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Home My WebLink About06-12-09IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISI ON No. ,~ ~}~ of 2009 EMERGENCY PETITION FOR ADJUDICATION OF INCAPACITY AND ANT APPOINTMENT PLENARY GUARDIAN OF THE ESTATE AND PERSON PURSU TO 20 PA.C.S. §5511 E ~ :-~; c.-~, r; TO THE HONORABLE JUDGE OF SAID COURT: ~ ~ < < ~ , Petitioner is the TY AARON BERRIOS of HUSBAND (the "alleged ~, 1 ~ f'.. . Incapacitated person"). ~ `~`~'~,, 2. The alleged incapacitated person was born on 10-15-1981, is MARRIED, and resides at 52 WINDSOR WAY, CAMP HILL, PENNSYLVANIA ). 3. The following persons, to the best of Petitioner's knowledge, information and belief, are the living next-of-kin of the alleged incapacitated person: Alicia Boodoo- SISTER 13111 Millhaven Place Germantown, MD 20874 4. The name and address of the person providing residential services person is/are: Alicia Boodoo 13111 Millhaven Place Germantown, MD 20874 5. To the extent known by Petitioner, the assets of the alleged incapacitated person are valued at approximately $3000.00, comprised of the following holdings: M & T Bank Account #9830431426 6. Petitioner estimates the alleged incapacitated person's annual income to be $75,000.00. 7. The alleged incapacitated person was not a member of the armed services of the United States and is/is not receiving benefits from the United States Veterans' Administration. 8. The alleged incapacitated person suffers from Paranoid Schizophrenia. 9. Because of his mental and/or physical condition, the alleged incapacitated person is totally unable to manage his/her financial affairs, property and business and to make and communicate responsible decisions relating thereto, including the ability to communicate his/her need for assistance in these areas. 10. Because of his/her impaired mental and/or physical condition, the alleged incapacitated person lacks the capacity to make or communicate responsible decisions concerning her person and is unable to pay household bills, and mortgage. 11. The severity of the alleged incapacitated person's mental and/or physical condition and the lack of viable, less restrictive alternatives necessitate that a plenary guardian of his/her estate be appointed to manage and handle all aspects of the alleged incapacitated persons estate, specifically, but not limited to: all issues relating to cash, checks, bank savings, stocks, bonds, personal property, real property, insurance policies, government entitlements, taxes, execution of documents, entry in contracts and the payment of reasonable compensation for services provided to the person. 12. The severity of the alleged incapacitated person's mental and/or physical condition and the lack of viable, less restrictive alternatives necessitate that a plenary guardian of her person be appointed to handle all issues relating to the person of the alleged incapacitated person, specifically, but not limited to: living arrangements, medical and psychiatric care, employment and discharge of physicians, and other medical decisions as may be required. 13. Petitioner is not aware that the alleged incapacitated person signed any powers of attorney or advance health directives or in any other way designated anyone to serve as his/her agent over any of his/her personal or financial affairs or as her surrogate over her medical care, or that he/she designated in writing his/her wishes with regard to health care, including the use or refusal of life sustaining treatment. 14. The proposed plenary guardian of the person and estate is TYAARON BERRIOS, HUSBAND. 15. The proposed plenary guardians have no interest adverse to the alleged incapacitated person. 16. No other court has ever assumed jurisdiction in any proceeding to determine the capacity of the alleged incapacitated person. 17. No other guardian has been appointed for the estate or person of the alleged incapacitated person. 18. MR. BERRIOS HAS ALL HIS PERSONAL FUNDS IN THE ACCOUNT OF LUCINDA K. BERRIOS. AND IS UNABLE TO ACCESS ANY FUNDS TO PAY HOUSEHOLD BILLS, AND FOR MEDICATIONS FOR HIS WIFE. WHEREFORE, Petitioner respectfully requests that this Court issue a Citation, directed to the alleged incapacitated person, with notice thereof to be given to her next of kin and to such other persons as this Court may direct, to show cause why LUCINDA K. (ZAMIR) BERRIOS, should not be adjudged fully incapacitated and TY AARON BERRIOS should not be appointed plenary guardian of her estate and his/her person. Respectfully submitted, ~~~ TY AARON BERRIOS ~--- MARRIAGE CERTIFICATE License Number: Z-15-440 1, REVEREND DR JOHN FORDON hereby certify that on June 10, 2006 at CAMP HILL PA TYAARONBERRIOS and LUCINDA KHATIJA ZAMIR were by me united in marriage, in accordance with license issued by the Clerk of the Orphans' Court Division of the Court of Common Pleas of Dauphin County, Pennsylvania. Certified from the record June IS. 2006 j/1 G~if Q. ~ . p F'~ Clerk of the Orphans' Court Division REVEREND DR JOHN FORDON Officiant ~Triang~e Refrigeration Co. ~ Earnings Statement P.O. Box 487 3200 Oregon Pike Check Date: June O5, zoo9 Leola, PA 17540 Period Beginning: May 16, 2009 Period Ending: May 29, 2009 Ty A Berrios Employee Number 228 Earnings Rate Hours Amount YTD Hrs YTD Amt Reg 21.00 58.17 1221.57 130.92 2749.32 O"C _ _. 31.50 1.00 31.50 3.83 120.65 Total Gross Pay 59.17 1253.07 134.75 2869.97 Batch Type Hourly Voucher Number 6886 Dept 004 Net Pay 1,089.72 Check Amount Taxes Status Taxable Amount YTD Amt Medicaze 1253.07 18.16 41.61 OASDI 1253.07 77.69 177.94 PA SUI - EE 1253.07 0.75 1.72 Manheim T. (Lancaste 1253.07 12.53 28.70 Manheim T.(Lancaster 1253.07 2.00 4.00 Pennsylvania SITW 1253.07 38.47 88.1 ] Federal Income Tax M/4 1253.07 8.58 59.29 Total Taa Withholding 158.18 401.37 Deductions Amount YTD Amt Account Receivable 5.17 5.17 Total Deductions s.17 5.17 Direct Deposits Account Amount xxxxx2955 xxxxxx1426 1089.72 Total Direct Deposits los9.7z i3enei-t~ Hours Amount YTDHrs YTD Amt Accruals Dollars // 6 3136112 7 8 9 ~f,CGI/lCClli ~ f7Q/JZ!/'' / <S2 ?~~ii//z//a~~f'/~O~~r ~/'~~~ G!C/7Z~1 /LC(G =GCG >7"O~ 9 DATE z PAY TO THE ORDER OF - _ pp s DOLLARS L!J a .~~~..~ r, ~ I~1M&T Bank i ~ ~eh~~~ o~~ ~~ MEMO ------ -------___-----------`----------------------- I~~! I:03~3029551: 983043~426~~'0789 ~. - --- Susan L. Thornsley MD Adolescent & Adult Psychiatry INVOICE , Name: ~~~~~~ j~Date: ~~~~ Address: Diagnostic Code: ~ ~~ Service Provided: ~~ ~,"v Fee: ~ ~ U~ Previous Balance: Total Amount Due: ~-~~' Paid: ~-~~ Current Balance: Next Appointment - ~~ Susan L. Thorn y M.D. License # MD-03 NPI # 184-122-2650 2448 Walnut Street Harrisburg, PA 17103 Telephone (717) 233-7499 Fax (717) 233-7498 Employer Identification Number 03-0442279 FORM 040592 R/03/OB ITEM 8101