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Home My WebLink About97-00744 !~t.li',," '~';t~~V"~'f'{< . 'm~r':'~' ~~:,~,I~~!",l""'-' .:.,:~~,:' r/~-i'.,';';' \, ~ ,.::.~/=:';;::::':':~' ,..~,' ., "..,"' . "'~ ..- ' ''.' ,!. " .. ',~'~', , . I:::: :(-"""-::,'-: , ~tl;" 1(' ",' , ,,-" 11:<'.;"'<. DI'gi ~1.\:;'f;~[' "'.. ""'N .~' ':~f<:~ii}~'i;':"(~' ',' ;",.'- "I,':: -.", .n, .'" \C. ":".- .'. :;',;');')2.'" ;;ih.,':''''~ ...".J., ,,' ~]~~'i:': "c';:;:: , ' ',' {\i<;\;' iff: .,., . '15 IIU u ',~ .... o. " . CI) '.... a 1ft LLI ,'~ ~ ) ~~ I". " ,~ Ct, < z ~ III < Z ~ <> 0 E< ~~ Ul E< Zz <t. ~>t ~ H P<1Il ~ U ~ ~H P<t!) ....O:tllo.. U>tH ~ .0: P< <c: ~ (/; E<0:t- 0 ~O .0:>- ...J >-....XC) ~Z ;t .. ~ ~U wzg~ OOE<t" ~~ .t!) OZ >- Z 0 ,0: O~ ~O :;:~ ~~ a: 0: 0 0.. E<UOI E< ~Z t!) Z QLLa.;(J) ~ Ot- E<~ ~~O Z~ 0 ~'" C) - z OOU ~~ U<Ul O~ I <t- ;! OZ iJ"' H ~ U<- <r E< ~Z~ H~ I- 0 lD ~Ul- ~Ul .o:<P< E< Z ~~ZI tI:~ H~ ::c~.o:- E< E<o <t. E<~tI:N 0 ~ :;: P< . ZZ P< zo~o H.o: HUOZ C'I'I) .'l p1.., o 9 199711) .' ~ , . 5. Alice M. Barber exhibits symptoms of mental incapacity, including but not limited to delusional disorder, dementia, absent- mindedness, and eccentricity. 6. Alice M. Barber's mental incapacity prevents her from managing and caring for the affairs of her person and estate. 7. Alice M. Barber's condition has deteriorated in that: A. Her appearance and hygiene are extremely poor; B. She is unkempt and disheveled; C. She arrears disoriented and confused; and D. She is unable to manage her financial affairs. 8. On or about August 12, 1997, a Protective Service worker for AAA visited the residence of Alice M. Barber and made the following observations: A. Trailer door was broken; B. Urine and fecal odors were overwhelming; C. Alice M. Barber was extremely thin and her dress was soiled due to incontinence; D. Floors, furniture, counters and inside of zefrigerator were filthy; E. Drinking glasses and plates were encrusted with dried food; F. Bathroom sink and toilet were filthy; G. Bathtub had junk piled up approximately three feet high; and H. Bedroom was so cluttered that Alice M. Barber could not sleep there. 9. Further investigation by the petitioner has revealed that: A. Her condition has severely declined over the last few months; B. She can barely walk to the mail box; C. She has become increasinglY confused and asks what day of the week it is each day; D. Check book stubs were not filled in and dates were out of order; and E. An ambulance has had to be called on two to three occasions this year when she was found on the floor unconscious. 10. on or about August 21, 1997, she was admitted to carlisle Hospital where she has continued to be a patient. 11. Additional investigation by Al\A reflects that: A. She had lost approximately 15% of her body weight over a four month period of time; B. She is malnourished and her blood sugar levels are out of control; C. She is non-compliant with her insulin regimen; and D. She has been diagnosed with breast cancer and had a mastectomy earlier this year. 12. The approximate gross value of the estate of Alice M. Barber is not presently known but her trailer home is believed to have a market value of not more than $100.00 and her monthly income is not known. 13. The Petiti.oner has reason to believe that Alice M. Barber will be discharged from carlisle Hospital any day and that she will require twenty-four (24) hour supervision which can only be provided by admission to a nursing home facility. 14. Less restrictive alternatives are not available because there is no one able to care for her. 15. The Petitioner believes and, therefore, avers that Emergency Plenary Guardians of the Person and Estate of Alice M. Barber should be appointed. 16. The Petitioner is willing to accept the appointment of Emergency Plenary Guardian of the Person of Alice M. Barber. 17. The Area Agency of Aging in and for Cumberland county, Pennsylvania is a human service agency that is qualified to be Guardian of the person of Alice M. Barber. -.,----.,.---.+'.-' ..."....."....- ?<'.:< 18. The Patitioner has no interest adverse to the alleged incapacitated person. 19. No previous application, to the knowledge of Petitioner, has been made for the Order herein asked for. 20. No other Court has ever assumed jurisdiction in any proceeding to determine the incapacity of Alice M. Barber. 21. The failure to appoint the Petitioner as Emergency Plenary Guardian of the Person of Alice M. Barber and another party as Emergency Plenary Guardian of the Estate of Alice M. Barber will result in irreparable haI~ to the person and estate of Alice M. Barber. WHEREFORE, Petitioner prays that this Honorable Court appoint Petitioner to be the Emergency Plenary Guardian of the person of Alice M. Barber and another party as Emergency Plenary Guardian of the estate of Alice M. Barber. Respectfully submitted, ~/rY~~ A~~h~~y~~~eLuca, Esquire 113 Front street P.O. Box 358 Boiling springs, PA 17007 (717) 258-6844 ol: lIlol: Z 0 ol:> 0 r.:I :><r.:I r.:I..:I III ~ ..:1:>:: U:c <l: z PllIl r.:I E-< Or.:lE-::Ool: ...J 0 ~PI~ :c PI E-<r.:I E-< W ~.... ':: E-::ol: ><::E:lIllll 0 :5 lli (I) ~ o ,> r.:IU r.:Ir.:IZr.:I ~g:l1lui U:><H r<. III 120 or<.;:io . E-<O 0 i>::H "'xc> r<.z .. ol: E-<Ooz ...J >-....g UJ z ~ ODE-::r<. III 0 ZE-::ol: >- Z 0 .0: E-<8!5 r.:IO r.:I OZ::5z 0:0:0"- E-o .~ Z ou. ,"' i>:: 0 E-<r.:I ::E:r.:I Hr.:I~O 0 ~","-c> DOU ~~ ..:IZ E-<::E: III - z <(- ::; 0120 r.:I..:IO HE-<:>:: :r: g U ol:- E-< Uol:lIl E-<Zi>::r.:I I- ..:IlIl r.:IlIl H i>:: r.:IHol:PI Z r.:Ii>::Z :Cr.:l ..:IZr.:l PlOz :Cr.:lol: E-< ol:ol:PI Plr.:I <l: E-<1ll:C z@ PI..:I ::E:PI . ol:PI ZDi>::O Hol: HUOZ .- , .' .' ~ IN THE MATTER OF THE PERSON IN THE COURT OF COMMON PLEAS OF AND ESTATE OF: CUMBERLAND COUNTY, PENNSYLVANIA ALIC EM. BARBER AN ALLEGED INCAPACITATED: ORPHANS' COURT DIVISION PERSON NO. 21-1997-744 OBDH_OL(QU.R.I AND NOW, this 17th doy of September, 1997, the petition of the Office of Aging for the appointment of on emergency plenary guardian of the person and emergency plenary guardian of the estate of Alice M, Barber, IS GRANTED. The Area Agency on Aging, County of Cumberland, is oppointed emergency plenary guardian of the person of Alice M. Barber, and Ann Thorek is appointed the emergency plenary guardian of the estate. By the coury \ /; 1J! Edgar B. Bayley, J. I I ~ ,\ I' ,I .r 'I- f' i) I. II " , 'I' . I', II " Anthony L, DeLuco, Esquire For The Area Agency on Aging Harold S. Irwin, III. Esquire For Alice M. Barber I (;G c ~- ''':: ~..,! .-.U :prs j: /i I I \ ! f'l '~ Ie) . \.r) (.j \ 4. The Order of Court entered on September 17, 1997 is effective of up to seventy-two (72) hours. 5. Alice M. Barber has been placed in the Cumberland County Nursing Home. 6. Petitioner avers that the emergency will continue if the Order of September 17, 1997 is not extended for a period of twenty (20) days from the expiration of the initial emergency Order. WHEREFORE, Petitioner prays that this Honorable Court extend the appointment of the Emergency Plenary Guardians of the Person and Estate of Alice M. Barber for twenty (20) days. Respectfully Submitted, Anthony 113 Front Street P.O. Box 358 Boiling springs, PA 17007 (717) 258-6844 ~ \~t~1~~:ii\~.~.;i.,,;:;~:~:~;!J~'Ii"'~_.~~~-'._" mn " VERIFICATION I hereby verify that the facts and information set forth in the foregoing Petition are true and correct to the best of my knowledge, information, and belief. I understand that any false statements contained herein are subject to the penalties of 18 Pa. C. S. Section 4904, relating to unsworn falsification to authorities. Dated: S;-e.~~,,^\'" ':' ) ~ z: --=Po.)' 0 Q \'\. \c{"t., . IN THE MATTER OF THE PERSON AND ESTATE OF: ALICE M. BARBER AN ALLEGED INCAPACITATED PERSON IN THE COURT OF COMMON PLEAS OF CUMBERI,AND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 97-0744 GRDER-OLe_O.URT AND NOW. this 9tl1 day of October. 1997, this matter having been called for 0 hearing this dote, we hereby incorporate all of the testimony and evidence token at the hearing of September 17. 1997, and make the following final order, I find Alice M. Barber is on incapacitated person. The petition of the Area Agency on Aging for the appointment of 0 permonent plenary guardian of the person and permanent plenary guardian of the estate of Alice M. Barber IS GRANTED. The Area Agency an Aging, County of Cumberland. is appointed permanent plenary guardian of the person of Alice M. Barber, and Ann Thorek is appointed the permanent plenary guardian of the estate of Alice M. Barber. The guardian of the estate shall maintain 0 reserve for burial expenses and the payment of guardianship fees, I ! Edgar B. Bayley; J. Anthony L. DeLuco, Esquire For Area Agency on Aging Harold S. Irwin, II I. Esqui re For Alice M. Barber :prs ~--_.,,"'''',,-.'..,'. -.' ..,....' '"". ~ ". I/J . .t 9, 97 INITIAL Guardianship Report In The Court Of Common Pleas of I!uWl6!111tJ,t.J. County, pennsylvania Orphans' Court Division In Re: The Person Of: 4.//t~ .AltI,F~~J. 13J4rlhI!!.L Fi1e No. 9'7 - I) '7"11 Report Period: From 9 - 17- '/ 1 To 1'z".J /. ? 7 . Guardian'S Name ANN THOREK/ Capitol Public Guardianship Aqency Address P.O. Box 1113, Camp Hill, Pa.17001 Telephone: 717-975-2577 Da te of Decree 1J e i "_b, eIr.. 9./ / ? P 7 Address of Ward tf'/ tL It.t! 'JIYlnd; YlUAd'/'n-g 1I/lVl1, '! (Ju ht iw./-.. J. (10" O!1lli >YJnLI J)tl. r? aA jl~~ , fJ&.. . . In Re: TilE ESTATE OF : IN TilE COURT OF COMMON PLEAS : OFt(/JJlb~COUNTY, PENNSYLVANIA : ORI'IIANS' COURT DIVISION AI,c (J .AI. BA,e ~ fit., (Illcnl'ncilatcJ) : File No. 97- ~ 7 "i i PERIODIC REPORT FROM IJ .r- /1- ?,'7 , 199 TO /,.z - ..J / - f l' OF THE GUARDIAN OF THE ESTATE ,199_ I am the Iimi[~ (circle olle) guardian of the person of my ward, named above, and my address, including zip code, is: ;:t" '" ..,-he:J It! t1 t- tt-#,'ILt- ~,,-ad,t'Al'1~"-p 4~1"m.''I- 1J. ~. 1.3c 1- / / 13 ,I e' ,:j In;; (1#./1// A.. I 7 ~CJ I' My telephone number at work is (717) 91~- .:2.677 and my telephone number at home is ('fIl) 9 7.5 - /" ." &1 2) I was appointed guardian by Order of Court dated O? - 1 7 - f 7 f> ~ which was/was not (circle one) modified by Court Order(s) dated I tf. ~ f. f 7 . I) 3) My initial Inventory was filed on I c1 . "z. f, ? 7 and listed a IOtal estate value of $ "'.1 IltJ . 0" comprised ofthe following: tS'oc, /iee. 6.Jnr , ~:t:;aA~ If 4/~. tJcJ / hip. , ,1"0:' ot1 "0 1t2(J . 4) At the beginning date of this reponing period, lilY initial balance on hand was $ 1)'7, ,;;.1 - chec..im~ . _ 'J?t:J ,j 1/0, n}.5 - 7'Ja ~ . The present amount and sources of income for my ward arc:, Source of Income (Indicate whelher monthly, qualledy, allllllally) Amount of Illcome 1. ___J(Le/Md_.1t-C!M.~1f---___'_________ 2. _____. 3. __.________,____ 4. S. 6. ~.!:/It1...~1 IHd'. -.-...----.-------.------- The regular mOlllhly expenses of my ward which I pay arc: 1() Whom Paid I. f' fAJu.::ol,.,,;(, 'Y1.t<.11.,oI.~A tj" mil! 2. .Aid '" hi. rD /4tz.1JJ- ~ /2-.tM ~ 3. . ~~___ 4. 4nn ~(/Ie~L (-}LttVJ~---# s. 6. Amount f ,.?~o. Or 11m. I ~o_ ;fo. OtJ I have lave no circle, one) petitioned the court for permissioll to invade principal to meet the needs 0 my ward. (If applicable) The following expenses of illY ward have been paid5mlll priheipal. To Whom Paid Purpose Amoullt I. ~ fJ/i. 2. S#.i.rIC. 3. (I~ ..l1rn'1~"I 4. 'If/{ ,II" (a') 1- n, ,..I '.L.~_ S. L.,,~ ~P...-r ~ 6. f} I An 'Yl'1Ind ')jtlA-dL~=-_Zt-.f3__ Nlft.: j)f. 6A~be;t -AI/.J nul).,tAo.cu '>1trJ'L bd.t.t ~~,1 /.(Ii,c,J 7.ilia k ~lt'h-{, ~ v1Jtdk..L :4.0',.>t~ ..,.; Ore lt1~-~. ..Llurnu, I I ..J ' Ii', 3,j. 5. I /f O. -Lil. ~~- / C. ~" t:z, ()CJ 7i' ~~d $.N:ia?~1(.1.ft,~.;tl,;~L~4:i.ii.f~'i.:~'..'.t.;~;'i~.,.;), :,,:,. \,"-" ^" ,',...".., ,I"~ ,~~;.~. \.),,~:.i~,:~.}7~~~ ...,;;.'7"-."'... .-- ... ...... ".- . .~_.. ...-.... -.. .... _.. ..~._- -. '8have 11111 (e1,de title) paid IIlyself l:OIl1pellSalillll 101 selvices I ,,',"lelcd ns H,,,"dlall, The :"11'"1111 I pahlmyscll llllal""l $ .,___ l'nk11lnled al Ihe folllllVilllllale: $ 'T,:'ItJ' ~ . ,L/.o I lot) - ....bJ(.t't"-,~. ~ r C/u.:"J + ~ flut., ~ 'f '0 -r1<<19,ffA .,. (!un re..a.O Cildc d,e correct lespOllSe nlld ClIl11plcle, il npl"opl i:'le. __.__ .'___. _H~_..__~ __ ._~___ ._.. ~___'_'_.____._.....~_.__.__ _.. __ ._..._ ,---- .-. ~..- '-~"-'--_"____h__.___.. _____.__ ____.. --.--.- ...-- -- ...-_. _._....__.u.._......._.__.""".._ __. .__._.__... Circle Ihe conecllespollSe alld cOlllplele, if applllpliale. ~ My ward receives 1lI0111hly Sodal SecllIily bellclhs direcdy. !::JV I alii the desillllaled payee to receive illY wald's Social Seclllity bellefils. l:. The desigllaled payee Ilf my ward's Social Seclllil y bCllefils is _.m_ '''__.._._.__._,__ ,___d2V:L.::r!J(./...g"J. -._-aU6/l...df"c.h. -rf- cd,if~, __.....__.____.__ .___ --'-.------.--------.-- ",' ______,...,_,..'....'..h,,_,:.... ..". ..'A,------ -.--, whose addless is_l.,_~ -,--'i6n---LlL3_'1__.1t!.4m /2.xl.iLt-.l..----'(-,-j7((!___ ._______u.__._______,_._.__..______._____._..______. __ ___.._ '--...~---h-.-.---------_-... ....., h_ alld i~chcle title) relalcd lO illY wald as. ..,... , ....----.- --...---- -- -----.--.----..-.. -'---...--.-----.-.-----.,. . -----...... ..-.. .~.._-_._-_._-~-----.~ ..---.--------.-._..._.__..._m_________... _._.___ _. _ __._._._____.._ _....___._ _~_.____._..___ --...-,...-.----h.---------.___,_duM/II..iJ. _. (insclf Ichu iOllship) . _..- -....- ------.---- --.----.---- Nt> ~ '. .Jj S ?; ,q t2 b el1- 0 wn d... 0.- /9.5 ;J. -r /) ~. -r,e' ~tI..a I- (l C/YJ I '-1<-"t.i -wVtt,. ~ ;z.~ u~ dw.. ~ a..J~ -1' wa.-:tz4.... 4ftUlt~', 71 ~ ~ ~ f~ 6(1 )tIs.,-1~- ~ 11/1")/ I ~ <&.oIV a"d(. r cl~ ~6-v nt ~ i)1 .P' J II n..u.:t: . -:z. fe.w., /11 d,t /( , oltL- uJ~~hl~a m~4.jllll( I !/V(JY/ luflledj SCt{/'d mtL~. A.J 13~ ~J "r)d d~~ o-t; oS'At/lnJ" ".."'\i".' ',.., ';." ':.' ';'.',.,".','--;'" ,;," .' CHECKS .-, ' CHECK # DATE AMOUNT CHECK # DATE 2269 0.9-0.+ ' 18.6+ I 2276* 0.9-0.5 IE ' DENOTES GAP IN CHECK SEQUENce NUHBERS TOTAL NUHBER OF CHECK-5 3 HIS C ELL A N E 0 U S DEB IT S , AHOUNT DESCRIPTION .59 + INTEREST PAYHENT D E P 0 S .IT S DATE POSTED AHOUNT 15.0.0. DATE PAGE 10-01-97 , 1 .,- 429~"1' 13578340 ',"", ~ ,~ I:I~~ ;~~ .;Jl; ~11:~,'" ".l "i':,.~ . . .~p D Dauphin Deposit Bal1~ -- -- - - MRS MILDRED BARBER 75 BONNVBROOK RD CARLISLE PA 17013 - - ,- 3 B CV 1 06 ,,!,! " ' f:t;~~~h:\~{~',~;~:~;?-,:';' ." ~ 7.,:,~.l.~~11,":,~:; :.>:;._;,,_::;> ..f~ .. . HAG ICARD HOLDERS ARE NOT SURCHARGED AT OUR ATHS. CONTACT A BRANCH TODAY OR, .CAL~ 1 80.o.-ANYTIHE TO .APPLY.. "';;11" '.:~T~ ' . ;..ei,r. "1''''''0(, .,....~:.,,:1~~ .'. ..1;\,.;:,',,',,;,.' ,'~ ".:.'. , .-, " . SUMMARY FOR ACCOUNT 13-07834-0 HRS HILDRED BARBER 75 BONNY BROOK RD PREVIOUS BALANCE' 09-0.2-97 2 DEPOSITS AND CREDITS 3 CHECKS AND DEBITS =URRENT BALANCE STATEHENT END DATE .,,:./ PRIHE OF LIFE +95.33 ' +10. .59 . 178.6+;' " 727.28'" 10.-0.1-97 .' sac SEC NUHBER INTEREST RATE AS OF 10.-0.1-97 1997 INTEREST PAID YTD ANNUAL PERCENTAGE YIELD EARNED CHECK # DATE 2278* 0.9-0.9 AND TOTAL CHECKS PAID C RED Irs DATE 10.-0.1 DATE 0.9-0.+ AHOUNT +10..0.0. POSTED AHOUNT DATE . -~,'i. AHOUNT .' . .::~ .'t' . "," ;"',~ DATE 0.9-0.+ 0.9-0.5 BALANCE 886.69 871. 69 o A IL y' DATE 0.9-0.9 B AL A N C E BALANCE 726.69 .' S U H " A R Y DATE 10.-0.1 .. , In ..ae ofeno.. or que.Uon. oonaemlng Electronlo Tlan.fe.. or your A 1M oard, plenoe oaII1.800.ANYTlME (1.800.269-8463), For hearing ITJ'4>Olred ..Niae oaII1.800.621.2068, " c IN TIlE MAT/'ER OF THE ESTATE OF: A.MILDRED BARBER IN TIlE COUIrJ" OF COMMON PLEAS OF CUMBERI.AND COUNTY, PENNSYLVANIA (INCAPACITATED) ORPHANS'COURT DIVISION NO, 97.0744 ORDER AND NOW, thisN day of ~~ , 1997, upon n:vie:w of pe:tition of the: guardian for Mildre:d Barbe:r, the guardian is authorized to name: HOFFMAN-ROSS FUNERAL HOME beneficiary of Ms. Barber's lilt: insurance policy lhrough Prude:nlial. / ,"':i ", ;..~ " .; ~.-~ '-, \.,J ,. ,..- ,. , ~1:~<j-.\lif~'W~~~l~;;l~,:i;;~ji'~{';;:i.'iN'I"I'~J I\'?,'~"~',,_,.,.. IN THE MA ITER OF THE ESTATE OF: A.MILDRED BARBER IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA (INCAPACITATED) ORPHANS'COURT DIVISION NO. 97-0744 ORDER BY THE COURT AND NOW, this day of 1997, upon review of petition of the guardian for Mildred Barber, the guardian is authorized to name HOFFMAN-ROSS FUNERAL HOME beneficial)' of Ms. Barber's life insurance policy through Prudential. EDGAR B. BAILEY, J. :"!....,..'-..,....."'''~',''''''"'1.~'..._, .,-"~,,,,.,'''''',,,, ..,..,:,' '-.J. ..-." . ., IN THE MATTER OF THE PERSON AND ESTATE OF: All C EM. BARBER AN ALLEGED INCAPACITATED PERSON IN THE COURT OF COMMON Pl.EAS OF CUMBERl.AND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 97-071111 llRllEU L1Jl URT AND NOW. this 9tl1 day of October, 1997, this matter having been called for a hearing this date, we hereby incorporate all of the testimony and evidence taken at the hearing of September 17, 1997, and make the following final order. I find Alice M. Barber is an incapacitated person. The petition of the Area Agency on Aging for the appointment of a permanent plenary guardian of the person and permanent plenary guardian of the estate of Alice M. Barber IS GRANTED. The Area Agency on Aging. County of Cumberland, is appointed permanent plenary guardian of the person of Alice M. Barber, and Ann Thorek is appointed the permanent plenary guardian of the estate of Alice M. Barber. The guardian of the estate shall maintain a reserve for burial expenses and the payment of guardianship fees. By t~ / Edgar B, Bayley. J. /' Antnony L. DeLuca. Esquire kor Area Agency on Aging A 'f 1(,1 f::'"< ,;', (" _::..~. :"';-, :\' F-':''''''''''-~ if,..., \",;", ;:;: I ;;:;"<F:'::'<:"~~':I' ':',:j TI ; 2 L I~ ", ' . '- , ,., " ; .:; _ },3 _L ,. (,f_O!! i' '1 fit,? !lll\\,((1'f: ' . --- "'-1) - ", AtU.'",.v,' 1'1.(. '( ,/ (1/1 (" I - """'/':11/1 .. ,L C' "9'" ,tt., I..u ;.)ok 01 ills Omh":'13'~ - r r - <.iOj", C,I;1'lberfe./ld COi;nt'y Harold S. Irwin. III. ESQulre For Alice M. Barber :prs . ,:",.., INTHEMAT ',"",\ ':") ~O~ A.MILDRED \- ' \ AG\ (INCAPACIT. Y"\~ \ C ,.. . S,~f'Cr'urc ~(~ CfI ~ ['f;\\ \. -c.., IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA . . NO. 97-0744 ORPHANS'COURT DIVISION MOTION OF GUARDIAN TO NAME BENEFICIARY OF LIFE INSURANCE 1. I was appointed guardian by the Court by its' Order dated October 9,1997. 2. In the course of my duties, I have discovered that Ms. Barber has a life insurance policy from Prudential Insurance Company with a face value of $1200. 3. Upon my request, Prudential provided me with the infonnation that Ms. Barber did not name a beneficiary on her policy. 4. 1 am requesting permission from the Court to name HOFFMAN-ROSS FUNERAL HOME as beneficiary in order to set up a pre-arranged burial agreement for Ms. Barber. 5. I have made an initial deposit of$500 to start an irrevocable burial fund with HOFFMAN- ROSS FUNERAL HOME. 6. Ms. Barber is afflicted with liver cancer, which is tennina!. 7. Currently, Ms. Barber resides at the Claremont Nursing Home; 1 believe it is her best interest to establish an irrevocable burial fund using her life insurance and by naming the funeral home as beneficiary. Respectfully, ~ J J ~ Ann M. Thorek ,Guardian for M.Barber ~l. it'- F.~ Theprudenball$ BENEFICIARY ARRANGEMENTS " '. W SHA 049 F For 8SSistance, get in t'lllch with your representative or call the BOO numbe, below: CHAMBERS BURG 442 STOUFFER AVENUE CHAMBERSBURG PA 17201 17171263-9550 800 778-2255 Contract Number 050 077 019 MILDRED BARBER 1963 Life Insurance November 18,1997 MILDRED BARBER % ANN THOREK, GUARDIAN CAPITOL GUARDIANSHP AGY PO BOX 1113 CAMP HILL PA 17001 You recently asked to have your contract changed. Please review this rider form to make sure we have made all the changes you requested. This form should be kept with your contract. If you have any questions, please get in touch with your Prudential representative or the office shown above. Settlement of the proceeds of the contract will be made in accordance with the following Beneficiary Provision. The "Beneficiaries for Other Proceeds" and "Special Conditions" sections on the other side of this form are a part of this Beneficiary Provision in any case to which they apply. Beneficiary Provision The proceeds that arise from the Insured's death will be settled in one sum as shown below. If the contract provides, by rider or otherwise, for income payments to begin upon the Insured's death, the word proceeds includes the one sum value of those payments that arise from his or her death. 5a Pay the proceeds in one sum to THE INSURED's ESTATE. o Pay the proceeds in one sum to the following beneficiary(ies): Beneficiaries In order of priority CLASS 1 NONE CLASS 2 NONE These statements apply to the beneficiaries: (1) One who survives the Insured will have the right to be paid only if no one in a prior class survives the Insured: (2) One who has the right to be paid will be the only one paid if no one else in the same class survives the Insured: (3) Two or more in the same class who have the right to be paid will be paid in equal shares: and (4) If none survives the Insured, we will pay in one sum to the Insured's estate. If this contract has an Automatic Mode of Settlement provision, beneficiaries who do not have a right to be paid at the Insured's death may still have a right to be paid under that provision. ThePr.;dljHtlsl ~ The Prudenliallnsursnce Company of America Eastern Home Office Po,t 0lfic9 Box 2031, Fort Washlnglon, Pa, 19034 Komber 11. 1991 Ann Yboret FO BOI IIIJ Calp Rill. PA 17001 Insured: Klldred Barber Ovner: Yhe Imud Contract: 050 077 Oil I :1 :1 il jl ,'1 :I Dear Ks, Yhoret: Ve are writing in respOOl! to lour recent letter nf October 22. 1m, Yhant IOU for providing us wltb the new lalllng address for tbe above lentloned pollcl, Ve have updated our records to reflect tbe new address, As requested, enclosed IOU will find a change of beneficlarl fori, Please Insert the nale(sl. relatlonsblpls) to the Insured. and address(es) of all desired beneflclarllies) on page two In order of prlorltl, Please sign and currently date the bottol of page one where highlighted, Please Include the title 'guardian of Klldred Barbsr' after your signature, As a general rule. the powers of a guardian are confined to the custodl and tbe protection of bis ward's estate, Yhese powers do not Include the emclse of discretional! Ifree decision) powers on bebalf of the ward, Ve consider the right to change the beneficlarl and/or ownership of a contract as being one of these discretionary powers, Yherefore, tbe guardian gsnsrally csnnot late tbese changes, In order for us to act on a request nde bl a guardian, we will need a certl!ied copy of a court order which specifically authorizes the guardian to late the requested beneficiary cbange to contract 050 011 019, Please return the guardianship papers, court order, and beneficiary cbange fori to II attention in the enclosed self addressed envelope. Also, please verifl that Alice K. Barber is the sale person as Kildred Barher, Ve are sorry for any Inconvenience tbls delaleal cause, If IOU have any questions, contact the Custom Service Office for assistance at IBOD) 71B-22SS, Sincerely, ~~ IJ U1/w(J Carla !, Veltrup Policy Adeinistratlve Division 12 Settlelent Options Section ".', ,... -:"" ", ._.~""'~M""""'''''' ",.,., ,'''....!'.'.Hlo..~.'....~':.'..,,,..;''''''\ ,.~!!,~<l....,'"..".".....,M~.'."'....,.... ( " AGREEMENT FOR PRE-ARRANGED FUNERAL BY AND BETWEEN 'CYb~lua ~ FUNERAL e , TRUST'. " ~>""~';;"~":~:-;,^""-",,,,,~,,j;;>';"',.;9';~#.>> Funeral Home: Hnffm~n_Rn"'h Pnnr.-r;"t] Hemp Name 219 N. Hanovar Street, Carlisle, ?a. 17013 BUlmess Address heleinafler relerred to as "Funeral Home;" AND Barber Name(,} MA MRS MISS MS A. Mildred Purchaser: ~ Ann Thorek PJ76. Box 1112 C~mo Hill, Address 717-975-2577 Telephone Number 150 14 G569 SOCIal Security, hereinaftel referred to as "Purchase," to provide funeral services upon the death of MR MRS Recipient: MISS MS A. Milrlr~rl ~~rb~r Name 150 It! '5569 717 975-2577 Social Security ~ Address: (if different than Purchaser's) Telephone # Slreel Address Date of Birth Dec~mber 22, 1919 Mailing Address County Cumberland Age 78 (Circle the ones lhal apply) Male ~ Single Married Widowed Whose funds are being used? l~~ Recipient City Slale Zip hereinafter referred to as "Recipient" WHEREAS, Funeral Home is licensed under the Funeral Director Law, Act of January 14, 1952, P,L. (1951) 1898 (hereinafter referred to as the "Act"), to provide funeral merchandise and services in the Commonwealth of Pennsylvania; and WHEREAS, Funelal Home and"~ ' Purchaser wish to enter Into this Agreement wherein Purchaser agrees to pay the contr~~9d costs ani'paCified funeral mercti;;ndise and services. which Funeral Home guarantees to provide and to perform upon the death of 'Recipient. NOW, THE~EFORE, Purchaser and Funeral Home. Intending to be legaily bound, hereby agree as foilows: 1. FUNERAL SERVICE. In consideration of Purchaser's agreement to pay the Contract Price set forth in Paragraph 2 below, Funeral Home hereby agrees to provide tor Recipient a funeral and to lurnish the complete luneral service more particularly described in Appendix "A," which Appendix has been signed by ail parties, for the linal rites of Recipient at a place within a radius oltwenty.live (25) miles of Funeral Home's business address set forth above (the "Service Area"), All funeral merchandise and services shall be furnished at the prices listed in Appendix "A," regardless of further price increases or decreases. except that: (a) If atlhe time death occurs Funeral Home customarily imposes an additional charge for funeral services rendered on Saturdays, Sundays or legal holidays, Funeral Home may charge an additionai amount not in excess of ilS cuslomary charge if the final rites of Recipient are held on any such day; (b) The price 01 any funeral merchandise and services provided by third oarties in connection with the final rites of Recipient fOI which Funeral Home is required to make an advance cash payment ("Cash Advance Items") shail be guaranteed only lor those Cash Advance Items listed in Appendix "A" lor which a specific doliar amount is stated; and (c) Additional charges may be imposed by Funeral Home in the event Recipient's death occurs outside Ihe Service Area or in lhe event arrangements are made with another funeral director to furnish the funeral services for Recipient as provided in Paragraph 9 of this Agreement. It is expressly understood that (i) nothing In this agreement shail apply to services tor the purchase andlor care of cemetery lots, mausoleum space, colurnbarium space and other places of sepulcher perpetuaily or for lesser periods of time and (iI) if any merchandise saiected is unavailable for any reason. Funeral Home reserves the right to substitute other merchandise of equivalent value and quality. Funeral Home promises to make a rsasonable effort to implement any special instructions set forth on Appendix -B," in connection with the luneral service for Recipient. The panies expressly agree that Funeral Home shail be required 10 make only a reasonable effort 10 foilow those instructions. 2, FINANCIAL AGREEMENT. In consideration of the funeral merchandise end services to be provided by Funeral Home to Recipient, Purchaser hereby agrees 10 ~ to Funeral Home ,at its business address set forth abov~ t~e ,sum of t4'i qo~RJotl1n(+""":-r1 nn 11 ;ers , ($ ~ ) (hereinafter referred to as the "Contract Price ') In accordance With the foilowlng schedule: Amount to be Paid on Execution ollhis NOTICE TO PURCHASER Agreement $ 500.00 1) DO NOT SIGN THIS AGREEMENT BEFORE YOU READ Amount to be Paid on or IT OR IF IT CONTAINS ANY BLANK SPACE. before ~_I_ $ 2) YOU ARE ENTITLED TO A COMPLETELY FILLED.IN mo, day yea, COPY OF THIS AGREEMENT. This funeral is not guaranteed. Amount to be paid In. -h .3\ UNDER THE LAW, YOU HAVE THE RIGHTTO PAY OFF equal (insert monthiy,'loney may be added to t. 115 IN ADVANCE THE FULL AMOUNT DUE AND UNDER bi.monthly, quarterly, or semi.annual) funeral costs. CERTAIN CONDITIONS TO OBTAIN A PARTIAL,RE. payments. each in the amount of FUND OF THE FINANCE CHARGE, IF ANY, $ commencing on ~~_ $ mO', day year THIS CONTRACT IS SUBJECT TO THE TERMS AND CONDiTIONS ON THE REVERSE SIDE .'''," ,'.,......,-..., ",_, You a~~~,?Wledq~_reCeIPI of a_c,?m,D.leted_CODV_'~I~!f.r~t,'.~'~E~;"'~'~'" . -, - j IlCens.d undor Ih. Funer.1 Ol,eclor Law, Aclol January '., :952, P,L, (1951) 169B (herelnoller relerred WHEREAS. S:uf'WlaJ Home 'I ,chandls8 and services In the Commonwealth of PIII.!'\:\/lvanin; and WHEREAS, Funeral Home and ,,,. .Ac1""1 1:1 DfOV'ldl 'unl,a me lh t' . ..... ~o .. , I" 5 Agreomonl whelSln Purchaser agroes Ie pay 8 con '1".'~.:o5t9 of speclfiod 'uneral merchandise and " ,'c~.UU' 'l'lo"~: "f"!or ,nlO t l1nto8S10 provldo and Ie perform upon tho death of Au. IlJ'~"t. . ".... ':ll~ ,<wI-:" . ." ...,H,ll HOmo gUolf, . 'iO'," .~'':: ~:onE. PurC;naser ,1nd Funeral Homo, Intending Ie be legally bound, l'lIH.:V agree as follows' . VICE In consideration at Purchase's agreemenllO pay the Comllll,' :'lce sol tanh In Paragraph 2 below. Funeral . ~U.NER ~~.:> SER rO'.:j(]O lor ReCipient a lunoral and to lurnlsh the complele lunerlll '.I:I"IICe mare partlcularly described In Appendix HC"1t! t! ,H.!oA~ ... t'S ~o Poeen s'gned ~y ail parties lor rhe hnal riles al ReCipient at a plach 'm",n a radIus of twenty. live (25) miles of Funeral " ..~nlcn t'~'~'''':,ll "as .... ' " Mome s OUSlntl.S! .:iooress sel lorln above (the 'Service Area ) '\lIlur1tl',\1 -.":nanOlse IInO services snail be turnlstled al toe pnces hsted 10 Appendix "A ., ''1:ardless 01 funher pflc91ncreases or decreases, olJ.cepl !hal . II . ....e r me aeattl OCCulS Funeral Home cuslomarlly Imposes an addlllonal f h:u~ for funeral services rendered on Saturdays, sun~~~s.:~ -:09,:111 hOlidays, Funeral Home may charge an addItIonal amount nollO IUI.I:"..'1 of its customary charge if the final rites of Reclplenr ..:.' ~ "eld on any suen day; (b) n"~ :rlce of any funeral merchandise and services proyided ,~y Ihird partlo~ III "..:nnection with the final rites of ReCipient for which Fune"~1 Home IS reqUired to make an adyance ca.sh payment ( CaS,h Advancb III;f-n") shall be guaranteed only for those Cash Advance It-=-~s listed In Appendix "A" lor whIch a specifiC dollar amount IS stated: .111'1 (el AO=~lonal charges may be imposed by Fune~al Home in I~e eyent Recipienl'~ rj:::Uh occurs outside the Service Area or in the eyent arrar :ements are made With another funeral dIrector 10 furnish the funeral sorVt',l:~ tor Recipient as provided in Paragraph 9 of Ihis Agreer:~~nt. II Is expre.. y understood Ihat (I) nolhlng In this agree men! shall apply 10 servico, '." '~e purchase and/or care 01 cemetery lOIS, mausoleum spa,:,e, columbarium space and other places of sepulcher perpetually or for less(JIIIII',:ds of time and (ii) if any merchandise selected Is unayailable fc. =.ny reason, Funeral Home reserves the right to substitute other merchanflle;~.; equiyalent value and quality, Funeral HOi9 promises to make a reasonable effort to implement any special instructinll" :~~. tonh on Appendix "S," in connection with the luneral service Ic' Recipient The panles expressly agreelhat Funeral Home shall be requu"'J \'. ."ake only a reasonable ellon 10 lollow Ihose instructions. 2. FINANCIAL AGREEMENT, In considerallon 0,' the luneral merchandise and serv" '" ',' pe provided by Funeral Home 10 Recipient, Purchaser heret,' agrees to P!Y to Funeral Home at ItS bUSiness address setlorth abovn It,:; sum of t;'; "1'''::\iUf" ~r1-~ri nl""ll 1 ~ rs ($ ::- lx') ) (hereinaller relerred to as Ihe "Conlrac! PlI' " 'n accordance With the (allowing schedule: Amounl!o be P; , on Execu!ioM 01 this NOTICI TC PURCHASER Agreemen! $ 500. ')0 1) DO tI<)TSIGN THIS AGREEMENT BEFORE YOU READ IT Olt IF IT CONTAINS ANY BLANK SPACE, 2) YOII AP~ ENTITLED TO A COMPLETELY FILLEO.IN not guaranteed .copy C, THIS AGREEMENT, ~dded to thia.! UNIH:RTliELAW, YOU HAVETHERIGHTTO PAY OFF IN AIIV A,~CE THE FULL AMOUNT OUE AND UNDER CEllfAlh CONDITIONS TO OBTAIN A PARTIAL RE. FUtllJ CF THE FINANCE CHARGE, IF ANY, Amount to be Ps 'J on or belore ----1_,_ mo. :., year $ This fun9ral is Amount to be pa :: In , equal (insert monthly;'!Oney may :.Je bi.monlhly, quar:;rly, or seml.annual) funeral costs. payments. each "': the amount of $ commencing on ~--c_ mo. day ,eal $ THIS CONTRACT IS SUBJECT TO THE TERMS AND CONDITiOn'; C'J THE REVERSE SIDE You acknpwledge receipt of a completed copy ""r;ol. IN :IITNESS WHEREOF, Ihe parties hereto have caused this Agreem""1 I~ oe executed this 2L;1: day of Octobe~' , 19~, al Car-If-He, ?a. l7,n3 WITNESS/A TTEST , . , (",-,' ,,"),1"'" ~Y./oJ '___ /1 . . ._ ;,(~~^-.'1............^-- o i;/ /1 ,,', "PURCHASEIi"" ',' .., .'" I ~. (..-" " " .' Hoffman-~I')~:1 r?unGr::l 'iomr-:-} 17 "FU EAAL}1t l~" (8usin~s or/flrm name) " 1/ J .1// - -/ L-r 'i' (~ B ~ /,I.:it (. - /" !LflY-- y ...J--f" .J'-A.,: , . I WITNESS/ATTkOST I' il J & 'i/ ~" , h)Z44, f.f. ' ~j#.t - -. j. FUNERAL HOME NUMBER 5031 LICENSE NUMI1ER 0J.27 ;.13L eMiaodalaSyslems, Inc,. 1991 (White Copy - Funeral Home Yellow Copy - Purchaser "Ink Copy - P FT ) .~'. .l\ :.'" . ~"l, '":,:,.'1 , !' ..... ',\ IRREVOCABLE TRUST AGREEMENT ARTICLE XVI LIABILITY OF TRUSTEE FOR CONOUCT OF AGENTS Truslee shall nol bo responsIble or lIablo in any event for Bny noglocl or wrongdoing ollho Accounl Admlnlstralor or 01115 agonls or omployees. ARTICLE XVII GOVERNING LAW: CONSTRUCTION In tho 9\10nt any provIsion olU'lls irust Agreemont o~ tho nppllcallon lherooltonny porson or cltcumslnncos shall be 'Innlly dotormlnod by a court 01 propor JUrlSdlCllon 10 be invalid or unenlorcoablo 10 any oxlonl, Ihe remalndor allhls Trusl Agroomont. or the 80plic..11lOn 01 such provISion to parsons or circumstances olhor than thoso as to which illS hold IOvnlld or uncnlorccnble sOfIII not bo RlIoctod IhOroby, ilnd each provision 01 thiS Trusl Agreemenl shall be valid and onlorcod 10 the fullest oxton 1 pormlllod by law ARTICLE XIX ENTIRE AGREEMENT ThiS TruSI Agreemenl embodIes the anllto agreoment and understanding 01 the parMs with respect to the subJoct mallcr hereof, ARTICLE XX PARTIES TO TRUST AGREEMENT Each Customer sevorally shall become a pany to thiS Trusl upon lho olCecullon thereof by himsell personally or by Funeral Home acting as hIS attorney 1M fact No Customer or Reclplenr shall have any mleresl horeunder except In lne Trust and Trust Account estabhshed in connecllon WIth the Agreemenl for Pre-Arranged Funeral made by or lor hIm WIlh Funeral Home I~j WITNESS WHEREOF. Funeral Home and Bank have affixed their hands and seals as ollhe day andyear first above mentioned and each Customer has by hiS attorney in lacl become a party to thiS Ifrevocable Trusl Agreement as ollhe day and year listed below Hoffman-Roth Fune~al Home l"funeral Home~l In Its Own RighI and as Allorney in Facl for A. Mild~ed Barbe~ IPurcnaset on Agreement for Pre.Arranged Funeral) "Customer" WITNESS/ATTEST: ~~~ -;r/ ~~~ B, /tJ;JJ.w:.-j- €!2JIl Title l4"l1n~r;:1l 1 ni r~~rnr Trust for the Benefit of !Jeu-b..r a Mildred Q']~ler ~ReCIOlenr" ATTEST: C/~~~~ MELLON B~NK .A. ~ ("Trustee") /. By ~. ~ ~ . DATE: Jthj~1 I . (For Use Where Customer Execules Trust Agreement) WITNESS: U/\,M.., /Yl. t..j,,~ (/ cJ- ~.f>1lc'Odalil Syslems.lnc.. 1995 Page 4 FOml PAT 04 4.95 .',...,'"..\ ".::..'.'";,--",,,., " ,:' Petitioner requests permission from the Court to distribute the remainingfundv of my ward, Alice M Barber, and sel/le the estate, thereby ending guardianship responsibilities unless otherwise ordered by the court. 4-n n (; ~n<./2 , i I r [ i \ I ~ 'I II ,I i' !i Respectfully Submit/ed, Ann Thorek - Guardian " ,<"- - O,!,2 CJ:;;: U::", :',-:' c:) c> .\~ -. ~i> ";~ 0", ~,- o ;:)J !rl<l) a: a: l"") N '" c:c 5~ o ) . ". n .:) ':< '" N ~ -::.i ~ ,Qj 'j .J:1 'C s= (1)- u8 " oq !3tE - N 0 !t2 0\ () m ~.:::; a: " 0 ('> -! ~-" ',) , ~ D .. '''; " ?j) c 0:: :13 c... 0 {,;) == "' ~'H_ i.Q 001 Q<ll CO .~ ~ .,- ala: ?' uO a: 09/04/97 - /0/07/97 - /0/2//97 - 1///2/97 - /2/03/97 - 0//02/98 - 02/03/98 - 02//2/98 - 4/0,00 Deposit ,""oc, See, Benefit 4/0.00 " " " 42.59 Deposit of refund 4/0.00 Deposit of Soc. Sec. JJenejit 4JO,OO Deposit of Soc. Se". JJenefit 4/9.00 " " " 4/9.00 " " " 2/9,00 Deposit of refund Tota/: Interest: $3.234.92 3,38 $3,238.30 1'ota/ deposits Debits To Checking Account: Purpose: 09/04/97 - $ /8.64 09/05/97 - /5.00 09/09/97 - /45.00 /0/07/97 - /3.57 /0/08/97 - 5,82 " 33.66 10//7/97 - /45.00 /0/20/97 - /90.00 /0/22/97 - /8./6 /0/24/97 - 500.00 11/03/97 - 40,00 /2/11/97 - 40.00 /2//5/97 - 60.00 /2/24/97 - 9/1.74 0//27/98 - 40.00 02//9/98 - 8,7/ 02/27/98 - 40.00 Check wrilten by Ms. Barber " " GPU Radiology Asc. Imaging Ctr. Lot rent Initial Guardianship fee Sprint Hoffman-Roth Funeral Home Guardianfee " Claremont Nursing Home " Guardianfee GPU Guardianfee Total Debits: Service Charge: $2,225.30 7.00 $ 2,232.30 Deposits: Debits; $3,238.30 - 2,232.30 Balance of Account: $1.006.00 '~:~)"It\~~~.(;'l'AM~~'j;,:',)i.jn,!!'4:i:;\',\~'::,';';~:"", ",.""" r: f..! ;~I'~~}~~~,ll~t;i,,~:;,;; <,j, ~;;','('},r.":,'I':':r:~~r<o)',< _,;,,;N,'~I,t'~~~,:r',: ._\,i:,' ,,',,:}:~/'::l!~~::,::,~t~::- ",- 1,.- \ .' UABII,I71HS: S 349.{){) 349.{){) 349.0{) 40.00 80.{)O 352.0{) 782.20 99,O{) 21,O{) .Ian. 199/! Feb. 1998 Mar. 1998 Nursing Home ( 'Iwrges Nursing Home Charges Nursing Home ('Iwrges Stoken ()pthamologist (/uardiaTlShipfee Carlisle Hospital " " " 2,421.00 - Total Liabilities 1,254,00 - Pending payment from Medicare & Medicaid 1,167.00 - Balance due I, 167.00 - Available Fundy/rom Checking Account & personal ,Ipending account $ 2.00 - Use towardfilingfee The Prudential Life lnsuranc policy 1!!,SI.205.00 was added 10 the S500.00 Burial Reserve and used to cover the expenses related to My. Barber's burial. 'tit", ,..,.'.; """",,,",,,,",,,,,,''',''.,','..,,,, " ('apilol (fuardianlhip ARency I',(), /Jox 1113 Camp 1IiII, I'a. /7001 March 25,I99H ('arli.~/e HI/spilal, ('arlisle, I 'a, I'alienl Financial Services 117 N. Hallover Street Carli,~/e, I'a, /7013-0/77 Allell: Shirley ShuRhart Ill'; A lice Mildred /Jarber 7h whom it may COl/ce1'll. Notice is herehy l{iven that your patiell/, Alice M Barber, died on March 18. 1998. Ms. /Jarber suhsisted Oil a ,llIlall socialsecUri~1' benefil of $4IWlIlol/lh and had no assets. As guardian '!fMI. Barher~~ estate, I amjilinl{ afinal reporlto the court and hoping 10 .~ellle all aCCOUlI/s by the el/d l?fApril,199R. Because MI. /Jarher resided in the Cumberland Co. Nllrsing Home, her only source of income was asse.ued toward Ihe cost (!{her care lindeI' Medical Assi.~tance reRulations, therefore. she does not have .~I!Uicient jill/tl~ to cover any remaining expen.les. I am reqlle.~tillg all'rite-I?U',{the halance of her hil/after medicare andlor Medical A,lsistance claims are compleled. Your cooperation in this mailer is great(l' appreciated. ({you ha~'e any concerns, please contact me 7/7-975-2577. Thank YOII.frJ/' your assislance. Sincerely, 477;1 ;~ Ann 711/Jrek - (fllardiall , " " .." '~~~4t~t,.~~lb~;'1bi\~i~;:i";::;'<{~~,~<~:;},,(.,,:~.,. ""';:'''''::;::~-:~;''::''''''':''>'I~,,1''~''':';;,'j...~: ,;,',',:,:,' ~"'/~" ~"i,'>,., . v -, ( 'apitol (hUlrdianship Agency 1'.0. Jiox 11/3 ('a/llp Hill, I 'a. 17001 Marcl/25,1t)l)8 Bromlein .Ieflhe." I'.A. Bu"ine.'., qfJice 4830 I,olldll/ld('/'ry I?owl Harri..bllrg, l'e1Illa. 17 1119-522-11) Ile: Alice Mildred Barber To wham il ml(I' COllcem, Nolice i.. hereby Riven Ihal yo"r palienl, Alice M. Barber, died on March 18, 1998. M... Harber ""hsisled on a slllull social sec/lrity benefil of $./ I (}imonlh alld had /10 assels. A.. gllardianl!fA'f." Barher'" estale, I amjilinR ajinal reporllo the courl and hoping 10 sellle al/ acell//IIls hy the end (~fApril,1998. Recall"e A/.,. Barher re..ided inlhe (:/lmberland (:0. Nllr"inR Home, her only sOllrce of incollle lI'a.. a....e.'..ed IowaI'd lire cosll!fher care IInder Medical A.,..i..lance reglllation." Iherefore, ..he doe.. nol /tave ,,"flicientfimtl, 10 cover any remaining expense... I am reqlle..ling 1I wri1e-(~frofllre halance I?lher bill ajier medicare and/or Medical A....islance claim.. are compleled. rOllr coopemlion illlhis moll"r is weally apprecialed, lfyolI Irave any concerns, please conlact me 717-975-2577. Hlank YOllf;lr YOllr assislance, Sincerely, ?idl~!,-.i/ Ann Hwrek - Gllardian