HomeMy WebLinkAbout01-0284
Guardianship Petition
IN THE MATTER OF Abe Holtry,
an alleged incapacitated person.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS COURT DIVISION No c2.1- 0 1- ~'O~
GUARDIANSHIP-INCAP ACIT A TED PERSON
NOW, this ~ ~ day of ,2001, on motion of
Michael Hynum, Esquire, and Elizabeth An , sideration of the attached
petition and after a hearing held following e notice, it is ordered and decreed that Abe
Holtry, 121 Walnut Bottom Road, Shippensburg, Pennsylvania 17257-9005, is adjudged an
incapacitated person. Larry Cottle is appointed guardian of the person and of the estate of
Abe Holtry. No bond shall be required of petitioner.
By the Court,
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prelim decree
MAR 1 5 ?n~
IN THE MA TIER OF Abe Holtry,
an alleged incapacitated person.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS COURT DIVISION No
GUARDIANSHIP-INCAPACITATED PERSON
2.I-01-D2- ~4
PRELIMINARY DECREE
/"1"'-
NOW, this /5 day of i:l1J~ ,2001, upon consideration of
the annexed petition, it is hereby decreed at a CItatIOn IS awarded dIrected to Abe Holtry to
show cause why he should not be adjudged an incapacitated person and a guardian of his person
and estate be appointed; the hearing thereon to be held in Courtroom S ,
Cumberland County Courthouse, Carlisle, PA on mllA.-d..-2. '1 2001 at It? :c../5 o'clock at
,4. M.
At least 48 hours' notice ofthe hearing shall be given to Abe Holtry, the alleged incapacitated
person by personal service of a copy of said petition and citation and by service of notice upon
his attending physician or the superintendent or other official of the institution having custody of
him who are sui juris personally or by registered mail
By the Court,
,
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Guardianship Petition
IN THE MATTER OF Abe
Holtry, an alleged incapacitated
person.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS COURT DIVISION No
GUARDIANSHIP-INCAPACITATED PERSON
Petition For The Appointment Of Guardian For An Incapacitated Person
NOW comes Larry Cottle, petitioner, by Attorneys Michael A. Hynum, Esquire and Elizabeth
Antoun, Esquire, and presents this petition for the appointment of a guardian by this Honorable
Court upon Abe Holtry, an alleged incapacitated person, representing as follows:
1. Petitioner is the Administrator at Shippensburg Health Care Center, a skilled nursing
facility located at 121 Walnut Bottom Road, Shippensburg, Pennsylvania 17257-9005.
2. Petitioner is not related to the alleged incapacitated person nor does he h~~an int:~est in
the estate of same.
3. The alleged incapacitated person resides at 121 Walnut Bottom Road, Shippensbu~,
Pennsylvania 17257-9005.
4. The alleged incapacitated person's diagnosis is Left CV A with right ataxic hemiparesis.
5. The alleged incapacitated person does not generally comprehend his surroundings to such
an extent that he requires consistent supervision in his activities of daily living. As a
result of his condition, Abe Holtry requires specific one on one assistance with grooming,
eating, ambulation, toileting and bathing.
6. The alleged incapacitated person is incapable of handling his financial and personal
affairs, however minor, and if called upon to grant informed consent to any medical
procedure would be unable grant same because of his inability to comprehend the nature
of the procedure. Additional information related to Abe Holtry's capacity is set forth in a
Guardianship Petition
letter dated January 12,2001, prepared by his treating physician and incorporated by
reference and attached hereto as Exhibit "A".
7. After reasonable investigation it has been determined that the alleged incapacitated
person's next of kin are either unwilling or unable to serve as his guardian.
8. Upon investigation, Petitioner can find no other individuals willing to act as guardian for
the alleged incapacitated person.
9. The Facility has requested the Cumberland County Area Agency on Aging to provide
guardianship services for the alleged incapacitated person.
10. The Cumberland County Area Agency on Aging has declined the Facility requests to
provide guardianship services.
11. Petitioner has no knowledge of any other court within this Commonwealth that has
appointed a guardian for the alleged incapacitated person.
12. Upon information and belief, the alleged incapacitated person has no assets.
13. Petitioner, having no interest adverse to the alleged incapacitated person, has agreed to
act as guardian of his person and estate ifthis Honorable Court shall so appoint. The
consent of the proposed guardian is incorporated herein by reference and attached hereto
as Exhibit "B".
14. If appointed as guardian, petitioner will act in compliance with regulations promulgated
under Court Order in Pennsylvania Bulletin 931, et seq., April 19, 1975.
Guardianship Petition
Wherefore, petitioner respectfully requests this Honorable Court issue a rule and citation
upon Abe Holtry, the alleged incapacitated person, with notice thereofto be given to such
other persons as this Court may direct, to be appointed guardian of his person and estate.
Respectfully submitted,
CAPOZZI AND ASSOCIATES, P.C.
Date:$
M A.HYNU ,
Identification No. 85692
ELIZABETH S. ANTOUN,
Identification No. 72592
CAPOZZI AND ASSOCIATES, P.C.
2933 North Front Street
Harrisburg, P A 17110
(717) 233- 4101
Attorneys for Petitioner
MAR 09 '01 01:46PM
'EI-27-2001 11;24AM FfttV-CAPOlZI AND AS80CI~TES
+717-213-4ID3
P.13
1-2&8 P.Ot4l020 F-708
OUIl'diantbtp petition
IN THE MA'ITER OF Abe HolU'Y.
an alloSed mcapacitated penlO11.
IN niB COURT OF coMMON PLEAS OF
CUMBERLAND COUNTY. PENNSYLVANIA
ORPHANS COtJR.T DIVISION No 57 of'2001
GUARDlANSlUP-INCA'PACITATBD "PBasON
YllRlPlCAT10N
Larry Cottle. potitioneri'll th1! matter. does bla'eby depose end. Atatetbauhe tiCtI
COl1taiDecl in the foreaoiDl patition lI'e we and correct to the best of my knowledge, information and bc!ief. 1
understlDd that fa}Ie 8tatemt!Qll Juade heroin are subject to the peD81ries of 18 Pa.C.S.A. Section 4094, relatinl
to Ul1JWom falsincation to authorities.
Dut<~1
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Exhibit A
..
HEALTH CARE CENTER
:JJN }" 9 2001
121 Walnut Bottom Road
Shippensburg, Pennsylvania
17257-9005
(717) 530-8300
FAX (717) 530-8304
TTY 1-800-654-5984
January 12, 2001
Elizabeth S. Antoun
Capozzi and Associates
2933 North Front Street
Harrisburg, PA 17110
Dear Ms. Antoun:
As per the capability form completed regarding Mr. Abe Holtry, I feel that
he is not capable of making decisions about his care.
A Mini-Mental Status Assessment, completed during July 2000, reflects
significantly impaired orientation, short term and long term memory. No
improvement is noted and prognosis related to mental status is poor.
Diagnosis related to mental status is Left CVA with right ataxic
hemiparesis.
since7IY'~_
YOginlta~lhara, M.D. J/ld.-/-o /
ABE S. HOLTRY
FAMILY CONTACTS
BROTHER:
RONNIE HOCKENBERRY (717) 532-3232
139 WHITMORE ROAD
SHIPPENSBURG, PA 17257
LONNIE SNYDER
ADDRESS, TELEPHONE #,
LOCATION, HEALTH STATUS UNKNOWN
FRIEND:
_! ~-...:..:.:... .:......:::-_-- . --
SHIPPENSBURG HEALTH CARE CENTER
PATIENT'S ABILITY TO UNDERSTAND
RIGHTS AND RESPONSIBILITIES
(Statement concerning signing of documents by resident or third party)
NAME: 19 JaE ,s'. /101... J./'?J/
DATE: I - IrQ. - t2eol
Above named resident appears capable of understanding information contained on
documents and forms and will be signing all paperwork, except to the extent that
resident has authorized another individual to act as his/her attorney-in-fact.
Above named resident appears capable of understanding information contained on
documents and forms but cannot physically execute a signature.
Reason for inability to physically sign papers:
~ Above named resident appears incapable of understanding any information
contained 011 documents and will not sign, but will have responsible third party
sign all paperwork.
Reason for being incapable of understanding: /l1/Y(3..E ~ /:3 E/2/CO/2S
/;Jk)IU;-}y~ ~pA.J/AcniJJ- ()?J/HVE //YJ;r'/l//0/ne.Jr-
A d' PI V~S' t-
tten lllg 1yslclan sIgnature
Date
Illtl/O / ,
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Title
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Name mil- 'I!o/fry
ResidentfJ Of} S .2:2- Date 7 j; ~ /00
l'vrINll'r1ENTAL STATUS TEST
.
LTM
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aufl1 m~~l
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Con"ect Answer
Xl. 7/10/00
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Resident Response
~
Questiou
1. What is today's date
2. What day of the week
3. The name of this place
4. Your room number
5. Howald are you
6. Your date of birth
7. Your mothers maiden name
8. The President ofthc U.S.
9. The President before
10. Subtrnction30-3; to zero. 30-3 =
24-3 =
18-3 =
12-3 =
6-3 =
111~luI
"'1.7-3 =
, ,
; 21-3 =
; 15-3 =
9-3 =
; 3-3 =
STtvl11flcr 5 minutes asked to recllll 1.
recalled 2.
3.
Occupation
Spollse's ]lame
Birthl>lace
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c: '}1'AfA m(J~: 17
current season
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code for MINI Mental Status Test Score: 0-2 errors, intact intellectual functionillg
3-4 errors, mild intellectU21 functionjng
~ors1 moderate intellechlal functioning
t~rrors, severe intellectual flUlcti~~Ilg .
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SHIPPENSBURG HEALTH CARE CENTER
ADMISSION SUMMARY RECORD
--___ J~.esiqent: Room Number: 204A Adm Date 03/28/2000
.., ,'"-.~~-~:~o~rv ..",..~-~.':~,\~:--------~~',;~~; "6i~'~ti~~;. -~--~~e:1'3bti~-.-'~.~.,-,C--!,'
.\ ,'_,II!~:'J 'yif:~', 'J' ". .'. '. : .
Fonner Address: 112 Meadow Drive
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Hospital Preference: Chambersburg Hospital
Address: 761 S 5th ST
Stre.et
Chambersburo
City
Phone:261-2583
Religion: Protestant
Clergy: .
Phone:
PA 17201
State Zip
Dentist:
Address:
Phone:
Mortician: F olgelsonger/Bricker
Address: 112 W Kina ST Phone:532-2211
Street
Shiooensbura
City
PA
State
17257
Zip
Street
Cit
Financial
State
Zi
P.O.A. None
Address:
Primary Insurance:Medicare
Policy # 174-20-3105
Street
Address:
City
State
Zip
Street
Telephone:
City State
Secondary Insurance:
Zip
Social Security# 174-20-3105
Policy#
Medicare#: 174-20-31 05A
Address:
Medicaid#: 0017352030
Street
Cit
State
Zi
CONTACT IN CASE OF EMERGENCY: (Surrogates in Priorit Order)
DURABLE (FINANCIAL) P .OA
Name: ,-.. .' ..,." -... . - - - . - ~ Relationship: .
, '" , . ... ~ t' , ~.- ...
Address: ,;'~;Telephohe: "
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Name:Ronnie Hockenbury
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Relationship: Friend
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Address: 139 Whitmore Road, ShiPpensburg'p~ Telephone: 532:~232
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Name:
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Relation~hip:.~~.,,~;;;~~-
8/24100 3:38 PM
Exhibit B
.," MAR 09 '01 01: 46PM
FEB-Zr~ZDD1 11:24AM FROM-CAPOlZI AND ASSOCIATES
+rtT-I89-41OS
P.14
1-2&1 P.D1S/DID F-7DI
Quar41lt\Ship Petition
IN THE MA TTSR. OF Abe Holtry,
an aUaged inQapacitate4 person.
IN THE COUR.T OF COMMON PLEAS Or
CUMBBltLANO COUNTY, PENNSYLVANIA
ORPHANS COlJllT t>MSION No
GUARDIANSHIP-INCAPACITATED PiUON
CDNSENT OF PROPOSED QlJ.tfRD1AN.
l, 14f'Y1I J I~ . do horeblI certlfy 1IW IllIIl wWIaI to "'" .. tbIl par4im of
hi, person aacl .lIata'. if Court .1110 appoint me.
Pwtha, 140 hereby certify that I ~ Dot a 4dllOlar)' of any e.tate in whldl the ailea<<' iDcapaci1&tCl4
petsan has an interest, nor have I an)' interelt a4vme to the ulleae4 inoapacitate4 penon.
The Dots and opiniODl DOl1tained berein are true aJJ4 cotreCt to the belt ofl11Y 1mawledBe, In:forxnation
and beUI:i~
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COURT COMMON PLEAS
OF CUMBERLAND COUNTY
PENNSYLVANIA
TO
IMPORTANT NOTICE
CITATION WITH NOTICE
A petition has been filed with this Court to have you declared an
Incapacitated Person. If the Court finds you to be an Incapacitated Person,
your rights will be affected, including your right to manage money and
property and to make decisions. A copy of the petition which has been filed
by CAPOZZI AND ASSOCIATES, ATTORNEY FOR THE PETITIONER.
You are hereby ordered to appear at a hearing to be held in Courtroom No.
_, Cumberland County Courthouse, Carlisle, Pennsylvania, on
, at . To tell the Court why it should
not find you to be an Incapacitated Person and appoint a Guardian to act on
your behalf.
To be an Incapacitated Person means that you are not
able to receive and effectively evaluate information and
communicate your money and/or other property, or to
make necessary decisions about where you will live, what
medical care you will get, or how your money will be
spent.
At the hearing your have the right to appear, to be
represented by an attorney, and to request a jury trial. If
you do not have an attorney, you have the right to
request the Court to appoint an attorney to represent you
and to have the attorney's fees paid for you if you cannot
afford to pay them yourself. You also have.the right to
request that the Court order that an independent
evaluation be conducted as to your alleged incapacity.
If the Court decides that you are an Incapacitated
Person, the Court may appoint a Guardian for you,
based on the nature of any condition or disability and
your capacity to make and communicate decisions. The
Guardian will be of your person and/or your money and
other property and will have either limited or full powers to
act for you.
If the Court finds you are totally Incapacitated, your
legal rights will be affected and you will not be able to
make a contract or gift of your money or other property. If
the Court finds that you are partially incapacitated, your
legal rights will also be limited as directed by the Court.
If you do not appear at the hearing (either in person or by an attorney
representing you) the Court will still hold the hearing in your absence and
may appoint the Guardian requested.
By:
Clerk, Orphan's Court
IN THE MATTER OF Abe
Holtry, an alleged incapacitated
person.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
ORPHANS COURT DIVISION No 21-01-284
GUARDIANSHIP-INCAPACITATED PERSON
Addendum to Petition For The Appointment Of Guardian For An Incapacitated Person
NOW comes Larry Cottle, petitioner, by Attorneys Michael A. Hynum, Esquire and Elizabeth
Antoun, Esquire, and presents this addendum to petition for the appointment of a guardian by
this Honorable Court upon Abe Holtry, an alleged incapacitated person, representing as follows:
1. Abe Holtry is a nursing home resident whose stay is paid for by Medicaid.
2. As a Medicaid resident, Mr. Holtry is required to maintain total funds of not more than
$2,000.00.
3. As a Medicaid resident, Mr. Holtry receives a personal needs allowance of$30.00 per
month.
4. Mr. Holtry's funds are maintained in a resident fund at Shippensburg Healthcare Center.
5. The Business Office at Shippensburg Healthcare Center supervises the resident fund,
which includes Mr. Holtry's funds. The business office employs persons who are bonded
for the purpose of handling resident funds.
6. Nursing Home resident funds are monitored by the P A Department of Health and/or the
P A Department of Public Welfare.
7. 20 Pa.C.S. S5515 states "... provisions relating to a guardian of an incapacitated person
and his surety shall be the same as are set forth in the following provisions of this title
relating to a personal representative or a guardian of a minor and their sureties:. . . Section
5122 (relating to when bond not required).
.
..
8. 20 Pa.C.S. S5122 (D) states: "in all other cases, the court may dispense with the
requirement of a bond when, for cause shown, it finds that no bond is necessary.
Wherefore, petitioner respectfully requests this Honorable Court dispense with the
requirement of the Petitioner to obtain a bond.
Respectfully submitted,
CAPOZZI AND ASSOCIATES, P .C.
Date:.
M CHAEL A.
Identification No. 8569
ELIZABETH S. ANTO
Identification No. 72592
CAPOZZI AND ASSOCIATES, P.C.
2933 North Front Street
Harrisburg, PAl 711 0
(717) 233- 4101
Attorneys for Petitioner
-
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IN RE:
ABE HOLTRY
an alleged incapacitated person
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NC(" -:. 284 ORPHANS' COURT 2001
IMPORTANT NOTICE
CITATION WITH NOTICE
A petition has been filed with this Court to have you declared an Incapacitated Person. If the Court
finds you to be an Incapacitated Person, your rights will be affected. including our right to manage money
and property and to make decisions. A copy of the petition which has been filed by
MICHAEL A. HYNUM is attached.
You are hereby ordered to appear at a hearing to be held in Court Room No.. 3 , Cumberland
County Courthouse, Carlisle, Pennsylvania, on ~ 23 2001, _, at 10:45 A.M. to
tell the Court why it should not find you to be an Incapacitated Person and appoint a Guardian to act on
your behalf.
To be an Incapacitated Person means that you are not able to receive and effectively
evaluate information and communicate decisions and that you are unable to manage your
money and/or other property, or to make necessary decisions about where you will live,
what medical care you will get, or how your money will be spent.
At the hearing, you have the right to appear, to be represented by an attorney, and
to request a jury trial. If you do not have an attorney, you have the right to request the
Court to appoint an attorney to represent you and to have the attorney's fees paid for you
if you cannot afford to pay them yourself. You also have the right to request that the Court
order that an independent evaluation be conducted as to your alleged incapacity.
If the Court decides that you are an Incapacitated Person. the Court may appoint a
Guardian for you, based on the nature of any condition or disability and your capacity to
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make and communicate decisions. The Guardian will be of your person and/or your money
and other property and will have either limited or full powers to act for you.
If the court finds you are totally incapacitated, your legal rights will be affected and
you will not be able to make a contract or gift of your money or other property. If the court
finds that you are partially incapacitated, your legal rights will also be limited as directed
by the Court.
If you do not appear at the hearing (either in person or by an attorney representing you) the court
will still hold the hearing in your absence and may appoint the Guardian requested.
By:
'man~ c. ~ 11.. p/3C:L.j;;,
Clerk, 0 phans' Court Di~ision I ~
Cumberland County, Carlisle, PA
My Commission Expires 1 st Monday,
January, 20~
DATED:
MARCH 16,
2001 ,