HomeMy WebLinkAbout04-0504HAT 2 8 2004
IN RE: Georgianna Kramer
an Alleged Incapacitated
Person
· IN THE COURT OF COMMON PLEAS
COUNTY, PA
· ORPHANS' COURT DIVISION
· 'zi
'GUARDIANSHIP
ORDER OF COURT
AND
Petition, and pursuant to 20 PA. C.S.A.~13§ 55 , this Court appoints Dennis Marion,
Emergency Guardian of the Estate and Person of Georgianna Kramer, an alleged
incapacitated person.
IT IS FURTHER ORDERED THAT:
Dennis Marion is appointed Guardian of the Person and Estate of Georgianna Kramer
so as to permit Dennis Marion to handle Ms. Kramer's discharge from hospital and admission
to a nursing facility upon her discharge from the hospital. The Guardianship shall terminate
and no report, other than submission of a copy of the discharge and admitting forms to be
placed with the Register of Wills, shall be required.
This guardianship appointment shall terminate at such time as the admission is
complete unless a twenty day extension is requested.
IN RE:
Ms. Georgianna Kramer
an Alleged Incapacitated
Person
· IN THE COURT OF COMMON PLEAS
· CUMBERLAND COUNTY, PA
· ORPHANS' COURT DIVISION
'NO.
'GUARDIANSHIP
PETITION FOR APPOINTMENT OF
AN EMERGENCY GUARDIAN PURSUANT
TO 20 PA. C.S.A. § 5513
1 ) Petitioner:
Petitioner:
Address:
Robert L. O'Brien, Esquire
19 West South Street, Carlisle, PA 17013
717-249-6873
2)
The Alleged Incapacitated
Name:
Age:
Address:
3) The Alleged Incapacitated
Spouse:
Children:
Parents:
Kramer for years
Address:
Person:
Georgianna Kramer
45 DOB 10/7158
110 Neil Road
Shippensburg, PA 17055
Person's Heirs: ',', : '.,
none
none
, Father address unknown, has had no interest in Ms.
, Mother
Other: None known
4) Residential Services Provider: CPARC had provided services and Ms. Kramer is
currently in Hershey Medical Center but has to be discharged to Claremont Nursing Home.
5) Other Providers of Services: Cumberland/Perry MHMR
I verify that the statements made in the foregoing Petition for Appointment of an
Emergency Guardian Pursuant to 20 PA. C.S.A. § 5513 are true and correct to the best of my
knowledge, information and belief. I understand that false statements herein are made
subject to the penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities.
Robert L. O'Brien, Esquire
Dated:
Cumberland &'Perry Counties'
Mental Health and Mental Retardation Program
Empowering and supl~orting individuel$ In the community with
Mental Health & Mental Retardation needs
FAX TRANSMISSION
Fax #:
From: ~.~;ff~
Pages: ~ , including this cover sheet.
COMMENTS:
The information contained in this facsimile message may be privileged and/or confidential to
Cumberland/Perry Mlrl/MR. Suet~ information is intended only.for the use of the individual or
entity named above, If the reader of this message is not the intended recipient or the
employee/agent responsible to deliver it to the intended recipient, you are hereby notified that any
dissemination, distribution, or copying of this communication is strictly prohibited, l~fyou have
received this communication in error, please notify us by telephone at (717) 240-6320 and
return tl~e original message to us at thc above address v/a the U.S~ Postal Scrv-/ce.
Suite 30t, 16 W High St, Carlisle PA 17013-2963
Carlisle: 717.240.6320 * West Shore: 717,697.0371 Ext. 6320 * Shippensburg: 717.532,7286 Ext 6320
Perry County; 866.240.6320 · Fax.' 717,240.6415 * E-Math
0~/27~2004 10~4~ 7172~06415 C~M~ PER~¥ ~HMR P~O~ P~E 0~0~
Cumberland & Perry Counties'
Mental Health and Mental Retardation Program
Empowering and supporfing individuals in the community with
Mental Healtt~ & Mental Retardation needs
May 27,2004
Mr. Robert L. O'Brien
Attorney at Law
I0 W South. Strect
Carlisle, PA 17013
RE: Ms. Georgianna Kram.er
.Dear Mr. O'Brien:
[ am. including the Petition for Appoi.ntment of a. Temporary Guardian of thc Person
Pursuant To 20 PA C.S.A. 5513 for Ms. Kramcr. Should Cm'nberland County Mental
Healtlt/Mental Retardation pursue Permanent Guardianship for Ms. Kroaner, since her
:physician stated that her level of fimctioning will only decrease from the present?
Clammon.t Rehabilitation Center has agreed to admit Ms. Kramer upon our offce
pursuing temporary guardianship,
I appreciate your time and patience in this matter. Thank you very much.
Sincerely,
Shirley Howell
Supports Coordinator Supervisor
SUite 301, 16 W High St, Carlisle PA 17013-2963
Carlisle: 717.240.6320 · West Shore: 717,697,0371 Ext, 6320 · -~h[ppe~lsburg: 717,532.7286 Ext 63;~0
Perry County; 866.2~,0,6320 * i=ax; 717.2,~0.641.~ * E-Malh ~_C.~A.NET-
05/27/2004 10:49 7172406415 CUMB PERRY MHMR PROG PAGE 03/09
IN THE MATTER OF
IN THE COURT OF COMMON PLEAS
COUNTY, PENNS Y-LVANIA
ORPHANS' COURT DIVISION
.IN RE NO.
PETITION FOR APPOINTMENT OF A
TEMPOtL~_ Ry GUARDIAN OF THE P~-~ON
PURSUANT TO 20 Pa, C.. -.S.A, 55'13
The Petition of_ ~ ~ ~ ~ _, respectfttlly represents:
1, Your Petitioner is
/B~ · ~ g.~ [ &/t~X..~[.~(,,~~ is currently receiving care at
fl4.,,I. ~ domiciled at
~tj'. t.t..,~.~ is 'ff __ years orag~
having been bom on I~ t~/_t q ~-~' ..
__ marital status is
i c__
rho.~e pe~o~s, ir,~ny, who .~rc ~r-~.*~'t~ _/~~ *~,.Z. ~ext-or-
kin and their relationship to same, of whom. your Petitioner has ~owledge are ~
10.
11,
12.
No other Court within the Commonwealth of which .Petitioner has kaowledge has
appointed a guardian for ~ ' ~
__/FI~- ~ __ is mentally retarded..
Because of mental deficier~ey,. //A.d - ~ . .. __ lacks
sufficient capacity to make or communicate responsible decisions concerning his/her
person as set forth in the attached Affidavit prepared by ~ ~~
marked, as E×hibit A and made a part hereof.
fflJ I~~ is in need of esidential__~enta)
has been accepted forplacement
~'~ _upon
J I
tl~e condition that a guardian of the person be appointed to consent to said placem~t
on his/her behalf.
I - _,. g .o interest adverse to
~/J' ~ ._, has agreed to act as Temporary Guardian of the
Person of ~1~ i ~ ifttfis Honorable Court sha,, so
appoint,
WHEREFORE, Petitioner prays this Court . place
- _, p ant to 20
Pa. C.S,A. § 5513 and empower said temporary guardian to provide substitute consent .for such
community-based or institutional services as may be necessary to prov/de for h/s/her needs.
BY:
I'IHY-~b-2UUtt '/'UP'
7172406415
TH FLOOR ~D SURG
CUMB
PERRY MHMR PROG
?R~ NO, 717~315317
PAGE
P,
PENN~TATE
Il~ilton ~ I~m,.h~y, Medical Center.
College of Medicine
6* Floor Nursing
?SHMC Mail Code H122
500 University Dr.
PO Box 850
Hershey, PA 17033
Phone 717-531-8826
Fax 717-531.5317
Date:
T~m¢ (am/pm)
Re:
Facsimile Cover Letter
---------- Authorized Recipient Information
Intended ~ient: -- ~
)ient's Address ·
,,ent~ [e Nnmbe~
Orig in_~_~nto_r'.$ lnf_o, rmation
Telephone Number ~2'5.["" ~_.S'~,L:-, ._~__~.~0. t' ~ J'-7
Facsimile Numbe--~"---'-
left r):
cover e · - --------..-__
****+*****CONFIDENTIALITY STATEMENT**********
Please notify us immediately if you received th~ commumcation In error
Ibc doctunents accompanying this fax transmis.qion contain information from the
Penn State Milton S. Hershey Medical Center and may be co.nfideotial and/or privileged..
The information is intended only for the use of the individual or entity named on this
transmission letter. If you are not the intended recipient, you are hereby notified that any
disclosure, copying, distribution, or the taking of any action in reliance on the contents of
, this information is strictly prohibited.. Thank you,
N~¥-25-2004 ?UE 01;07 ?~ 6 T~ FLOOR HED SURg
0~/25/20~4 ~2116 717240641~
CUMB PERRY MHMR PROG
FAX NO,
P~GE 86/89
?, 02
PA~E ~2/e4
THE COURT OF COMMON PI,gAS
COUNTY, P,F2qN~IYLV A_NIA
ORPHANS' COLrRT DIV~ION
1N 1t~ NO.
COMMONW~ALTM OF PRNNSYLVAN~A : :
and s~y that;
(Stax).., ~ , who Was a~i~ed
~o wlth a h~ory of
NAY-25-2004 TUE 01:07 PM 6 ?H FLOOR
05/25/2~04 12:16 7172486415
CUMB PERRY MHMR PROG
F~X NO. 7175215317
Ct]MB PE;~Y NHN~ PROG
PAGE 87/89
?, 03
PA6E 04! 84
,~m ~h{ch th~ dia¢od=
with
gat4z cee...,]
On the b~sis ofth~ ~otegotng history and ~xallqirmtioa, the ~e~t is oftE~ opi~{o~
~ctmt e~aclty ~ ~k~ or co~i.~ ~o~s~le decisions
cl~oiee to receive ~munity.-bas~. or i~imti~al s~ices for th~
B~at~ o~ ~,e ph~l or men~t e~dJ,fio~ of ~aid paget. ~is~
wo~Wwould not be Bmm.o~d By hi.er ~rmgeneo i~ Cou~
NOTARY
! .....
Client:
Birth Date:
Age:
Education:
R~femng
Case Manager:
Evaluation Date:
PSYCHOLOGICAL EVALUATION
10/7/58
43
.10th
C? MIt/MR
Kelly Cook
9/6/02, 9/20/02
Referral Information. Crcorgianna has been referred for a .psychologica/evaluat/on to help
determine intellectual and aciap0ve functioning toward qualification for county services.
Assessment Tools. Observation and Interview, Bender Motor Gestalt Test, Wechsler Adult
Intcll/gcncc Scalc-//I.
Observation. Georg/mma pre, sented in casual attire as a woman of short stature and moderately
excesskvc weight, Mobility was sOmewhat labored. Thc ftrst day thc evaluation was only partial~r
completed duc to Cvcorgianna's ambivalence about being labeled "retarded. - She said many
"i'm not .retarded. I am slow. Do ! hav~ to do th/s?~ She a/so complained about not having her
glasses that day. Th, second day of the evaluation her driver Leo Goodman. was pmaent for
support. She also brought her ~-Iaqscs She indicated that she had problems sleeping the night
be£ore. ~ - -
Gcorgianna commtm/cated with clear speech, and she was marginally informative. She had
difficulty retaining even brief/retract/OhS and explanations, and constant rem/nders were requ/rcd
during the testing. Her abil/ty to process was inconsistent; for example, she knew that there were
12 .months in a year and what to do with an addressed stamped cnv¢iol~c' but she was unable to
accurately state her age or to idenlffy the common category for yellow/green as colors. Task
pemistence was adequate, and she did extmd hcrse/f beyond the standard time limit on two hands-
on items.
Interview. Georgiarma res/des at Safe Harbor following approximately one year of incarceration.
The rca, on had zorn,thing to cio with a hoydend with whom she had lived in Mechanicsburg.
She has a parole officer. She indicated that ho' mother i~ d~ceased and that her fath~ and three
sib//ngs do not v/sit. Th/z makes her ~ad. She named a friend at Safe Harbor as Ch~, but she
seemed confi~¢d, unhappy, and very needy about relationsh/ps. She cried last n/ght because,
thought I had a boy~enc["
No laundry/s/mmediately ava/lable at Safe Harbor, and she washes her under clothes in her room.
She ha~ a bath and shower. It/s not clear how often someone provides tranzporrat/on for the
laundry or shopping or how much help Georg/anna requires. It/s not clcar how often she/s
eating. People bring apples to the shelter, and she mentioned having a microwave, and she can
cook macaroni, pancakes, and similar foods. C-eorgianna mentioned that her legs stiffen and swell-
up. She takes medication for t/tis condition. She takes Advil for headaches.
Socially., Ge~ indicates that she'does not get/nto arguments with othe~, although, "Some I
like, some I don't like." She recalled being "stabbed with needles" before she quit school in 10th
grade. She has experience working as a bagger at G/ant, but the time frame/s unclear_ She
mentioned attending a bible study, but again the t/me frame is unclear.
Standardized Assessment. I(~ and subtest scaled scores follow for the W___AIS,Iff: Verbal IQ-57,
Performance IQ-58, F'~5~"~9. Verbal Tests: Vocabulary-3, Sim/lag/t/es-2, Arithmetic-3,
Digit Spanl3, Information-2, Comprehension-5. Performance Tests: Picture Cotnpletion-4, Digit
Syrnbol-Coding. 1, Block Des/gn-3, Matrix Reasoning-3, Picture Arrangement.5. These measures
of ¢ogrfitive skills suggest function/rig at the lower end of mild mental retardat/on.
Georg/anna was resistant to making a human figure draw/rig, but she did attempt to draw the
Bend~ figures which are USed to screen for a neurological factor. Her effort .indicated in tact
Spatial orientation (left/right, top/bottom), but consistent with level of intellectual funet/oning there
were some d/fficulties with maintaining gestalt and with pofftts of contact and detail a~uracy.
D/agnostic and Clinicafl Impressions. Both formal scores and adapt/w sk/ll suggests ~tal
i-~a~ dati'~£~-a ~-/-.oFcomplicated by a language disorder (315.3 I). Georgianna is an had/v/dual with
substantial needs 'who cou/d very much benefit flora serv/ces that are ava/fable to persons with
multiple intellectua/and adapt/ye linaitatiom.
Psyeholog/st
OAP/PsyEval/CP1Vff-IMR/G-~orgian~na~am~r 9/20/02 2
JUN U~ 2004
IN RE: Georgianna Kramer
an Alleged Incapacitated
Person
· IN THE COURT OF COMMON PLEAS
COUNTY, PA
· ORPHANS' COURT DIVISION
· NO. 21-04-504
-GUARDIANSHIP
ORDER OF COURT
AND NOW, this I" day of __~'~-- ,2004, upon
review
of
the
attached Petition, and pursuant to 20FA. C.S.A. § 5513, this Court appoints Dennis
Marion, Emergency Guardian of the Estate and Person of Georgianna Kramer, an
alleged incapacitated person.
IT IS FURTHER ORDERED THAT:
The Guardianship shall appointment shall terminate at 11:44 a.m. on June
20,2004, and no report, other than submission of a copy of the discharge and admitting
forms to be placed with the Register of Wills, shall be required.
IN RE:
Ms. Georgianna Kramer
an Alleged Incapacitated
Person
: IN THE COURT OF COMMON PLEAS
:CUMBERLAND COUNTY, PA
: ORPHANS' COURT DIVISION
: NO. 21-04-504
:GUARDIANSHIP
PETITION FOR AN EXTENSION OF APPOINTMENT OF
AN EMERGENCY GUARDIAN PURSUANT
TO 20 PA. C.S.A. § 5513
1. Petitioner is Robert L. O'Brien, Esquire, attorney for the Cumberland/Perry
MHMR Office. Petitioner obtained a 72 hour appointment of a Guardian for Ms. Kramer
on May 28, 2004. The Claremont Nursing Home has refused to admit Ms. Kramer to
their facility upon her discharge from the Hershey Medical Center.
2. Section 5513 permits an extension of 20 days after the initial 72 hours has
elapsed. The initial 72 hours ended on May 31, 2004, at 11:44 a.m. An extension to
11:44 a.m., June 20, 2004 is requested.
WHEREFORE, Petitioner respectfully requests that Dennis Marion be appointed
guardian of the estate and person of Georgianna Kramer for an additional 20 days.
Respectfully submitted,
O'BRIEN, BARIC & SCHERER
Robert L. O'Brien, Esquire
Attorney for Petitioner
I.D. # 28351
17 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
I verify that the statements made in the foregoing Petition for an Extension
of Appointment of an Emergency Guardian Pursuant to 20 PA. C.S.A. § 5513 are true
and correct to the best of my knowledge, information and belief. I understand that false
statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to
unsworn falsification to authorities.
Robert L. O'Brien, Esquire
Dated: (~ll [0u~
IN RE: Georgianna Kramer
an Alleged Incapacitated
Person
· IN THE COURT OF COMMON PLEAS
COUNTY, PA
· ORPHANS' COURT DIVISION
'NO.
·GUARDIANSHIP
ORDER OF COURT
AND NOW, this ?"~ TAJ ,_.{
day of ~ Pr ,2004, upon review of the attached
Petition, and pursuant to 20 PA. C.S.A. § 5513, this Court appoints Dennis Marion,
Emergency Guardian of the Estate and Person of Georgianna Kramer, an alleged
incapacitated person.
IT IS FURTHER ORDERED THAT:
Dennis Marion is appointed Guardian of the Person and Estate of Georgianna Kramer
so as to permit Dennis Marion to handle Ms. Kramer's discharge from hospital and admission
to a nursing facility upon her discharge from the hospital. The Guardianship shall terminate
and no report, other than submission of a copy of the discharge and admitting forms to be
placed with the Register of Wills, shall be required.
This guardianship appointment shall terminate at such time as the admission is
complete unless a twenty day extension is requested.
BY THE COURT,
TRUE COPY FROM RECORD
in Testimony wherof, I hereunto
set my hand and the seal
°f. zs~d Court at Carlisle, PA
Cumberland Counly
IN RE: Georgianna Kramer
An alleged incapacitated person
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
:
: NO. 21-04-504
IMPORTANT NOTICE
CITATION WITH NOTICE
A petition has been filed with the 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
Robert L. O'Brien is attached.
You are hereby ordered to appear at a hearing to be held in Court Room No. 5, Cumberland
County Courthouse, Carlisle, Pennsylvania, on Monday August 23 ,2004, at 1:00 P.M. to tell the
Court why is 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 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 of 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 to 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.
Date:07-29-2004
Cler}, Orphans' Court Division
Cumberland County, Carlisle, PA
My Commission Expires 1st Monday,
January, 2006
JUL 2 6 2004
IN RE: Georgianna Kramer
an Alleged Incapacitated
Person
: IN THE COURT OF COMMON PLEAS
COUNTY, PA
: ORPHANS' COURT DIVISION
: NO. 21-04-504
: GUARDIANSHIP
TO GEORGIANNA KRAMER
IMPORTANT NOTICE
CITATION WITH NOTICE
A petition has been filed with this Court to have you de.c~.~d a~
Incapacitated Person. If the Court finds you to be an Incapacl~t~d P~on,
rights will be affected, including your right to manage money ~id prol~rty
make decisions.
A copy of the Petition which has been filed by Robert L. O'Brien:;is at~che~
You are
f- hereby ordered to appear at a hearing to be held in Courtroom No.
~.~, Courthouse, Carlisle, Pennsylvania, on ~., the~'~._day of~
2004,, at/.~_~li~.M, to tell the Court why it should not find ~rou 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 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.,g,r,~-a~attorney
representing you) the Court will still hold the hearing in.,~r abs,enc~ and may appoint
the Guardian requested. ~~
By: ~"~ \ \
J.
IN RE:
Ms. Georgianna Kramer
an Alleged Incapacitated
Person
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PA
: ORPHANS' COURT DIVISION
: NO. 21-04-504
: GUARDIANSHIP
PETITION FOR AN APPOINTMENT OF
A GUARDIAN PURSUANT
TO 20 PA. C.S.A. § 5511
1. Petitioner is Robert L. O'Brien, Esquire, attorney for the Cumberland/Perry
MHMR Office. Petitioner obtained an emergency appointment of a Guardian for Ms.
Kramer on May 28, 2004 and on June 1, 2004.
2. Attached hereto is the original Petition filed that provides information
about Ms. Kramer. The MHMR office has determined that Ms. Kramer would benefit by
having a permanent Guardian of the Estate and Person.
WHEREFORE, Petitioner respectfully requests that Dennis Marion or his
successor as Director of the MHMR office, be appointed Plenary Guardian of the
Estate and Person of Georgianna Kramer.
Respectfully submitted,
O'BRIEN, BARIC & SCHERER
Robert L. O'Brien, Esquire
Attorney for Petitioner
I.D. # 28351
17 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
I verify that the statements made in the foregoing Petition for an
Appointment of an Plenary Guardian Pursuant to 20 PA. C.S.A. § 5511 are true and
correct to the best of my knowledge, information and belief. I understand that false
statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to
unsworn falsification to authorities.
Robert L. O'Brien, Esquire
Dated:
IN RE:
Ms. Georgianna Kramer
an Alleged Incapacitated
Person
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PA
: ORPHANS' COURT DIVISION
:NO.
: GUARDIANSHIP
PETITION FOR APPOINTMENT OF
AN EMERGENCY GUARDIAN PURSUANT
TO 20 PA. C.S.A. § 5513
1) Petitioner:
Petitioner:
Address:
Robert L. O'Brien, Esquire
19 West South Street, Carlisle, PA 17013
717-249-6873
2) The Alleged Incapacitated Person:
Name:
Age:
Address:
Georgianna Kramer
45 DOB 10/7/58
110 Neil Road
Shippensburg, PA 17055
3) The Alleged Incapacitated Person's Heirs:
Spouse:
Children:
Parents:
Kramer for years
Address:
none
none
, Father address unknown, has had no interest in Ms.
, Mother
Other: None known
4) Residential Services Provider: CPARC had provided services and Ms. Kramer is
currently in Hershey Medical Center but has to be discharged to Claremont Nursing Home.
5) Other Providers of Services: Cumberland/Perry MHMR
6) Proposed Guardian:
The petitioner, Robert L. O'Brien, Esquire, of MHMR, requests the
appointment of Dennis Marion, Director, Cumberland/Perry MHMR as guardian
of the estate and person of Georgianna Kramer.
7) Averment of Disinterest:
The proposed Guardian has no interest adverse to that of Ms. Kramer.
8) Reasons Why Guardianship is Requested:
To assist in medical decisions, collect benefits and insure availability of all
possible resoumes for Ms. Kramer's care and treatment. She also is being
discharged from the hospital and papers have to be signed in connection with
discharge and transfer to Claremont.
9) Functional Limitations and Physical and Mental Condition:
see attached report, basically, mild mental retardation
10) Value of Estate:
Gross value: 0
Income: SSI.
Financial
Obligations: Cost of care.
WHEREFORE, Petitioner respectfully requests that Dennis Marion be appointed
guardian of the estate and person.
By
Respectfully submitted,
O'BRIEN, BARIC & SCHERER
Robert L. O'Brien, Esquire
Attorney for Petitioner
I.D. # 28351
17 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
I verify that the statements made in the foregoing Petition for Appointment of an
Emergency Guardian Pursuant to 20 PA. C.S.A. § 5513 are true and correct to the best of my
knowledge, information and belief. I understand that false statements herein are made
subject to the penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities.
Robert L. O'Brien, Esquire
Dated:
05/2?/2004 10:49 7172406415 CUHB PERRY HHHR PROG PAGE 01109
Cumberland &'Perry Counties'
Mental Health and Mental Retardation Program
Empowering and supporting individuals in lhe community with
Manta/Health & Mental Retardetlon needs
FAX TRANSMISSION
Fax #:
$.bject:
Pages: ~ , includi.ng this cover sheet.
COMMENTS:
The information contained in this facsimile message may be privileged and/or confidential to
Cumberland/Peaxy M'HfMR. Such information is intended only for the use of the individual or
entity named above. If the reader of this mes6ag¢ is not the intended recipient or the
employee/ag,hr responsible to deliv*r it to the imended recipient, you are hereby notified that any
dissemination, distribution, or copying of this communication is strictly pro]'dbited. If you have
received this communication in error, plea.ye notify It~ by telephone at (717) 24e0-6~20 and
rerm, n the original message to us at the above address v/a the U.$~ Postal SCrmce,
Suite 30t, 16W High St, Gar[Isla PA 17013-2963
Carlisle: 717.240,6320 · West Shore: 717.697.0371 Bxt, 6320 · Shippensburg; 717.~32,7286 Ent 6320
Perry County; 866.240.6320 ' Fax: 717.240.6418 * E-Mall: ~
85/27/2884 18:49 7172486415 CUMB PERRY MHMR PROG PAGE 82/89
Cumberland & Perry Counties'
Mental Health and Mental Retardation Program
~mpowe,~ng and supporting individuals in the community witl~
Mental Heal~l~ & Mental Reterclatlon needs
May 27, 2004
Mr. Robert L, O'Brien
Attorney at Law
10 W South Street
Carlisle, PA 17013
RE: Ms. Georgianna Kramer
Dear Mr. O Bnen
! am including the Petition for Appointznent ora Temporary Guardian of thc Person
Pursuant To 20 PA C.S.A, 5513 for Ms. Kramer. Should Cumberland County Mental
Health/Mental Retardation pursue Permanent Guardianship for Ms. Kramer, since her
physician stated that her level o£ ftmctioning will only decrease from the present?
Claremont Rehabilitation Center has agreed to admit Ms. Kramer upon our office
pursuing temporary guardianship.
I appreciate your time and patience in this matter. Thank you very much.
Sincerely,
Shirley Howell
Supports Coordinator Supervisor
Suite 301, 16 w High St, Carlisle PA 1701 ~-2063
Carlisle: 717,240.6.!120 · West Shore: 7t?.697,037t Ext. 6320 · Shippe~sburg: 717,532.7286 Ext 6320
Perry Cour~ty: 866.240,6320 ~' Fax; 717.240.6a15 ~ E-MaII:~
05/27/200~ 10:49 7172406415 CUHB PERRY HHHR PROG PAGE 03/89
IN THE MATTER OF
AN ALLEGED [NC OMPETEN T -
IN THE COURT OF COMMON PLEAS
COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN KE NO.
The Petition of ....
1.
PB rrrlON FOR APPOiNTMeNT OF A
TEMPORARY GUARDIAN OF THE PERSON
PURSUANT TO 20 Pa. C.S.A, $51~33
~ f['~ ~{..4. ~/'1~ respectfully represents:
Your Pctitioner is
~~--' is currently receiving care at
domiciled at
~f years of age
status is
having been bom on
marital
kin and their relationship to same, of whom your Petitioner h~ ~owledge are ~
ronow~: ~~ ~ ~ ~ ~ ~
10:49 7172486415 CUMB PERRY MHMR PROG PAGE 04/09
10.
11.
12.
No other Court within the Commonwealth of which Petitioner has knowledge has
appointed a guardian for ~ ' ~
Because of mental deliciency,
is mentally retarded.
lacks
sufficient capacity to make or communicate responsible decisions conceming his/h er
person as set forth in the attach ed Affidavit prepared by
marked as Exhibit A and made a part hereof. ._
is
ices.
at
in need of reaidential--~enta'l .~
has been accepted forplaeement
~ upon
the condition that a guardian of the person be appointed to consent to said placement
on his/her behalf.
Person of ~rll i ~._.
rt/~'~.- , having no interest adverse to
, has agreed to act as Temporary Guardim of the
if this Honorable Court shall so
appoint,
WHEREFORE, Petitioner prays this Court place
Pa. C.S,A. § 5513 and empower said temporary guardian to provide substitute consent for such
community-based or institutional services ~s may be necessary to pro'e/de for his/her needs.
BY:
.05/27/2004 10:49 7172486415 CUNB PERRY NHNR PROG
na¥-zo-~uu~ 'ru~ gl;06 ?H 8 TH FLOOR ~D SUR8 FAX NO, 717S315317
PAGE 85/89
P, 0~
PENNSTATE
College of Medicine
6~b Floor Nursing
PSHMC Mail Code H122
500 University Dr.
PO Box $$0
Hershey, PA 17033
Phone 717-531 q~826
Fax 717-531~$317
Date:
Tinlc (am/pm)
Facsimile Cover Letter
~ ~d Recipient Inform ttan
~ ~ inntor's Info~nt~'~
O~flfl~or~ ~hnn~ Nnmhs~ ~~-7 ~ _
Re:
Page ~ount (including ~vot [eRcr)~
Notes:
*** * * * * ** *CONFIDEYrlALITY STATEMENT*****+****
Please notJ£y us i~mediat¢ly i~'you received thi~
The d~umen~ accomp~y~g this f~ tr~mis~Jon con~n info~aQon ~om
Pc~ 8tm¢ ~lton 8, Hershey Me~cal Center ~d may be confidentNl ~Wor privileged.
~e igo~a~on is intend~ only for ~e ~c of~e individ~ or
tr~sml~ion lo~r If you
. ~e not the Mtend~ ~ciplent, you ~e hereby noticed ~at ~y
disclosure, copying, distributio~ or ~e ~mg of any action in roll,ce on the contenB of
, ~is infomation i$ strictly prohibited. ~k you,
.85/27/280~ 18:49 7172485415
MaY-a5-~004 TUE 01;07 PM 6 TH FLOOR NED SURE
05/25/2864 12118 71724~6415
CUMB PERRY MHMR PROG
F~X NO, 7175915317
PAGE 05/09
P. 02
P~E 8~184
I~T T~ MATT~P~ O~
~ ALI.,~oI~D INC OMP,~,T~'lC'r
~ COUItT OF COMMON PLEAS
COUNTY, pEN'NSYT.,V A-,NI A
OI~PHA-N$' COURT DIVI~ION
IN I~NO,
COUNTY
1.
~-"-¢')cQ ~ H J"A. J IO ~. being duly sworn according to law, d~osms
J
,,j
($,~x,)~ ~' . who wss
k'~a,me.,r' , (,~) d'-/
~5/2~/200~ 10:49 7172406415
~Y-25-200~ TUE 01:07 PH 6 TH FLO0~
05/~6/2~04 12:16
CUMB PERRY MHMR PRDG
F~X NO. 7175315317
PAGE 87/89
P, 03
PAGE 04184
O~ the basis oft~ae foregoing history and cxar~inafioo,
m~d~t c~as[ty ~ ~kc o~ c~u~[c~o~le d~isio~s
choic~ to recurs c~muniV--b~ed or i~{m~al ~ices for ~ m~ ~.
~a~ Of te phial or men~l C~J~ of s~d p~ ~s~ We~e
w~Wo~d ~ot be p~momd by hi.er ~co ~ COU~
05/Z'~/2004
10:49
7~724064~5
CUMB PERRY MHMR PROG
PAGE 08/09
Client:
Birth Date:
Age:
Education:
Case Marogen.
Evaluation Date:
PSYCHOLOGICAL EVALUATION
10/7/~g
43
10th
CP MH/MR
Ke~y Cook
9/6/'02, 9f20t02
Referral Information. G-eorgianna has been referred for a psychological evaluation to hclp
determine intellectual and adaptive · · .
functaoning toward quatificat/on for county services.
AsseSsment Tools. Observation and Lnter~ew, Bender Motor Gestalt Tesg Wechsler Adult
LnteJligence Seale4II.
Observation. Ge, org/anna presented ia casual attire as a woman of short stalure and moderately
excessive weight, Mobility was sOmewhat labored. The fi~t day the ~"/aluation was only partia~y
completed due to Cveor~ianna's ·
a~bivalence about being labeled "retarded." She said many
"Fro not retarded. ! am slow. Do ! have to do this?"
glasses that day. The second day of the evaluation hJhe a/so ~'Omg/ained about not having her
driver Leo Goodman was present for
support. She also brought her ~a~scs She indicated that she had problems sleeping the night
before. -
Georgiamaa commuriicated with clear speech, and she was margina/iy informative. She had
di~¢,ulty retainiag ~ brief/mnruetions and explanations, and constant reminders were required
during the testing. Her ability ·
to process was inconsistent; for example, she knew that there were
12 months in a year and what to do with an addressed stamped envelope, but she was unable to
accurately state her age or to identify the common category for yellow/green as ¢olo~. Task
pe~istencc was adequate, and she did extend herself beyond thc standard time limit on two hands-
on itmms.
Inlet'view. Ge°rgianna resides at Safe Harbor following approximately one year of incarceration.
Thc reason had someth/ng to do with a boyfriend with whom she had lived in Mechanicsburg.
She has a parole officer.
siblings She indicated that her mother ,a deceased and that her father and three
do not visit. This makes her sad. She named a ~Jend at Safe H ·
seemed confused, unhappy, and very needy about relationshln, ~.. __,_ar~b.or~..C~.', but she
thought I had a boy~end.~ ----,--- .~,,- ~,=u ~as~ mgm ~,eeause,
No laundry is immediately available at Safe Harbor, and she washes her under clothes in her room.
She has a bath and shower, It/s not clear how often someone provides transportation for thc
laundry or shopping or how much help Georgianna requires. It is not clear how often she is
IN RE:
GEORGIANNA KRAMER : IN THE COURT OF COMMON PLEAS OF
AN ALLEGED : CUMBERLAND COUNTY, PENNSYLVANIA
INCAPACITATED :
PERSON : ORPHANS' COURT DIVISION
: NO. 21-04-504
IN RE:
hearing,
person.
APPOINTMENT OF GUARDIAN
ORDER OF COURT
AND NOW, this 23rd day of August,
we find that Georgianna Kramer is
Dennis Marion or his successor as
2004, after
an incapacitated
director of the
Cumberland County Mental Health/Mental Retardation Office is
hereby appointed the plenary guardian of her person and
estate.
Edward E. Guido, J.
Robert L. O'Brien,
For the Petitioner
:lfh
Esquire
-
Marjorie A. Wevodau
First Deputy
One Courthouse Square
Carlisle, Pa. 17013
Gienda Farner Strasbaugh
Register of Wills &
Clerk of the Orphans' Court
(717) 240-6345
FAX (717) 240-7797
Kirk S. Sohonage, Esquire
Solicitor
OFFICES OF
l\egister of Wills anb (!Clerk of tbe ~rpbans' ([ourt
([ount!, of ([umberlanb
December 1, 2005
Dennis Marion
One Courthouse Square
Carlisle, P A 17013
IN RE: Estate of Georgianna Kramer, an incapacitated person
File No. 21-04-504
Dear Sir/Madam:
It has come to my attention that you have not filed the guardian reports required
by 20 Pa.C.S.A. g5521(c) in the above captioned guardianship. Enclosed you will find
the suggested formes).
Please mail those reports, along with a check for the filing fee which is $15 for
each report filed, payable to the Clerk of Orphans' Court, to the following address within
(30) days:
Clerk of Orphans' Court
One Courthouse Square
Carlisle, P A 17013
If you have any questions, please contact your attorney.
Respectfully,
iM4I~L t.5t;WVIJ~
Glenda Farner Strasbaugh <. /
Clerk of the Orphans' Court
CC: Robert L. O'Brien, Esquire
,
Clerk of Orphans' Court of Cumberland County
IN RE: ~A- tv;.),,","" ~ JV' ~
An Incapacitated Person
Docket No. ;)./ - Q'-{ - SO +
ANNUAL REPORT OF GUARDIAN OF THE PERSON
T, 1Jr;.JN J.f ~ I 0 -~ , frl1-f. f"I. vZ- th> '" J roll J ~ , was /were. appointed
./
plenary guardian(s) of the person of Gco~Pr,J.N-+ k'tI!.lt /"Vty(./ by Decree of the
Honorable Judge f1>".l"\"vVD &vJ1>O , dated -Avu"'\I.1r 2r7j ')-1rt'-(. This is my annual report for
the period from 11_. &vJ, }-) I otf to _4v(rV{ r ~ I () ~ , ("The Report Period").
~./ )
1.
Present age of the incapacitated person:
47 Yrs.
2. Current address of the incapacitated person
fv'J~ut: HAI"N4 V..-tv-vt.6 NWV-l'''''~ +- rttl4/t-1'-:> >
7~5"'-- Ut.-''i vp ~ ~ 4 >
[,1.. vM.1/ + J (J.It / 7 J-, '}-
3. The incapacitated person's residence is:
0 own home/apartment
~ nursing home
0 boarding home/personal care home
0 guardian's home/apartment
0 hospital or medical facility
0 relative's home
0 other:
(.' ")
I')
(..,,'1
(Name and relationship)
(describe)
4. The incapacitated person has been in the present residence since b/U /0 i . If
, I
the incapacitated person has moved within the past year, state change and reason(s) for
~t
...
change:
5. Name and address of the incapacitated person's primary care giver:
S' u ( ~';G- 11 +J'!JJ1\- V.fh..v ~ )JVvvf I ~ t- yf-(- ~'/ J
74~"'" C~ ~v~ l-b J,-/r yt't;>
0>Ulk ~ I /r. P A- lion )..-
6. The major medical or mental problems of the incapacitated person are as follows:
!1 f !II'~ ~~,+vl> +='\I ~ U>JV v..MI'\J ~ l)t l J'V'l--- ~ ~..c Jv G-
"'RILA-t.,.) ~~ ~;:> 171 o..vA-'l- /V"t::-Dl ~~- CA.w'9IT\D....JJ
ttAvf ! ,.j~t.-tt-) /.,.J<,I...VvkL:' Ifof""/f1:--J.f") r t>1.f~.(l'.J
8.
Specify what, if any, social, medical, psychological and support services the incapacitated
person IS recelvmg: \11t Nw..(/,..h t+vtv'\: ..~ Irr Si 6--"vt..:;) AN m 'P(- j'b fJo J J 'If:-
..("t> c.- t It'". I z-~ ~ d- X P6- ~K. ve...- I fIJ .+01>)1'\ u-..J ,... '4 Cr'n.....wv Cktv6 ..
frk. t/l4~ itt1 ~f"t,JJ ND.JJ - M .[f()#~ I v'~ ~ f+t6,r. c. ~ .
-of o(.,vvf"~ 1l..N./h- "Ptl......~ I H . f tt? w J......tr.r r /1't't. 41/J...tCQ
--f1. &>1"\Jl1 v /OJ, L A-r1./ iAi1 ee~l II t'---O .tv l-0 I ~ C ~"'O ~.r fo,f (~ ,
It is our opinion as guardian of the person that the guardianship should: ( check one)
~ontinue, 0 be modified, 0 be terminated. (Briefly explain your response)
7.
~ J I J>fl. _ 'FJtv.- 1 -0 t^4 "",(j ~ tfl.f-/( ..f'~
~1f.11~ /l-1rl'(.-(; Jl'I""''''~ Pf-r..., r:~E- .
During the past year, I have visited the incapacitated person
av-erage visit lasting
/M,v 1\-H Wl~ ftr J<~j
9.
times with the
~Wt VI[I~ ~I~I e -nw1(...i' -ftJ.l(...( ~. ktZ-~~\J !tt>.MljJ'IC...J)
(Statenu~~o~~,:) t/tv-- Svf(~ c,t>-ND1""~ i~ (/1.('1 ~
~ . _.A' "FV- A;".J ..tv r- A--vt 3" 1lt\.1.,J-J TIr7 t1~ VIi" IT .
N~v6 .s-o T1~~ IJ
I
The report of a social service organization employed by the guardian to oversee and coordinate
the care of the incapacitated person for the period covered by this report may be attached to
supplement this report.
I verify that the foregoing information is correct to the best of my knowledge, information and
belief; and that this verification is subject to the penalties of 18 Pa. C.S.A. 94904 relative to
unsworn falsification to authorities.
i.).. . 3 (,) ~ o-S-
Date
~ L\-::- "'ft.!\'\VV ~""'''\~
Signature of Guardian
* FILING FEE $15 MUST ACCOMPANY THIS FILING.
,
/
INRE:
~ttN.-.J.A- k:e.~
An Incapacitated Person
Docket No.
d-J - 0</ - ~y
ANNUAL REPORT OF GUARDIAN OF THE ESTATE
I, D{.,v.rJ!./ ~-r-J ) I'1H. f\1w A1>,II;- 1""1.f~~ , was /were
appointed plenary guardian(s) of the estate of &~~'"",#.f\...,- Ytl..1-~
by Decree ofthe Honorable Judge flMi+-o lNl'DO . Dated ~ (rvJ r 'J-I) h" '-I. This is mYalll,lual
report for the period from -Avrrv~l PJ o't to Av VVl (" ?- )) oy, ("The Report; Peri04~.
I. SUMMARY
, , ' I
C) -- I
.'
( ,,)
$ 53 {. j ;~~O
0.;
$ 1/ r-J.. ~
A. Value of principal assets at the beginning of the Report Period?
B. Total amount of income earned during the report period?
~~
f
II. ADDITIONAL INFORMATION
A. Principal:
1. Total amount remaining at the end ofthe Report Period?
$ /J'1'1, r?,
2. How is principal currently invested?
~v,..r;- If>~P j..-J C~/'V'G- ~,.w ,
/&-;-
/,?,-r ~AlI~
3. Have there been any expenditures from principal during the Report
Period?
~esONo
If you answered YES, was there Court approval for all expenditures
from principal?
4. Did you receive any principal assets during the report period which
were not included on the inventory or a prior report filed for the estate?
OYes~No
OYes~
If you answered YES, did you receive Court approval prior to receiving
additional principal?
DYes 0 No
5. State the sources and amounts of the additional principal you received:
~/d-
$
$
B. Income:
1. State sources and amounts of income received during the Report Period (i.e., social
security, pension, rents, etc.):
S.fP ~~ r;~r:.)
Jf,.c ~~4-/-)
L --'
$ ~/. ~t:J
$ fr/. Y 6
$
Total Income received during Report Period $ 1/ ?;; . h
2. How is income currently invested? (Please specify, restricted bank accounts, client care
account, etc.)
,
4r1"?7"-J ~ ~7) /~ ~/.r/c.- ~'-J ~
#-r /71'-/ ~.v~.
3. Specify what payments were made for the care and maintenance of the incapacitated
person (i.e., clothing, nursing home, medicine, support, etc.). .y .
~?01. cS--
~W - 4P7~ /"(/- 9/ ~.6) --
" 7/~ 7"9
~, j"~
4~~~~~
~4-z- -~ - ~~;.-
4. Specify what other payments were made during the Report Period.
~qJ7/
.r- ~,/V'~
~ .5ZJ I
0-0
ffl/"2.-//f'Z- ~v}-'\.-~~
JIf., ___
c:;><, /) rJ . -;Q C)
.;
~h~--r-' CJ7z, C:VCv~~~-r 'J't; .Jfr I' /6"rfYo-v
tvtl"h-,-~ - .K'4P/o d-,{. J-(;
I verify that the foregoing information is correct to the best of my knowledge, information and
belief; and that this verification is subject to the penalties of 18 Pa. C.S.A. 94904 relative to
unsworn falsification to authorities.
/eI-' J &:) - oY---
Date
ttJ~.~ ~'A-<- ~"'l""/~
~ure of Guardian
* FILING FEE $15 MUST ACCOMPANY TillS FILING.
Kirk S. Sohonage, Esquire
Solicitor
Marjorie A. Wevodau
First Deputy
Glenda Farner Strasbaugh
Register of Wills &
Clerk of the Orphans' Court
Wanda S. Zeigler
Second Deputy
One Courthouse Square
Carlisle, PA 17013
OFFICES OF
(717) 240-6345
FAX (717) 240-7797
1-888-697-0371 x 6345
3&egister of Wills anb Q[Ierk of tbe <l&rpbans' Q[ourt
<!Countp of <!Cumberlanb
October 8, 2007
Delmis Marion
One Courthouse Square
Carlisle P A 17013
IN RE: Estate of Georgianna Kramer, an incapacitated person
File No. 21-04-0504
Dear Sir/Madam:
It has come to my attention that you have not filed the guardian reports required
by 20 Pa.C.S.A. 95521(c) in the above captioned guardianship. Enclosed you will find
the suggested formes).
Please mail those reports, along with a check for the filing fee which is $15
payable to the Clerk of Orphans' Court, to the following address within (30) days:
Clerk of Orphans' Court
One Courthouse Square
Carlisle, PA 17013
If you have any questions, please contact your attorney.
Respectfully,
u...~~7f
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
CC: Robert L. O'Brien, Esquire
...
ANNUAL REPORT OF
GUARDIAN OF THE PERSON
Q
--::0
-:-]
1'''
r::-:')
t~.: :)
-.I
--J
- c:-:)
"- ,)
--. ..,
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
:"
,
C)
.; ~..
(---')
-- ,
-n
c.)
C,_,
.;:.-~
Estate of Georgianna Kramer
, an Incapacitated Person
No. 21-04-504
I. INTRODUCTION
Dennis Marion as Administrator of Cumberland-Perry MH-MR , was appointed
IZ1 Plenary []Limited Guardian of the Person by Decree of Edward E. Guido , J.,
dated Au~st 31 , 2007
IZI A. This is the Annual Report for the period from September 1 2006
to Au~st 31 , 2007 (the "Report Period"); or
[] B. This is the Final Report for the period from
to
(the "Report Period"), and is filed
for the following reason:
1. The death of the Incapacitated Person. Date of death:
2. The Guardianship was terminated by the Court by Decree of
1., dated
For a Final Report, omit Sections II through IV.
Form G-03 rev. /0.13.06
Page 1 of4
~
'.
Estate of Georgianna Kramer
. an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: 49
Date of Birth: 10/07/1958
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
Susquehanna Valley Nursing and Rehabilitation
745 Chiques Hill Rd.
Columbia, PA 17512
B. The Incapacitated Person's residence is:
D own home / apartment
lZI nursing home
D boarding home / personal care home
D Guardian's home / apartment
D hospital or medical facility
D relative's home (name, relationship and address)
Dother:
C. The Incapacitated Person has been in the present residence since 6/16/2004
. If the Incapacitated Person has moved within the
past year, state prior residence and reason(s) for move:
Form G-03 rev. 10./3.06
Page 2 of4
Estate of Georgianna Kramer
, an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
Susquehanna Valley Nursing and Rehabilitation
745 Chiques Hill Rd.
Columbia, PA 17512
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
A systemic loss of conscious interaction with her environment as well as loss of
mobility and capacity for self care. Specific diagnoses include Amnesia, Aphasia,
Dementia, Hypertension, Mental Retardation and Seizure Disorder.
B. Specify what, if any, social, medical, psychological and support services the
Incapacitated Person is receiving:
MR Supports Coordination
Hospice care
24/7 support for all activities of daily living
Monthly monitoring by primary care physician
Annual eye exam
Dental examination every six months
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
IZI continue
o be modified
o be terminated
Form G-03 rev. 10.13.06
Page 3 of4
.
.
. .
Estate of Georgianna Kramer
. an Incapacitated Person
The reasons for the foregoing opinion are:
Georgianna continues to experience a slow decline in overall functioning,
demonstrates only marginal awareness of her surroundings and cannot participate in
decision making on her own behalf.
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
49
times with the average visit lasting
hours, 30
minutes.
The report of a social service organization employed by the Guardian to oversee and
coordinate the care of the Incapacitated Person for the period covered by this Report may be
attached to supplement this Report.
I verify that the foregoing information is correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties of 18 Pa. C.S.A. ~ 4904
relative to unsworn falsification to authorities.
11 /8/07
Date
Dennis Marion, MH-MR Administrator
Name of Guardian of the Person (type or print)
16 West High St.
Address
Carlisle, PA 17013
City, State. Zip
717240-6320
Telephone
Form G-03 rev. 10.13.06
Page 4 of 4
ANNUAL REPORT OF
GUARDIAN OF THE ESTATE
C)
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~
J.j
f'......)
(:::;,
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:'f~:'
;;:::)
....~~-
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I
CJ
COURT OF COMMON PLEAS OF
Cumberland COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
, ,
~
-0
/,
CJ
W
, f',
~
-
Estate of Georgianna Kramer
. an Incapacitated Person
No. 21-04-504
I. INTRODUCTION
Dennis Marion as Administrator of Cumberland-Perry MH-MR , was appointed
IZJ Plenary D Limited Guardian of the Estate by Decree of Edward E. Guido . J "
dated 8/23/2004
lZI A. This is the Annual Report for the period from September 1 2006
to August 31 . 2007 (the "Report Period"); or
D B. This is the Final Report for the period from
to
(the "Report Period"), and is filed
for the following reason:
1. The death of the Incapacitated Person, Date of death:
Name of Personal Representative:
2. The Guardianship was terminated by the Court by Decree of
1., dated
Fonn G-02 rev. 10.13.06
Page lof5
~-
~""
~.-.,,~
Estate of Georgianna Kramer
, An Incapacitated Person
II. SUMMARY
A. State the value of the estate reported on the Inventory $
B. State the value(s) of principal assets at the beginning of
the Report Period. (Same as Inventory if first Report,
otherwise, ending balance from last Report.)
$
1.267.42
C. What is the total amount of income earned during the
Report Period?
$
139.97
D. What is the total amount of income and principal
spent for all purposes during the Report Period?
$
4.74
E. What are the balances remaining at the end of the Report
Period?
1. Principal $
2. Income $
3. Total of Principal and Income
1.267.42
135.23
$
1.402.65
III. ADDITIONAL INFORMATION
(If more space is needed, please attach additional pages.)
A. Principal
1. How is the principal balance listed above currently
invested? (Please specify, e.g., real estate,
certificates of deposit, restricted bank accounts, etc.):
Checking account
2. Have there been any expenditures from the principal
during the Report Period? ............................ 0 Yes III No
If yes:
a. Have all expenditures from the principal been for
the sole benefit of the Incapacitated Person? . . . . . . .. 0 Yes 0 No
Form G-02 rev. 10.13.06
Page 2 of5
,",_. _ __'r_,-
-.,~
Estate of Georgianna Kramer
, An Incapacitated Person
b. List purpose and amount of expenditures:
$
$
$
$
c. Was Court approval received prior to
expending the principal? ....................... Cl Yes Cl No
3. Were additional principal assets received during the
Report Period which were not included in the
Inventory or a prior Report filed for the Estate? ........... 0 Yes IZI No
If yes:
a. Was Court approval requested prior to
receiving the additional principal? . . . . . . . . . . . . . . .. Cl Yes Cl No
b. State the sources and amounts of the
additional principal received:
$
$
$
$
$
B. Income
1. State sources and amounts of income received
during the Report Period (e.g., Social Security,
pension, rents, etc.):
Refund from overpayment prior period
Interest
$
$
$
$
$
$
139.00
0.97
Total income received during Report Period:
$
139.97
Form G-02 rev, 10,13.06
Page 3 of5
Estate of Georgianna Kramer
, An Incapacitated Person
2. How is income currently invested? (Please
specify, e.g., restricted bank accounts, client
care account, etc.):
Checking account
C. Expenses for Care and Maintenance
Specify what expenditures were made from the principal and
income for the care and maintenance of the Incapacitated
Person (e.g., clothing, nursing home, medicine, support, etc.):
4.74 for personal item to decorate room
D. Other Expenditures
Specify what other expenditures were made during the Report
Period. (Do not include any items stated in response to
question C above.)
E. Guardian's Commissions
List amounts of compensation paid as Guardian's commission
and state how amount was determined:
Amount
Method of Determination
Court
Approval Obtained
DYes DNo
DYes DNo
Form G-02 rev. 10.13.06
Page 4 of5
.
Estate of Georgianna Kramer
, An Incapacitated Person
F. Counsel Fee
List amounts paid as counsel fee, and indicate whether Court approval was obtained.
Amount
Court
Approval Obtained
elYes elNo
elYes elNo
I verify that the foregoing information is correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties of 18 Pa.C.S. ~ 4904
relative to unsworn falsification to authorities. ~_..,
November 8,2007 ) ~A.^ - -- ......:.......
Date L.sa~ ~he Estate
Dennis Marion, MH-MR Administrator
Name of Guardian of the Estate (type or print)
16 West High St.
Address
Carlisle, PA 17013
City, State, Zip
717 240-6200
Telephone
Form G-02 rev. 10.13.06
Page 5 of5
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