HomeMy WebLinkAbout01-15-14 FINAL REPORT OF GUARDIAN OF
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Estate of Pauline K.Cover .an Incapacita�l�ierson r�-- r�'
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No. 179 of 2013
I. INTRODUCTION
Kevstone Guardianship Services was appointed
�Plenary Limited Guardian of the Person by Decree of Christylee L. Peck , J.,
dated 5/31/2013
❑ This is the Annual Report for the period from ,
to , (the "Report Period"); or
� B. This is the Final Report for the period from Mav 31 , 2013
to , June 17 , 2013 (the "Report Period"), and is filed
for the for the following reason:
1. The death of the Incapacitated Person. Date of death: 6/17/2013
2. The Guardianship was terminated by the Court by Decree of
J., dated
For a Final Report, omit Sections II through IV.
Form G-03 rev. 10.13.06
Page 1 of 4
i
Estate of Pauline K. Cover ,an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: Date of Birth:
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
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:
Furm G-03 rev. 10.13.06 Page 2 0£4
Estate of Pauline K.Cover .an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person areas follows:
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
be modified
be terminated
f�orm G-03 rea.10.13.06
Page 3 of 4
Estate of Pauline K.Cover .an Incapacitated Person
The reasons for the foregoing opinion are:
B. During the past year,the Guardian of the Person has visited the Incapacitated Person
2 times with the average visit lasting 30 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 faregoing 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 unsworn falsification to authorities.
/ /3 /�
�Q�e �gnature of Guardian of the Person
Constance E.Stoneroad
Name of Guardian of the Person(rype or print)
PO Box 804
Address
Elizabethville.Pa 17023
Ciry,Stare,Zip
717-265-4056
Telephone
Form G-03 rev. 10.13.06 Page 4 of 4