HomeMy WebLinkAbout09-16-14 ,- . .
ANNUAL REPORT OF "' 4�
Q
� � � rn
GUARDIAN OF THE PERSON � ° ��� � o
p �'C.1 -O f,� %L1
rn -�- `~' ._� �
-.� •„..;. (-° � j F.� ��-�
� �... ! Cn :�;1 C:7
��, n
COURT OF COMMON PLEAS OF ' ' •� -.� -•,��
Cumberland , - �-'
COUNTY, PENNSYLVANIA � ��^'�:; �,
ORPHANS' COURT DIVISION ° `r`i- rn
►—� �,, °
--� -n
Estate of Joan Ann Renzo , an Incapacitated Person
No. 21-14-450
I. INTRODUCTION
Lauren A. Renzo , was appointed
�Plenary�Limited Guardian of the Person by Decree of A1 Masland J�
dated June 13, 2014 '
� A. This is the Annual Report for the period from June 13 � 2014
to September 15 , 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.
Form G-03 rev.10.13.06 Page 1 of 4
�
�
.�
Estate of Joan Ann Renzo , an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: 79 Date of Birth: 07/26/1934
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
Joan Ann Renzo still maintains her permanent address as 6 Cedar Road,
Mechanicsburg, PA. She is,however,presently living at Vibralife, a new Senior
Housing facility at 707 Shepherdstown Rd,Mechanicsburg,PA 17055.
B. The Incapacitated Person's residence is:
�own home/apartment
m nursing home
�boarding home/personal care home
�Guardian's home/apartment
0 hospital or medical facility
�relative's home (name, relationship and address)
�other:
C. The Incapacitated Person has been in the present residence since August 1,2014
. If the Incapacitated Person has moved within the
past year, state prior residence and reason(s) for move:
Prior residence was 6 Cedar Road, Mechanicsburg, PA,where she lived for more
than 20 years.
Form G-03 rev.10.13.06 Page 2 of 4
Estate of Joan Ann Renzo , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
Lauren A.Renzo, 107 C South Chestnut Street,Mechanicsburg PA 17055.
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
Dementia.
B. Specify what, if any, social, medical,psychological and support services the
Incapacitated Person is receiving:
She is presently receiving appropriate care at the Vibralife facility,referenced
above.
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
m continue
�be modified
�be terminated
Form G-03 rev.10.13.06 Page 3 of 4
Estate of Joan Ann Renzo , an Incapacitated Person
The reasons for the foregoing opinion are:
Joan Ann Renzo's dimentia renders her unable to function and completely
incapacitated.
B. During the past year,the Guardian of the Person has visited the Incapacitated Person
365 times with the average visit lasting 2 hours, � 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 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. �
09/15/2014 (2,bG2�Ci�l� - �
Date Signature of Guardian of the Person
Lauen A. Renzo
Name of Guardian of the Person(type or print)
107 C South Chestnut Street
Address
Mechanicsburg,PA 17055
ctry,srare,ztp
(717) 462-2933
Telephone
Form G-03 rev.]0.13.06 Page 4 of 4