HomeMy WebLinkAbout03-05-14 RECAPNJEU OFF CE OF
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ANNUAL REPORT OF
GUARDIAN OF THE PERSON `AN S O
ORPHAN'S COURT
CUMBERLAh6 CO., PA
COURT OF COMMON PLEAS OF
Cumberland County COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of Inez Davis an Incapacitated Person
No. 21-07-0200
I. INTRODUCTION
Gloria J. Banks was appointed
M Plenary rhimited Guardian of the Person by Decree of Oler J
dated April 4, 2007
0, A. This is the Annual Report for the period from July 12 2012
to July 11 , 2013 (the"Report Period"); or
E3 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, omit Sections II through IV.
Form G-03 rev. 10.13.06 Page 1 of 4
Estate of Inez Davis an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: 83 Date of Birth: 6/1/30
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
Jewish Home of Greater Harrisburg
4000 Linglestown Rd,
Harrisburg, PA 17112
B. The Incapacitated Person's residence is:
®own home/apartment
nursing home
boarding home/personal care home
rl Guardian's home/apartment
hospital or medical facility
®i relative's home (name, relationship and address)
0 other:
C. The Incapacitated Person has been in the present residence since
August 2012 . If the Incapacitated Person has moved within the
past year, state prior residence and reason(s) for move:
The Incapacitated Person moved from Golden Living Center, 770 Poplar Church
Road, Camp Hill, PA 17011, to a preferred facility closer to guardian.
Form G-03 rev. 10.13.06 Page 2 of 4
Estate of Inez Davis
an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
Jewish Home of Greater Harrisburg
4000 Linglestown Rd,
Harrisburg, PA 17112
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
Alzheimer's Disease
B. Specify what, if any, social, medical, psychological and support services the
Incapacitated Person is receiving:
The facility provides activities and medical care in conjunction with care and
outings provided or arranged by guardian.
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
Mcontinue
0 be modified
rl be terminated
Form G-03 rev. 10.13.06 Page 3 of
Estate of Inez Davis
an Incapacitated Person
The reasons for the foregoing opinion are:
There has been no improvement in the Incapacitated Person's condition.
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
Q2025 times with the average visit lasting hours, minutes.
—240 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. § 4904
relative to unsworn falsification to authorities.
2 2—kp I
Signature ojGuardian of(he son
Gloria J. Banks
Name ofGuardion ofrhe Person(type ar print)
5776 Catherine St.
Address
Harrisburg, PA 17112
F Srare zlp
(717) 545-4816
Telephone
Form G-03 rev.10.13.06 Page 4 of 4