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ANNUAL REPORT OF � � � � �
GUARDIAN OF THE PERSON m � � � � �
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COURT OF COMMON PLEAS OF f' ° -"' 3 ?'
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CUMBERLAND COUNTY,PENNSYLVANIA � —�'i '~ � m
ORPHANS' COURT DIVISION �' n � "'�
Estate of TIEN KHAI TRAN
, an Incapacitated Person
No. 21-12-l 251
I. INTRODUCTION
Ut Michael K. Tran and KimQui T. Tran
,was appointed
❑✓ Plenary�Limited Guardian of the Person by Decree of M.L. Ebert, Jr. �J�
dated 31 January 2013
0 A. This is the Annual Report far the period from 31 January 2013
�31 March � 2014 (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 Guardianship was terminated by the Court by Decree of
J., dated
For a Final Report, omit Sections II through IV.
Forn�c-o3 rev.10.13.06 Page 1 of 4
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Estate of TIEN KHAI TRAN , an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: 1 g Date of Birth: 10/07/1995
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
508 Ellen Road
Carnp Hill, PA 1701 l
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 1 May, 2005
. If the Incapacitated Person has moved within the
past year, state prior residence and reason(s) for move:
Forni G-03 rev. 10.13.06 Page 2 of 4
Estate of TIEN KHAI TRAN
, an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
Ut Michael K. Tran and KimQui T. Tran
508 Ellen Road
Camp Hill,PA 17011
IV. MEDICAL INFORMATION
A. The majar medical or mental problems of the Incapacitated Person are as follows:
Autism and Mental Retardation
B. Specify what, if any, social, medical,psychological and support services the
Incapacitated Person is receiving:
Behavioral Health Rehabilitation Services- Behavior Supports Consultant
Cumberland County MH IDD Supports Coardinator
Penn State Hershey Medical Group—Psychiatry - Autism Life Care Model
V. GUARDIAN'S OPIIVION
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.�J6 Page 3 of 4
- ,� <
Estate of TIEN KHAI TRAN
, an Incapacitated Person
The reasons for the foregoing opinion are:
Tien lacks the capacity to communicate and make decisions regarding his finances,
his healthcare, ar other critical matters in his life.
B. During the past year,the Guardian of the Person has visited the Incapacitated Person
times with the average visit lasting ho�urs, minutes.
Tien lives with both of his guardians all year long.
The report of a social ser-vice organization employed by the Guardian to oversee and
coordinate the care of the Incapacitated Persor�for the period covered by this Re��rt 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. � pr�it,t.�.�.�t�:� �.ct��vun1_
�O ��C � �� _�����.� ����^✓l/
Date Sigmature of Guardian qf the Per.son
Ut Michael K. Tran and KimQui T. Tran
Name of Guardian of fhe Persnn(lype or print)
508 Ellen Road
Address
Camp Hill, PA 17011
Ciry.State,Zip
717-731-1677
Te7ephone
Form G-03 rev.lOJ3.06 Page 4 of 4