HomeMy WebLinkAbout08-03-06
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
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IN RE:
LILLIAN G. HUNTZ, an incapacitated person FILE NO. 21-06-0146
GUARDIAN OF THE PERSON FINAL REPORT
[20 Pa.C.S.A. 5521 (c))
FROM March 28, 2006 TO May 27, 2006
1)
I am the
above.
Limited X
Plenary Guardian of the Estate of my ward, named
2) I was appointed Guardian by Order of Court dated March 28, 2006, which was modified
by Court Order(s) dated April 27, 2006.
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3)
Is the incapacitated person still living?
If no, answer the following:
(a) Date of Death 5/27/2006
(b) Place of Death 105 Valley Street., Summerdale, P A 17093
No
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(c) Name of Administrator/trix or Executor/trix Jacque Brink & Bemette lhlntz
(d) Date Guardian of the Person tiled the last Annual Report N/ A
4) If the incapacitated person is still living, ans\\'cr the follovving questions:
(a)
(b)
Date Guardian of the Person tiled the last Annual Report?
Current address of the incapacitated person:
(c)
(d)
Current age:
Date of birth of incapacitated person:
The incapacitated person's residence is:
Ward's own residence
My home/apartment
Relative's Home
Boarding Home
Nursing Home
Hospital or Medical Facility
(e) The incapacitated person has been living there since
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,
If moved within the past year, state from where and the reason for the change:
(0 I rate his/her living arrangement as:
Excellent
Average
Below Average
Explain:
(g) I believe he/she is:
Content with the living situation
Unhappy with the living situation
Unaware with the living situation
5) Physical Health
(a) Current physical condition of the incapacitated person is:
Excellent
Good
Fair
Poor
(b) His/her major physical health problems are as follows:
(c) During the past year, his/her physical condition has:
Remained about the same.
Improved. Explain
Worsened. Explain
(d) During the past year, he/she received the following medical treatment (include
check-ups and dental work):
Date
Ailment
Type of treatment
Doctor's name
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6) Mental Health
(a) The incapacitated person's condition is:
Excellent
Good
Fair
Poor
(b) His/her m~ior mental health problems are as follows:
(c) During the past year, his/her mental condition has:
Remained about the same.
Improved. Explain
Worsened. Explain
(e) During the past year, treatment or evaluation by a psychiatrist, psychologist or
social worker was was not provided. Such mental health services are
briefly described as:
7. Social Activities/Services
(a) His/her current social condition is:
Excellent
Good
Fair
Poor
(b) During the past year, his/her social condition has:
Remained about the same.
Improved. Explain
Worsened. Explain
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(c) during the past year he/she has participated in the following activities:
Recreational
Educational
Social
Occupational
No activities available.
He/she refuses to participate in any activities.
He/she is unable to participate in any activities.
8) Visitation
(a) During the last year, I visited him/her as follows:
(b) The average amount of time I spent on each visit was
(c) The Iast time I visited was on (date)
9) During the last year I have performed the following activities on behaIf of the
incapacitated person:
10) I believe he/she has the following unmet needs:
11)
The guardianship
modification because:
should
should not be continued without
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,
12) Please note any concerns about the incapacitated person's physical or mental well-being
or the finances that the Court should know:
13) I am the guardian of the incapacitated person's estate. If yes, my report is attached.
I CERTIFY under the penalties of perjury that the information contained in this report is true and
correct to the best of my knowledge, information and belief.
Name: Jacque Brink
Telephone No.
(30 I ) 668-9426
(home)
Address:
503 Schley Avenue
(301) 748-8823
(work)
Frederick, MD 21702
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Sl ture
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Date
Send to:
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
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