑be terminated
Foim G-03 rev 10.13.06 � Page 3 of 4
r � s
Estat�of Jay W.Bedard ,an Incapacitat�d Persan
The reasons for the foregoing opuuon are:
There 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 average visit lasting � hours, 30 mi.nutes.
T'�ie report of a social service organization employed by the Guardian to oversee and
�oordina#e tl:e care of the Ineapacitated Person for the period covered by this�eport may be
attached to supplement t�iis Re�ort.
I verify that the foregoing information is con�e;ct to the best of my knowledge,
inform�.tion and belief;and that this Verification is subject to the penalties of l8 Pa. C.S.A. §4904
relative to unsworn falsification to authorities. ,
�
Janua�y 3,2014
I�ate lg�u+��1' a�J' i�e�
Kelly A. Landis
Ncrnte of Griardian of the Persan(type or print)
�23 Main.S�reet
Address
York Springs,PA 17372
> crry,sr�,z�
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'717-528-7357
TeJephar+e
� Form G-03 rev.l o.�3.06 Page 4 of 4