HomeMy WebLinkAbout09-09-15 (2) G
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ANNUAL REPORT OF � u, �, �
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GUARDIAN OF THE PERSON � �' �' �' �
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COURT OF COMMON PLEAS OF �' �
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CUMBERLAND COUNTY,PENNSYLVANIA rv � `'
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ORPHANS' COURT DIVISION �,, ;;,, o
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Estate of MARTHA JEAN McCURDY , an Incapacitated Person
No. 21-2014-0815
I. INTRODUCTION
Robert McCurdy , was appointed
�Plenary�Limited Guardian of the Person by Decree of Thomas A. Placey J,
dated October 15, 2014
� A. This is the Annual Report for the period from October 15 2015
to September 15 , 2015 (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:
L 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 tl7rough IT�
Form C-03 r-en.10.13.06 Page 1 Of 4
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Estate of MARTHA JEAN McCURDY , an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: gs Date of Birth: March 6, 1930
IIL LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
11 Dulles Drive West
Camp Hill, PA 17011
B. The Incapacitated Person's residence is:
�own home/apartment
�nursing home
�boarding home /personal care hoine
�Guardian's home /apartment
�hospital or inedical facility
�relative's home (name,relationship and address)
�other:
C. The Incapacitated Person has been in the present residence since 1961
. If the Incapacitated Person has moved within the
past year, state prior residence and reason(s)for move:
Form C-03 rev.10.13.06 Page 2 Of 4
Estate of MARTHA JEAN McCURDY , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
Robert McCurdy
11 Dulles Drive West
Camp Hill, PA 17011
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
Senile Dementia
B. Specify what, if any, social,medical,psychological and support services the
Incapacitated Person is receiving:
-In addition to her husband's care, in-home caregivers attend to Mrs. McCurdy one
day each week for 11 hours that day.
-Mrs. McCurdy is under the care of her primary care physician, Dr. Gustavson.
- Kenneth Brubaker,who was Mrs. McCurdy's foster child, assists with home repair.
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
�continue
�be modified
�be tenninated
FoYm c-os ,�ev. �0.13.06 Page 3 of 4
Estate of MARTHA JEAN McCURDY , an Incapacitated Person
The reasons for the foregoing opinion are:
Mrs. McCurdy's needs are being met at home.
B. During the past year,the Guardian of the Person has visited the Incapacitated Person
times with the average visit lasting hours, ininutes.
Guardian lives with Mrs . McCurdy.
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.
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Date Szgnature of Guardi n of the Person
Y�'�i,/�'�C-:,�"� ��'�`��,��_�>�/
Name of Guardaatt of the Person(hpe or pririt)
11 Dulles Drive West
Address
Camp Hill, PA 17011
Ciq�.State,Zip
717-732-3137
Telephone
Fo�m G-03 rer.10.13.06 Page 4 of 4