HomeMy WebLinkAbout04-20-15 2i -�z -iz�
ANNUAL REPORT OF
GUARDIAN OF THE PERSON
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANI.A� a
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ORPHANS' COURTDIVISION z � � ^ �
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� Estate of �/y/3�/� % CJ �/ UEL'P , an lncapacitata�Per@a�
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` No. �U OG v7CI�. . ' ,., co 0
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I. INTRODUCTION
�G/3el2 %�F�= /'//�% rC �i�i�`—,was appoinced
❑Plenary❑Li�nited Guazdian of[he Person by Decree of c) r/.a6P o�/O�la�.��-7.,
dated l/�3�/.�
❑ A. Thiyis-tla w� ort for the period from �-
to , (the R rt Period'�; or
� �B. 'Il�is is the Final Report for the period from_i l�/`�
to , ([he`Rcport Period"), and is filed
� for the followin reason:
. l. Thc death of the Incapacitated Person. Date of death: 6 .�
2. The Guazdianship was tertninated by the Court by Decree of
J.,da[ed
For a Final Repnrt, omit Sections II throagh II:
FmmG-03 m.10t3.06 F3gC 1 OI4
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Estate of �l/�� i ��`/`P , an Incapacitated Person
, II. PERSONAL DATA
� Age ofthe Incapacitated Person: ,��C�'�PP Da[e of Birth:__��/� / Z
III. LIVING ARRANGEMENTS
A. Current address of[he Incapacitated Person:
dec �.�-S��
B. The Incapacitated Persods residence is:
❑own home/apartrnent
❑nursing home
� �boarding home/personal care home /� ,p
� �Guardian's home/apartment �C C��`�
�❑hospital or medical facility � ,(0� ���e�'
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` ❑relative's home(name,relationship and address)
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S�l� � � � 5����-
other: �—l / ��L[ � (f �.�
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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:
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Estate of �O/JC�2% �� /� C/Ll��— , an Incapacitated Person
D. Name and address of the Incapacitared Persod s primary caregiver:
� IV. MEDICAL INFORMATION
F A. The major medical or mental problems of the Incapacitated Petson are as follows:
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B. Specify what, if any,social,medical, psychological and support services the
Incapacitated Person is receiving:
�G� �-
^ V. GUARDIAN'S OPINION .
. A. It is the opinion of the Guardian of the Person that the guardianship should:
❑continue
❑be modified
�be terminated
F G-03 rev.1013(I6 Page 3 of 4
Estace of_ _ �d��lPT � � ����— ,an Incapacitated Person
�� The reasons for the foregoing opinion are:
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B. During the past yeaz,the Guazdian of the Person has visited the Incapacitated Person
� V times with the average visit lasting_�hours,�minutes.
The repor[oja social service organrzation employed by the Guardran to oversee and
coordiwte the cme of the/ncapacifa[ed Person for the period covered by fhis Report may be
anached to supplement thrs Report.
� 1 verify that the foregoing informa[ion is correct to[he best of my knowledge,
information aod belief; and that this Verification is subject to the penalties of 18 Pa. C.S.A. §4904
.. relative to wswom falsification to authorities.
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