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Appendix G(2):   Annual Report of Guardian of Person under Local Rule 14, Sec. 8(d)

IN THE COURT OF COMMON PLEAS OF
ALLEGHENY COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: ESTATE OF
                                                             
Incapacitated Person
 )
)No.
)
)


ANNUAL REPORT OF GUARDIAN OF THE PERSON
  1. Current address of incapacitated person:
                                                                                                                                     
                                                                                                                                     
  2. Describe the type of placement and living arrangements of the incapacitated person, e.g.: private residence, personal care or nursing home, institution, hospital, etc.
                                                                                                                                      
                                                                                                                                      
  3. Briefly describe the incapacitated person's medical care and any social, psychological or other support service he or she receives.
                                                                                                                                      
                                                                                                                                      
  4. As guardian of the person, do you think the guardianship of the person should continue, be terminated or modified:
                                                                                                                                      
                                                                                                                                      
    Reasons:                                                                                                                    
                                                                                                                                      
                                                                                                                                      
  5. Number and length of times you have visited the incapacitated person since your appointment or last report.
                            Date                                Duration
                                                                                                
                                                                                                
                                                                                                
                                                                                                
                                                                                                
                                                                                                 
                                                                                                
                                                                                                
                                                                                                
      
Date:                                                         
                                                                      
Guardian's Signature
Guardian's Address: 
City, State, Zip code:
Daytime Telephone No:		                                                
                                               
                                               
RECEIVED:                                             
APPROVED:                                           
SIGNATURE:                                          

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