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ANNUAL REPORT OF
GUARDIAN OF THE PERSON
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Cumberland COi1NTY, PENNSYLVANIA �f;� ��-� �u� o '-.`; �
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ORPHANS' COURT DIVISION `
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Estate of Derick W. Bobb , an Incapacitated Person
No. 21-11-608
I. INTRODUCTION
David W. and Tammy J. Bobb , was appointed
�Plenary OLimited Guardian of the Person by Decree of J. Wesley Oler, Jr � J.�
dated July 18, 2011
� A. This is the Annual Report for the period from August 1 � 2013
to Julv 31 , 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 Ii�
Form G-03 rev.l0.l3.06 Page 1 of 4
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Estate of Derick W. Bobb , an Incapacitated Person
II. PERSONAL DATA
Age ofthe Incapacitated Person: 21 Date of Birth: 10/10/1992
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
333 Oak Flat Road
Newville, PA 17241
B. The Incapacitated Person's residence is:
❑own home/apartment
�nursing home
0 boarding home/personal care home
❑Guardian's home/apartment
�hospital or medical facility
m relative's home (name, relationship and address)
Mother and Father
❑other:
C. The Incapacitated Person has been in the present residence since 1995
. If the Incapacitated Person has moved within the
past year, state prior residence and reason(s) for move:
Form G-03 rev. l0.13.06 Page 2 of 4
Estate of Derick W. Bobb , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
David W. Bobb and Tammy J. Bobb
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
Traumatic Brain Injury at 11 months of age
B. Specify what, if any, social, medical, psychological and support services the
Incapacitated Person is receiving:
Total Medical and Therapeutic Support as needed, including vision, speech and
vocational training
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./3.06 Page 3 of 4
Estate of Derick W. Bobb
, an Incapacitated Person
The reasons for the foregoing opinion are:
Continued need for supervision and guidance with daily living
B. During the past year,the Guardian of the Person has visited the Incapacitated Person
365 times with the average visit lasting 24 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.
q13o1i�
Date Signature of Guardi of t rson
Tammy J. Bobb
Name of Guardian of the Person(type or print)
333 Oak Flat Road
Address
Newville, PA 17241
ctry,srare,z�p
(717) 776-6970
Te(ephone
Form G-03 rev.l0.13.06 Page 4 of 4