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HomeMy WebLinkAbout04-23-15 (2) `CD 00 ANNUAL REPORT OF W GUARDIAN OF THE PERSON c� cL C> CaC 1 W N C I-, U -1- w COURT OF COMMON PLEAS OF QCL g Cumberland COUNTY, PENNSYLVANIA C) © ORPHANS' COURT DIVISION Estate of Dodie Rae Stimeling , an Incapacitated Person No. 21-2012-00485 I. INTRODUCTION Eileen Heberlig , was appointed M Plenary OLimited Guardian of the Person by Decree of Thomas A. Placey J., dated June 7, 2012 A. This is the Annual Report for the period from a�fit�til ,0 to I (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 IV. Form G-03 rev.10.13.06 Page 1 of 4 �J� Estate of Dodie Rae Stimeling an Incapacitated Person II. PERSONAL DATA Age of the Incapacitated Person: Date of Birth: / III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: 149 East Louther Street Carlisle, Pennsylvania 17013 B. The Incapacitated Person's residence is: F7 own home/apartment 0 nursing home _; boarding home/personal care home 0 Guardian's home/apartment hospital or medical facility ®relative's home (name, relationship and address) M other: C. The Incapacitated Person has been in the present residence since If the Incapacitated Person has moved within the past year, state prior residence and reason(s) for move: -(�opk- Jo-,f�— 7, ullfi! t rd a4- 8a- Rii i ��!ems fi --f i �' � s (j v�-u� Form G-03 rev.10.13.06. ,5 / � / Ct Page 2 O 4 OLVYA rVc�Y�� Er �e Ps �1a Estate of Dodie Rae Stimeling , an Incapacitated Person D. Name and address of the Incapacitated Person's primary caregiver: Eileen Heberlig 149 East Louther Street Carlisle,Pennsylvania 17013 IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: die Grad h-M CA.41t� 6,LA=V�d a.S 0--r-1 B. Specify what, if any, social, medical,psychological and support services the Incapacitated Person is receiving: Ckq 1, cries L 14�5- V. GUARDIAN'S OPINION A. It is the opinion of the Guardian of the Person that the guardianship should: continue ®be modified M be terminated Form G-03 rev.10.13.06 Page 3 of 4 Estate of Dodie Rae Stimeling an Incapacitated Person The reasons for the foregoing opinion are: oxxreJ 4451- b6cilzff _�►,, -�" -�G wez 'S CSC i..c-1q DOA k "�ce ji'4AP Du mg the past year, the Guardian of the Person has visited the Incapacitate;Verson �s times with the average visit lasting hours, minutes. OttThe 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. Lls S::�� Date Signature of Guardian of tfie Person Eileen Heberlig Name of Guardian ofthe Person(type or print) 149 East Louther Street Address Carlisle, Pennsylvania 17013 City,State,Zip (717) 433-1721 Telephone Form G-03 rev.10.13.06 Page 4 of 4