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HomeMy WebLinkAbout01-12-15 (2) S 'v h C=:D ANNUAL REPORT OF C— M GUARDIAN OF THE PERSON ;:a A o C) COURT OF COMMON PLEAS OF COUNTY,PENNSYLVANIA;p ,r— rn ORPHANS' COURT DIVISION "'j -n Estate of /-I'✓1 1`7 D u) e JL , an Incapacitated Person No. a 1— / cj —03 7-s- 1. INTRODUCTION p J;' I I 0 f C C C, , was appointed EI Plenary OLimited Guardian of the Person by Decree of '7—A oeq &,t 4 1o) G C e j ,C,eT dated \:T"u n e A . .20 14 . ff A. This is the Annual Report for the period from `J -A p LC to AC e. na In..e A— ,.0 l �j (the "Report eriod"); 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 A A/N o M n U) C tz, , an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person: F Date of Birth: In 4/o //9 a0 III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: Sc, r&h Todd n/v/s ;n� 4°4 �nr►e i000 0a-ni e� f 0-arl ',r1 c , SpA / -7013 B. The Incapacitated Person's residence is: M own home/apartment 01hursing home boarding home/personal care home E]Guardian's home/apartment M hospital or medical facility relative's home (name,relationship and address) other: C. The Incapacitated Person has been in the present residence since .Tu�v a c71 3 If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: Form G-03 rev.10.13.06 Page 2 of 4 �. Estate of_ /4 n n u tM AD i A) c /L , an Incapacitated Person D. Name and address of 1the Incapacitated Person's primary caregiver: `�Jo rab, To c� Nu/fVIli 1+0 6eO/gC' �/'an5��✓v� � M6(7 0 d l l� `� Sd u ► S F, t e T '7 7 /U�P-I,! ©n �6tIi"s 0 ;41 t- p /701 IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: p e. V1 t A+-:1 w a �;>►a �► �r�r i'n one eY B. Specify what, if any, social, medical,psychological and support services the Incapacitated Person is receiving: NuCS ►n� CaY- e, rn pe en kun 1+ 0 � o d 9 me, V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: ontinue 0 be modified El be terminated Form G-03 rev.10.13.06 Page 3 of 4 Estate of AV) 4 a 114 n ('CJ e 'f' , an Incapacitated Person The reasons for the foregoing opinion are: COnd ,-'i-i0A Con-i-cn ues +o 5 e-- wa B. During the past year,the Guardian of the Person has visited the Incapacitated Person L/X u e c 6 times with the average visit lasting f a hours, _ z':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. � y Date Signa re of Guardian of the Person Name of Guardian of the Person(type or print) 'ZOOC) Address 0-u -hD H. II eA 170, li City,State,Zip ��a, S 7 �7 / q- � I Telephone Form G-03 rev. 10.13.06 Page 4 of 4