HomeMy WebLinkAbout06-10-15 (2) ANNUAL REPORT OF �
c� �; r� �
GUARDIAN OF THE PERSON � a � !:r; �
.__, _�
, _... _._-> ,
.� ,;�
_, :� ,.. ,
_ . , „ ,
,.. �..-. ;
_ � � ;,
COURT OF COMMON PLEAS OF '
__� _ �
CUMBERLAND COLTNTY,PENNSYLVANIA ', � �'�
�,�
ORPHANS' COURT DIVISION � ' _ r��
�-� �, c.:�
..� _..�r
Estate of Susan J. Myers , an Incapacitated Person
No. 21-10-0220
I. INTRODUCTION
Patricia A.M. Havens , was appointed
✓❑Plenary �Limited Guardian of the Person by Decree of Wesley Oler, Jr. J
dated April 26, 2010
❑ A. This is the Annual Report for the period from ,
to , (the"Rep�rt Period"); or
✓Q B. This is the Final Report for the period from April 26 2014
to May 13 2015 (�he"Report Period"), and is filed
for the following reason:
1. The death of the Incapacitated Person. Date of death: May 13, 2015
2. The Guardianship was terminated by the Court by Decree of
J., dated
For a Final Report, omit Sections II through IV.
Form C-03 rev. 10.l3.06 Page l of 4 �y
V�
��
Estate of Susan J. Myers , an Incapacitated Person
IL PERSONAL DATA
Age of the Incapacitated Person: Date of�3irth:
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
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 address)
❑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:
Form G-03 rev. 10.13.06 Page 2 of 4
._�, iii�. ir iri�i �
Susan .l. Myers , an Incapacitated Person
Estate of
D. Name and address of the Incapacitated Person's primary caregiver:
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacita.ted I'erson are as follows:
B. Specify what, if any, social, medical, psychological and support services the
Incapacitated Person is receiving:
V. GUARDIAN'S OPINION
A It is the opinion of the Guardian of the Person that the guardianship should:
❑continue
❑be modified
0✓ be terminated
Form C3-03 rev. 10.13.06 Page 3 of 4
.,.w,... nirc—�r irrmi _
Susan J.Myers
Estate of _, an Incapacitated Person
Death af Susan J.Myers an May 13,2015.
The reasons for the foregoing opinion are;
Estate opened in Cumberland County, Pennsylvania at Docket No.21-15-0570
B. During the past year,the Guardian of the Person has visite:d the Inca.pacitated Person
3� times with the average visit Ias�ing_4-$ ._ _ __hours, minutes.
The report of a socia7 serv�ee organiza�ion ernployed by the G�crr�dicm to oversee and
coordinate the care of ihe Inccrpacitated Person for the period cover�ed hy this 12eport may Be
attached to supplement this Report.
I verify that the foregoing information is correct to the best of my knowledge,information
and belief; an.d that this Verification is subject to the penaliies of 18 Fa.C.S. §4904 relative to
unsworn falsification to authoriries.
�Z��� ��r''r ���M.�- -
Ih�te Sigmahrre ofCtta�arr of"the Pr:,�son
Pafricia A.M. Mavens
Nmrte af(�ittw�dia�t ofthe Perso�a(type orptint)
1235 Crestfield Ddive
�ss
Wiiliamsport,PA'i7701
Ctry,Srate,Ztp
(570)327-9079{h)
Te�t�o�
r�,,,r,-o3 �ra�3.oa Page 4 of 4