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ANNUAL REPORT OF
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GUARDIAN OF THE PERSOl� � � m
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COURT OF COMMON PLEAS OF �-�. �, ^•�
Cumberland ' '` -t� n �
COUNTY, PENNSYLV��
ORPHANS' COURT DIVISION �' �� � �� �
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Estate of David B. Weaver , an Incapacitated Person
No. 21-12-0357
I. INTRODUCTION
Pauline E. Myers , was appointed
�Plenary OLimited Guardian of the Person by Decree of , J.,
dated
� A. This is the Annual Report for the period from •�anuary 1 2014
to December 31 , 2014 (the "Report Period"); or
� B. This is the Final Report for the period from ,
� to , (the "�eport 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 Cou�•t 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 David B. Weaver
, an Incapacitated Person
IL PERSONAL DATA
Age of the Incapacitated Person: 45 Date of�Birth: 9-7-1969
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
365 E. Baltimore Street
Carlisle, PA 17013
B. The Incapacitated Person's residence is:
�own home/apartment
0 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 October 9, 2011
. If the Incapacitated Per•son has moved within the
past year, state prior residence and reason(s) for move:
Form G-03 rev. l0.l3.06 Page 2 of 4
,
Estate of David B. Weaver _ , an Incapacitated Person
D. Name and address of the Incapacitated Person's primar}� caregiver:
365 E. Baltimore Street
Carlisle,PA 17013
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
Down Syndrome
B. Specify what, if any, social, medical, psychological and support services the
Incapacitated Person is receiving:
Angels On Call comes twice a week(TUE& FRI) for 2 1/2 hours each day
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. 10.13.06 Page 3 of 4
Estate of David B. Weaver
_ , an Incapacitated Person
The reasons for the foregoing opinion are:
David is happy &thriving
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
times with the average visit lasting _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.
• l
April 6, 2015 �����µ µ
Date Signature of G7.�areflurr af the Person
Pauline E. Myers
Name of Guurdian of rlte Person(type or pi•int)
365 E. Baltirnore Street
Address
Carlisle, PA 17013
City,State,Zip�
717-448-911_5
Telephone ^
Form G-03 rev. 10.13.06 Page 4 of 4