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Home My WebLink About01-0285 Guardianship Petition IN THE MA TIER OF Kenneth Kunkle, an alleged incapacitated person. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS COURT DIVISION No GUARDIANSHIP-INCAPACITATED PERSON ~J -01 -curs NOW, this l( ~ day of ,2001, on motion of Michael Hynum, Esquire, and Elizabeth Antoun, Es ui , upon consideration of the attached petition and after a hearing held following due notice, . is ordered and decreed that Kenneth Kunkle, 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 Kenneth Kunkle. J r l_u III ^ 6~(J. ~ ~ By the Court, . It .J ~ motion for continuance IN THE MA TIER OF Kenneth Kunkle, an alleged incapacitated person. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS COURT DIVISION No 21-2001-285 GUARDIANSHIP-INCAPACITATED PERSON DECREE NOW, this :2 (p f11 day of M ~ ,2001, on motion of Michael Hynum, Esquire, and Elizabeth Antoun, Esquire, upon consideration of the attached Motion, it is ordered and decreed that the hearing on petition for guardian of Kenneth Kunkle, 121 Walnut Bottom Road, Shippensburg, Pennsylvania 17257-9005, an alleged incapacitated person, is continued until May 4, 200 I. ~: "3 0 f\1IV1 ' J By the CoS!-- fJJ. . ~ motion for continuance IN THE MATTER OF Kenneth Kunkle, an alleged incapacitated person. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS COURT DIVISION No 21-2001-285 GUARDIANSHIP-INCAP ACIT A TED PERSON Motion for Continuance of Hearin2 WHEREAS; a petition was filed on March 15, 2001 for the appointment of a guardian for Kenneth Kunkle, an alleged incapacitated person, and, WHEREAS; petitioner became aware on March 16, 2001 that Velva M. Morris was appointed guardian of Kenneth Kunkle in Franklin County, Pennsylvania, on February 13, 1997, while Kenneth Kunkle was a resident of South Mountain Restoration Center, and, WHEREAS; Velva M. Morris has filed a petition for resignation of guardianship and final accounting dated February 21,2001 with the Court of Common Pleas, Orphans Court Division, Franklin County Pennsylvania, and, WHEREAS; the hearing on the petition for resignation of Vel va M. Morris' guardianship has been scheduled for May 3,2001, and, WHEREAS; a hearing has been scheduled for March 23,2001 for appointment of Larry Cottle as guardian of Kenneth Kunkle in Cumberland County, Pennsylvania, Wherefore, petitioner respectfully requests this Honorable Court issue a continuance of the March 23, 2001 hearing for guardianship of Kenneth Kunkle until May 4,2001. Respectfully submitted, CAPOZZI AND ASSOCIATES, P.c. Date 4$L M BAEL A. Identification No. 85692 ELIZABETH S. ANTOU Identification No. 72592 CAPOZZI AND ASSOCIATES, P.C. 2933 North Front Street Harrisburg, PAl 711 0 (717) 233- 4101 Attorneys for Petitioner .. . motion for continuance IN THE MATTER OF Kenneth Kunkle, an alleged incapacitated person. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS COURT DIVISION No 21-2001-285 GUARDIANSHIP-INCAPACITATED PERSON ~\~ VERIFICATION , attorney in this matter, does hereby depose and state that the facts contained in the foregoi g motion are true and correct to the best of my knowledge, information and belief. I understand that false statements made herein are subject to the penalties of 18 Pa.C.S.A. Section 4094, relating to unsworn falsification to authorities. vGw\ Date: aY1\Ol \ \. 03/22/01 THU 09:28 FAX 2406462 __~~/COUNTY COURTS 14/ UU2 SP 4-131(1-18) COMMONWeALTH OF PENNSYLVANIA NOTIFICATION OF MENTAL HEALTH COMMITMENT The Unlbm F"1I8InN Act, 11 irA. c.s. 1305 (c)(4) IIp8CiIles lilt IIIhII be lI'IIawAI rc.. qo pilla! ~ 1&11I k.....~ or. till beerI /nYaUItIrQy l:lOIIlINlIed ID IIl'llIIltaI inI1IIutian for ~ care IIld ll-.tnlIint lOW SeQIon aoz. 3OS. or 304 of lie Mental HeaIlh PfOCIIdura Ad 01 July 9. 1171 (P .L117. No. 143) \0 poaeu. .... ~ conInlI, sell ornnsfetnr.ma. lbil,.,. inducIe ~ oflnclplclly.....1II 20 Pa.c.SA. 55501. Pvl1UItIlIo tI'le ~ Menial HMIItI PrclcIIduraAcc, Sec:lbi 109. llClIIIeatIan SI'lIlI be Irw1smlalld III lhe PemsyIv8nI8 Sl.all PoIIca Dr Ihe Judge, menrallleidIh rMIw ofIIcer or CI:lUI'Ity menl8I he8Ilh II1d menfiII rwllIrdallon adrNnillraCor ~ lIVEN days of 1tI, ~1Ion. CQ,...A._hr n.lmeftl by lint diu melllo IIle Ptnnylvlnla StItI Police. Abntlon: Plrtllnft Unit. 1100 !11M",," AVlnue, HIn1aburg. PA 17110. Note: '111. elMllope ahall be marked "CONFIDINTIAL.- . Place an ox- on either Invo(untalY Commitment or Adjudicated Incompetent INVOLUNTARY COMMITMENT ADJUDICATED INCOMPETENT x. Date of Involuntary Commibnent ~r Adjudicated Incompetent 5 /4/0 1 INDIVIDUAL INFORMA T~ON (INCMCUAL INVOLUNTARILY COMMITTED ORADJUCICATEC INCOMPETENT) LAST N:".i'olE Kunkle FIRST Kpnnprn MIDDLE JR., ETC. MAiDEN NAME ALIAS DATE OF BIRTH 8/15/34 SOCIAL SECURITY NUMBER 1 q') ?n h 'i Q A SEX M RACE r. HEIGHT 'i' A II WEIGtfT 140.4lbs HAIR Brown EYES Grey ADDRESS 121 Walnut B_o~ttom ROg.~hippensbu.rg, PA 17257 9005 NOTIFICATION BY (Please print nalM, address. area code. and phone number or agency or county court.) County Submitting NotIficatrOn County Mental Health and Mental Retardation Administrator County Mental Health Review Officer --, I i ..~. Physician Hospital I Fadlity PIWldlng Treabnent I Address Judge SIGNATURE OF NOTIFYING OFFICIAL DATE Court Case Number Date of Court ORt.r ------.................. ~ ~-- ~-------__......I ~_____..______I 1 ~. ..~. .. --.. -----...---...--...........- NOTIFICATION OF PHYSICIAN'S DETERMINATION THAT NO SEVERE MENTAL DISABILITY EXlST~ The Ilh'tslc:lan SI'llI// pnMd. signed c:ontm1Idon cl1he l1cfIlmIhdIan cllh8lac1c 01.,.. menial clSltlDlly rolawlng the Inllllll UMlinallon undIr S8Cllon ao2(bl ot lhe MenIal HeiNl p~ Ad. and pIDUiII1llll the UIlIronn FiteInM Ad., SIClIan 8111.1 fg)(3], NOUce snal be hnsmlbd by !h. phyllclln 10 the Pennsylvania Stale PolICe JIVl:lUgh 111/1 couft" menllll huIII1 and mental retal'Clallon IdmlnlltrllDr or mlllllll heaIUI teYlcw alllair. Name or Physician (please print.) Signature or Physician Date ~aw D~ Dl 02~47p p.1 ! I I .I .I m TO tfM"l!D 01' :"! XI ru COUU' aT CCIOfOlI PLIAS or ~ CotnftY, IBlISYLVAnA ~DIVISIOR lumber or 19 ~ B. ICDIlna.Il 11IcOIqIetnt) ORlIEa .OW. this . ~ cia,. of -- /IJ1tt? . ~, upon cOD.14a~a~1oa of the Petitiou fo~ th8~the Quarcl1an af bftft.rh I. Y",n1rl.. , aDd proof of notiee of the .aid 1I.t:1U,o-a. to Y<<ftft.rh K. Xunkla IS u~t-of-k1u hav1nC been . appo:i.ntd Guard1all fU.cl, ehe Coure fiDel. tha.e VELVA. X. xoaus b1 degree of th1. Court dated rabrua;r:v 13 . 19 97 1.& DO lousez &b~. eo fUDctioD a. suard1an of the Estate of the 1.14 ~el1n.th E. XunUe . It is OIDD!D AND D!CBUD that the First and. l:!.ual Acc'ouut of XaDDeth I. lunkle , .u&mitte4 to this Cou~t for audit on , 19 , :ta hereb, aOllfirmed and l:ha.~ VEL'''' X. HOllIS lB di.ch~8ed Of du:ies and ~.,pODI1bi1iC1el a8 Guardian of the Eetate of laftnath B. Eunkle It i8 furthl!~ ORDEUD 1f Kenneth E. Iunkle 18 na4a'Lcced to Bouth HOunta~ ~..torat1on Ceuter " VELVA H. MORlUS " Guardian Of!1ca~, o~ 1\1s/hcr successors shall 1aaed1ately reassUIle the du~1ea mcl l'capol18:L.&:U1t188 of $u&r4iau of elle It.tate of Kenne~h E. XunkJ.. When this occurs, the Guard,1u. ab&1l 11va lotic. to the OZptumB' Court . -A Di.is1au of the Court of Common Pleas. All costs aud expellles of chis P.~ieion are to be borne by the Estate of the said Xenneth B. Kunkle . .....~ -CPY , ~ . ..... , f. i;'"t... ~ l. ~ MAY 0 3 20m - ~ C:.r!l e Cc~:i"fI 2'd Wd0v:l0 l0. E0 ^~ KENNETH KUNKLE an alleged incapacitated person IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA NC(" '; 285 ORPHAN$' COURT 2001 IN RE: IMPORTANT NOTICE CITATION WITH NOTICE A petition has been filed with this Court to have you declared an Incapacitatl Person. If the Court finds you to be an Incapacitated Person, your rights will be affected, including our rht to manage money and property and to make decisions. A copy of the petition whichhas been filed by MICHAEL A. HYNUM is attached. You are hereby ordered to appear at a hearing to be held in Court Room. 3 , Cumberland County Courthouse, Carlisle, Pennsylvania, on MARCH 23 ,20~ t 11: 00 -1L. M. to tell the Court why it should not find you to be an Incapacitated Person and appt a Guardian to act on your behalf. To be an Incapacitated Person means that you are not able to recl and effectively evaluate information and communicate decisions and that you are unsto manage your money and/or other property, or to make necessary decisions about Ire 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 represente an attorney, and to request a jury trial. If you do not have an attorney, you have dht to request the Court to appoint an attorney to represent you and to have the attop fees paid for you if you cannot afford to pay them yourself. You also have the right t,Jest that the Court order that an independent evaluation be conducted as to your allfncapacity. If the Court decides that you are an Incapacitated Person,:ourt may appoint a Guardian for you, based on the nature of any condition or disalf1d your capacity to """"":: ,,'F,. .. ..". .~;.o.~......... _. -------.... .. jJ. . . . 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: 'tnt'cJ (', ~ o.....PP,.'lf"\ Clerk, rphans' Court O(vision Cumberland County, Carlisle, PA My Commission Expires 1 st Monday, January, 2002 DATED: MARCH 16,2001 prelim decree IN THE MATTER OF Kenneth Kunkle, an alleged incapacitated person. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS COURT DIVISION No GUARDIANSHIP-INCAPACITATED PERSON 21-01-02 ~5 PRELIMINARY DECREE /11\ ~ NOW, this / j day of ~ ,2001, upon consideration of the annexed petition, it is hereby decreed that a citation is awarded directed to Kenneth Kunkle 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 ';' , Cumberland County Courthouse, Carlisle, P A on k ~ e.13 2001 at II; pi) 0' clock at 4.M. At least 48 hours' notice ofthe hearing shall be given to Kenneth Kunkle,'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, c_ MAR 1 5 ?n~~ ~0~' to\J Guardianship Petition IN THE MATTER OF Kenneth Kunkle, 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 Kenneth Kunkle, 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 have an interest in the estate of same. 3. The alleged incapacitated person resides at 121 Walnut Bottom Road, Shippensburg, Pennsylvania 17257-9005. 4. The alleged incapacitated person's diagnoses are Dementia, Schizophrenia, CV A and mental retardation. 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, Kenneth Kunkle 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 Guardianship Petition of the procedure. Additional information related to Kenneth Kunkle's capacity is set forth in a 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 Kenneth Kunkle, the alleged incapacitated person, with notice thereof to 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:~ CHAEL A. Identification No. 856 ELIZABETH S. ANTO 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: 47PM · F!8-1T-2001 11 :z!AM FROM-CAPOUI ANO AISOCIATlS , +717-231-4103 P.1S T-Z&8 P.Olt/OiO p-rol . Q\WI'dianahiP petition tN THE MA Trl!R OF K.enneth Kuakle, an aUBpcl i11CBp&ciWed person. IN THE COURT OF COMMON PLEAS OF cmmmtLAND COUNTY, PENNSYLVANIA ORPHANS COURTOMSIONNo 57 of2001 GUAROIANSHIP-lNCAPAClTATED PEasON JlBJUFlCATION iiO=liaocI ~a rTV Cot <1 p . poIiIlaIW In l!>II m_. doea bootI>y dopa.. ond - duIt 1be i'aalI . iD I1w far'aoina pedtton are trUe IN1 comet IlD tho bes~ ofmy kll.OWll4J8. ~fom1ation and belief. I ~ 1bat false statamcts made herem are subject to the penalties of \B PLO.S.A. Section 4094. relatinl 10 ~om falsificadon to a\Uhoritica. Da1C:.J/LtJtL ~, .,;, ~ "Exhibit A ~ 3~' '.. Ill., HEALTH CARE CENTER 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 Frant Street Harrisburg, PA 17110 Dear Ms. Antoun: As per the capability form completed following the admission of Mr. Kenneth Kunkle, I feel that he is not capable of making decisions about his care. A Mini-Mental Status Assessment, completed during November, 2000, reflects significantly impaired orientation, short term and long term memory. No improvement has been noted and prognosis related to mental status is poor. Diagnosis related to mental status includes Dementia, Schizophrenia (Undifferentiated), CVA - right caudate and right temporal encephalomalacia, and mental retardation. Sinqereiy, I/olo / KENNETH E. KUNKLE FAMILY CONTACTS: BROTHER: BROTHER: SISTER: COUSIN: NEPHEW: RAYMOND KUNKLE (610) 807-0140 723 BROADWAY STREET BETHLEHEM, PA. 18015 ROBERT KUNKLE, PHONE UNLISTED BOX 227 EFFORT, PA 18003 ELEANOR FISCHER (717) 530-8300 SHIPPENSBURG HEALTH CARE CTR. 121 WALNUT BOTTOM ROAD SHIPPENSBURG, PA 17257 ZELDA LLOYD (717) 532-3836 143 HOSTETTER AVENUE SHIPPENSBURG, PA 17257 GARRETT FISCHER (717) 901-6606 208 SENATE AVENUE APARTMENT # 817 CAMP HILL, PA 17011 . -) ...... SHIPPENSBURG HEALTH CARE CENTER RESIDENT'S ABILITY TO UNDERSTAND RIGHTS AND RESPONSIBILITIES (Statement concerning signing of documents by resident or third party) NAME:~f/, idA I DATE: ///ut Above names 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: v Above named resident appears incapable of understanding any information contained on documents and will not sign, but will have responsible third party sign all paperwork. Reason for being incapable of understanding: U -II IllrJ(~/ I Date ~ . ~;/ ~ZU;OJ D/~ Title epresentative ':. " .... "....- Shippensburg Health Cm-e Center rvllNI NrENT AL STATUS TEST , .. Name J(EV),)EfHI )fWJJ<.iL Resident# (;) 05 UJ t.; Assessment Date II - PI - ~o MINI NIENT At STATUS TEST vSThI (! cLu~ r'"h t>-C --LLi-r ~~ '-..' 3 Items: 1. STM after 5 minutes asked to recall 1. 2. recalled 2. \ .., .., .J. ':J. LThf r! cJ..dcl rncd- ~<<- V LThI Occupation v Spouse's name v Birthplace ~ currem season code for iVIINI Mental ScaNs Test Score: 0-2 errors, incact iIiiellecnial fur.doning 3-4 errors, mild intellectual func:ioning 5- 7 errors, moderate intellectl.1C.l functioning /.d~ E/2/2o.tCS 8-10 errors, severe intellectual f.:nctioning '-- comPletedBq~ 3SJ::J Correct Answer vi. v'2. 1./'3. v4. v'S. V"b. ~ - I~ -193~ /'/7. v8. ~9. 00. ~"'" t. ~ -." minit=t.dcc Question Resident Response 1. What is today's date /Y?" -~{'.., ~ 2. What day of the week /YlO ../?~ 3. The name of this place Yv-oC ~~ 4. Your room number II ~ 5. How old are you II I, 6. Your date of birth /kUJ 7. Your mothers maiden name ~o 8. The President of the U.S. )"'h 0 9. The President before . ;' I 10. Subtraction 30-3; to zero. 30-3 ~ ; 27-3 = 24-3 = _; 21-3 = 18-3 = ; 15-3 = 12-3 = 9-3 = 6-3 = 3-3 = \. ---.----..- Date //-11;- Do -. ~_"".._, '." ".. ....."-, . -. '",,",. . ,'~_ "'" .>o<.~ ~...~...."" .~" _ ~ ~_.... .Ji. ..... "...................-....,... -~"..~,.-.........--"".;...-~-......."....? . . .. '\ I , I Shipp~nsburg Health Care Center Admis_sion Summary Record "i."~"~_':;"'''~_'\!.'_'':''',,''' .~~"'.~~~'- 3sident: Kenneth E. Kunkle Admission Date: 11-01-00 ..Time:..._ _ =.-'1' . er Address: South Mountain Restoration Center 10058 South Mountain Road State: PA Zip: 17261 Sex: Male Resident Number: 00564 ., ,.' - .: '~~~l , . \~ ty: South Mountain ,ihday:' 08-15-34 Marital Status S Allergies: W M - - D ~,. "". . i~plac~: Mercersburg, PA lce:Caucasian Occupation: No occupation known Admitting Diagnoses: Dementia Dysphasia - . ICD-9 codes _ 294.8 _.'_ 787.2 Imitted from: Home Hospital Other , , . lde of Transportation: wheel chair van , I Hos ita I Preference: Chambersbur Religion: Protestant ending Physician: 'or. Balhara. &ess: 761 5th Ave Phone: ambersburg, P.A. 17201 261-2583 Clergy: House of Worship: Address: Phone: ntist: Mortician: jress: Phone: Address: ,r\NCIAL ).A.: Primary Insurance: Medical Assistance kess: Policy: 0019267178 Address: ephone: ;ial Security #: 195-26-6598 Secondary Insurance: Medicare dicare #: 195-26-6598A Policy #: 195-26-6598A dicaid #: 0019267178 Address: NTACT IN CASE OF EMERGENCY: (Surrogates in Priority Order) DURABLE (MEDICAL) P.O.A. ne: Relationship: jress: Telephone: ne: Larry Cottle, Administrator ';~ss: Shippensburg Health Care Center 121 Walnut Bottom Road Shiooensburo, PA 17257 Relationship: Administrator Telephone 717-530-8300 . ." ne: Gary Fischer !ress: Relationship: Nephew Telephone 717-901-6606 Exhibit B .' MAR 09 '01 01: 48PM 'I" · .lEl-iT-ZUUl "IZ5AM FReM-CAPOZZI AND ASSOCIATES +7l7-ZU-4lD! T"268 P.DZD/DZD ~:'fDl Cll.'Imdlanship 1'cIition IN Ttm MATfER OF Kenneth .KUllkl,,- an lIlieleel inelplLC\tat14 person. IN THE COURT OF COMMON PLEAS OJ! CUMBERLAND COUNTY. PENNSYLV A'NlA OlU'BAN8 COUllT DMS10N No GUAlU)lANSHlP-1NCAPAcrrATlID PBllSON CONSENT OF PROPtJSED GUARDIAN I, U/~ ~/)) (~ T71l.- _ cIo hclfObY con;ilY lbal I om wil\lJlg to act u..... CINQllIllll/ gulfdiaft orhis pldOD ad estate. if the Court ahaU so 1PP01nt me. F\IrIIIer. 1 cIo benl>y ~ lbao 1...IlOl a flduclltY of lIlY -- in whloh tho aIlePl ~ penoD bas an. in1ef8It, nor bave laDY il\lucst a4ver&e to the alleged incapacitated pef80n. The _ ..,d opiuionS """tabled boNiA "'" rruo ..,d _I. tho belt of'lJrl kaDw1eclp, ~ _b~~ . . . . .:..... .... .:..... . ., ~ .... ..... . - .- :. tI" ..".' :" ~ .,SWcn'l\ 'to m41~sorIbocl ~\:..'~~me.thil ~ day or1f/(lA.. fliLA. 200 \. ,. 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