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ANNUAL REPORT ��� � > rn � r=:� �
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GUARDIAN OF THE PE�2S���T `�'- `�s
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COURT OF COMMON PLEAS (:)F t' ni � `'�
CUMBERLAND COUNTY,PEI�SYE�'VANIA
ORPHANS' COURT DIVISIaI�
Estate of Emily Anne Smoker _.�_._._, an Incapacitated Person
No. 21-2012-00540
I. INTRODUCTION
Dawn Michelle Smoker _�__. , was appointed
✓�Plenary�Limited Guardian of the Person by Decree of Thr:»71as !\_Placey CPJ ,�.
dated 6-14-2012
✓� A. This is the Annual Report for the period from�_ti�n��`�� 2013
to June 14 , 2014 (t:r3�; "R.�e�port Period"); or
❑ B. This is the Final Report for the period from___�.__ ,
to , (tl�» "I��port Period"),and is filed
for the following reason:
1. The death of the Incapacitated Person. �)ate<►f'death:
2. The Guardianship was terminated by th�, +Cc�t�r�t by Decree of
J.,d<<�ed_..---
For a Final Repor� o»rit Sections II through IV.
Form G-03 rer./0.13.06 Page 1 of 4
Estate of Emily Anne Smoker __�.___, an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: 20 Date of�:xirth: g-�1-94
IIi. LIVING ARRANGEMENTS
A. Cunent address of the Incapacitated Person:
104 Louisa Lane
Mechanicsburg, PA 17050
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 addrf�ss)
❑other:
C. The Incapacitated Person has been in the present re�iderlc;e; since May 2004
. If the Incapacitatecl Peu�S��n has moved within the
past year, state prior residence and reason(s)for mo�w�-:
Form G-03 ren. /0.13.06 Page 2 of 4
Estate of Emily Anne Smoker _�,___, an Incapacitated Person
D. Name and address of the Incapacitated Person's prirs�wiry� c;;:��regiver:
Dawn Michelle Smoker
104 Louisa Lane
Mechanicsburg,PA 17050
IV. MEDICAL INFORMATION
A. The majar medical or mental problems of the Incap�citat�;d Person are as follows:
Low-functioning Autism and Severe Developmental ]Delwiy (Mental retardation)
B. Specify what, if any, social,medical, psychological �:xnd :�u�port services the
Incapacitated Person is receiving:
Attending NHS Autism School
Behavior Therapy and TSS services through NHS
Psychological/Autism care through Dr. Ramer at��e�•she��� Medical Center
Healthcare through Carlisle Pediatrics
Daycare through UCP and PA Lifesharing
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that tl�e g,:iardianship should:
✓�continue
❑be modified
❑be terminated
Form G-03 rev. lOJ3.06 Page 3 of 4
Estate of Emily Anne Smoker __�.__,_, an Incapacitated Person
The reasons for the foregoing opinion are:
Emily is a low-functioning, non-verbal autistic perso►� w�t�h little comprehension of
everyday events. She requires 24 hour care and as�ih�tanee to function in society.
B. During the past year, the Guardian of the Person ha�,`risite�cl the Incapacitated Person
365 times with the average visit lasting 15 ___�y<�urs, minutes.
The report of a social service organization employed b��i`he �:T�cardian to oversee and
coordinate the care of the Incapacitated Person for the periocl cc�vered by this Report may be
attached to supplement this Report.
I verify that the foregoing information is correct to the nf�st cyi;'my knowledge,
information and belief; and that this Verification is subject to thE� pen�z�lties of 18 Pa. C.S.A. § 4904
relative to unsworn falsification to authorities. ..'
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Dare Signat e of Guurdi�zn�,�f the Persott
Dawn M �'mc�ke�x�
Name of Guar�la'an nf tia�F��Person(type or print)
104 Louisa Lar��e
Address �
Mechanicsl�ur�;, PA 17050
City,State.Zip ��_
717-737-G708
Telephone -n".._^
Form G-03 re,�. 10.�3.06 Page 4 of 4