HomeMy WebLinkAbout04-17-15 i
4
ANNUAL REPORT OF
GUARDIAN OF THE PERSON
COURT OF COMMON PLEAS OF
m Ler COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION C= o '
rn
cxs � C
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Estate of L o A ie Lx-v W 1 tm e r ,an Incapai a d P on
ry � c-r1
No. -? 1 - 07-0 4 3 7 �; ~� c/�� 0) �
M:fi W/
I. INTRODUCTION
Clarence V wi- rMcr- and c t Wifiner ,was appointed
Plenary E]Limited Guardian of the Person by Decree of E-Aw erd, F G u ic1 o ,J.,
dated /t►O v err bcr- /30 R 00 7
EA. This is the Annual Report for the period from .S-'zn u-,trx a 01
to Oc-c c M h er- 31 , r2 O 1Y (the"ReporteP riod");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
3., dated
For a Final Report, omit Sections II through IV.
Form G-03 rev.10,13,06 Page I of 4
Estate of L o n i c da-!� M tm er ,an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: -5 9 Date of Birth:_ D ecemLer 7r11SS
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
�urn6cr]an.d W5
Ia-7 3 York Rd,
!7 d 1
B. The Incapacitated Person's residence is:
own home/apartment
nursing home
boarding home/personal care home
Guardian's home/apartment
rl hospital or medical facility
E]relative's home (name,relationship and address)
E]other:
C. The Incapacitated Person has been in the present residence since S_Afie.�, cr a oa b
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 L o n i e j1 ay 1!�,n er , an Incapacitated Person
D. Name and address of the Incapacitated'Person's primary caregiver:
e14rencc- �- 3�tfy t.tt'Pfnncr (-A/'najh (umdtr'JancL
3 &Y Neva- jar? u� cJ
G rCCA c4-Stle
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
c on i e-- W i Itm e-r h a.S m e t-f l &-A d p A y s i ca..(
re.laf,k -+1 , MIA 6Q1m..-u-fc, He iS un L/ok -a rmanarf�. /t�S
1'n 4,-) c.i Q t u. -qua rS' -!t lo/`012c I'^tl. 4e- f 5 M 0 n-verb--( -,O,-J,
`}a.$ /i,i } Gn11N.1n IkLA i ca i an s 1�r`�1S. �{C iSs 44 n -ole- �/
p rb�tr jY t C ae^t. r h tK x e f f a/L dL.1 it e Gat r ,1�a-x-r i s lLz" c e— Gu t�t7
,6C/-SQ/LJ by jben S G�c 11 �� G a"�+t+n �la lntoorae nee- .5j ar.e JG2fSan a �r
B. Specify what, if any, social,medical,psychological and support services the
Incapacitated Person is receiving: J / i
411 SGf vl ac t Q�t 'Arvin A A i,' rersoaa- l Cat`c-
qno� a �so 'l�rnw his ..SLippa,-Jr co-ordU'^,L rr tvr X �•
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
continue
0 be modified
El be terminated
Form c-03 rev.10.13.06 Page 3 of 4
Estate of L o n► e- �aY t '��1 �r ,an Incapacitated Person
The reason's for the foregoing opinion are: a.
4 oris e- W-VMtr h a s -fA c- m c,%
,Q dr 3 yc. r old , Hc- his ha-A m 1 Ai5-4i
Sine c birth wifA no -far irn"0rove-vnent,
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
_�_times with the average visit lasting v-Z 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. OVL,4 ,V W,,:;��
Date Signature of uardia 01fthe Person
t&r-A V, W;fire r
t3: f y -I-, V�if,�rr
Name of Guarde n of the Person(type or print)
3 b y Irl ova.. Dry v G
Address
Ore-f r< d.s -"la 1/4 1222-5-
City,state,zip
717 .577 0 2 -3 -7
Telephone
Form G-03 rev.10.13.06 Page 4 of 4