HomeMy WebLinkAbout02-07-14 (2) ;�
ANNUAL REPORT OF � '=�= � �
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GUARDIAN OF THE PERSON � �' � �� ,`:;
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COURT OF COMMON PLEAS OF � �:'; � � : 4��
Cumberland _ COLJNTY,PENNSYLVAI�'�; ►--� ���, s:�s
ORPHANS' COURT DIVISION � �` � �"' °
Estate of Nancy M Sttick ,an Incapacitated Person
Na r " L��
I. INTRODUCTION
Donald B. Stuck ,was appointed
❑Plenary ✓�Limited Guardian of the Person by Decree of •J•,
dated
✓Q A. This is the AnnQal Report for the period from 3anuary O1 2Q13
to �ember 31 2013 (the"Report Period"};or
❑ B. This is the Final Report for the period from
ta {the"Report Period"),and is filed
for the following reason:
1. The death of the Incapacitated Person. Date of deat�:
2. T'he Guardianship was terminated by the Court by Decree of
J., dated
For a Finat Report,o�nit Sections II through IV.
Form C-03 rev.10.13.06 Page 1 of 4
Estate of Nancy M. Stuck ,an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: gg Date of Birth: 04-27-1925
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
9952 Autumn Sage Way
Elk Grove,CA 95757
B. The Incapacitated Person's residence is:
❑own home/apartment
❑nursing hame
❑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 January Ol 201�
� �c z,m b�,2 3 �. o��' �� • If the Incapacitated Person has moved within the
past year, state prior residence and reason(s)for move:
Form G-03 rev.10.13.(16 Page 2 of 4
Estate of Nancy M. Stuck __ ,an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
Donald B. Stuck
9952 Autumn Sage Way
Elk Grove,CA 95757
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
None
B. Specify what, if any, social,medical,psychological and support services the
Incapacitated Persan is receiving:
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V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
�continue
❑be modified
❑be terminated
Form G-03 rev.10.13.Ob Page 3 of 4
Estate of Nancy M. Stuck 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
� times with the average visit lasting � hours, � minutes.
The report of a social service organization employed by the Gttardian to oversee and
coordireate the care of the Ineapacitated Person for the period covered by this Report may be
attached to supplement this Report. �a���L� � N�Nc m. ST c!<
sTu <�� s tp ys ��TH y
�� � �y ��y 3��-��ys A y���, d ��Qs�� s ,�N� ���2d , ti�T� N�:�z �flR�.
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 unsworn falsification to authorities.
January 21,2014 �� �5��� �
]Jate Signahve ofGuardian ofthe Person
Donald B Stuck
Name of('�uardian of the Person(type or print)
9952 Autumn Sage Way
Aa�ss
Elk Grove,CA 95757
csry,srare,z�,
717-60&9399
Telephoree
Fonn G-03 rev.10.13.06 Page 4 of 4