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Home My WebLink About12-28-09IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MATTHEW BRINK, an ORPHANS COURT DIVISION Alleged incapacitated person NO.09- GUARDIANSHIP-INCAPACITATED PERSON PETITION FOR APPOINTMENT OF GUARDIAN NOW comes petitioners, LISA A. BRINK and THOMAS S. BRINK, by their attorney, Karl E. Rominger, esquire, and presents this Petition for appointment of guardian of the person and estate of MATTHEW BRINK, representing as follows: 1. Petitioners are LISA A. BRINK, an adult individual residing at 7761 Solid Rock Drive, Alexandria, Pennsylvania 16611-2433 and THOMAS S. BRINK, an adult individual residing at 89 Country View Estates, Newville, Pennsylvania 17241. 2. Petitioners are the natural mother and father, respectively, of MATTHEW BRINK, the alleged incapacitated person, born on December 31, 1991, who resides with his father, Thomas S. Brink. 3. The alleged incapacitated person was seriously injured in an automobile accident which left him with serious medical conditions making him mentally unable to handle his own financial affairs. See Competency Affidavit executed by Dr. Louis Hieb, D.O., incorporated herein by reference and attached hereto as Exhibit "B". 4. The alleged incapacitated person is in daily and immediate needs of medical care and the assistance by Petitioner, Lisa A. Brink to handle his medical care and for proposed guardian of the estate Orrstown Bank to handle his financial decisions and fairs. Bch his r,= ..:~ c~ ~ j_.. r ; medical care and financial circumstances will be seriously impaired if emer~~~.~~lie nod . ~ _ ranted, now that he will no lon er be a minor in December 2009. ~ ~ ~ "~' `~' ~~ ' -,~, y ._.. ,\ 1 V '~ w..' •~...Y'~ f 5. The alleged incapacitated person's natural father, Thomas S. Brink, is agreeable with appointing Petitioner, Lisa A. Brink as guardian of the person MATTHEW BRINK and appointing Orrstown Bank as guardian of the estate of MATTHEW BRINK. An affidavit signed by Thomas S. Brink is attached hereto as Exhibit "C". 6. Petitioner Lisa A. Brink is qualified to make medical decisions and proposed guardian of the estate Orrstown Bank is qualified to make financial decisions. Petitioners have executed a consent to have Lisa A. Brink act as guardian of the person for the alleged incapacitated person and to have Orrstown Bank appointed to act as guardian of the estate for the alleged incapacitated person, which consent is incorporated herein and is attached hereto as Exhibit "D". 7. Petitioners have no knowledge of any other Court within the Commonwealth which has appointed a guardian for the alleged incapacitated person. 8. Petitioners have no interest adverse to the alleged incapacitated person and have agreed to have Lisa A. Brink act as guardian of the person and Orrstown Bank act as guardian of the estate if this Honorable Court shall so appoint. 9. The alleged incompetent has substantial monies and assets in his name, and the same should be frozen pending the outcome of this Petition. HEREFORE, Petitioners respectfully requests this Honorable Court appoint Lisa A. Brink as guardian of the person and Orrstown Bank as guardian of the estate of Matthew Brink pending further order and to schedule a hearing in which this matter may be heard and the guardianship made permanent. Respectfully Submitted, Rominger & Associates Date: December 28, 2009 Karma: Rominger, Esquire 155 South Hanover Street Carlisle, Pennsylvania 17013 (717) 241-6070 Supreme Court ID #81924 Attorney for Petitioner IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COtTNTY, PENNSYLVANIA MATTHEW BRINK, an ORPHANS COURT DIVISION Alleged incapacitated person NO.09- CrUARDIANSHIP-INCAPACTI'ED PERSON VERIFICATION We, Thomas S. Brink and Lisa A. Brink, Petitioners in this matter, do hereby depose and state that the facts contained in the foregoing Petition are true and correct to the best of our knowledge, information and belief. We 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. Date: ' Lisa A. Brink, Petitioner 12-17-'89 12:22 FAOCI-EOMINGEP & ASSOC 7172416878 T-927 Pa02%a02 F-353 IN THE MATTER OF IN THE COURT OF COMMON PLEAS OAN'IA CUMi3ERLANU COUNTY, PENNSYLV MATTHE`W' BRINK, an ORPHANS COURT DIVISION Allesed incapacitated person NO.09- : GUARDIANSH'Q'-INCApACITED PERSON COMPETENCY .A,~FIDA~VY'T Y, Louis Hieb, D_O., being duly sworn according to law, depose and state that Y am a licensed physician in the Commonwealth of Pen»syl~rania employed by Sadler Health Centex, I have examined the alleged incapacitated person, Matthew Brink, with care and diligence, Based upon said examination and observation, I am of the opinion that he is incompetent to manage his own affairs and there is no expectation of his recovery within a reasonabtc medical certainty. Date: -1--,~,~G_ ~ / ~ _~... Louis Hreb, D.O. COMMONWEALTIi OF PENNSYLVANIA COUNTY OF SS: On this, the ,~~ day o~ ~ ~ , ?009, before me a notary public, the undersigned officer, personally appeared Y.ouis ~ieb, D.O., known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed the same for the purposes therein contained. In witness whereof, I hereunto set my hand and offici seal. CO v VY m OF F'ENNS vANIA Tam ~,~~ otary ~'ublic aAele®oio, Gtxr~ ~br-~ yw~s~ "~~~~aen ~~ EXHYB~T "B" IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MATTHEW BRINK, an ORPHANS COURT DIVISIO~~ Alleged incapacitated person NO. 09- ' GUARDIANSHIP-INC ALIT PERSON AFFIDAVIT I, Thomas S. Brink, Natural Father of Matthew Brink, and ask the Court to approve the Guardianship Petition provided by Attorney Karl E. Rominger, Esquire, which I am in favor of. I waive my right to be present at any hearing. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. Cons. Stat. § 4904 relating to unsworn falsification to authorities. Date: COMMONWE TH OF PENNSYLVANIA COUNTY OF ' ~~/~L ~ ~~~ ~ ~ Thomas S. Brink, Natural Father of Matthew Brink SS: On this, the~~ day of<~ , 2009, before me a notary public, the undersigned officer, personally appeared Thomas S. Brink, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. In witness whereof, I hereunto set my hand and officialse~al. ~ ~~ TH Tsn'mM~L ~ 1 ~~pa~bNo ~ ~- X11 r~ otary Public EXHIBIT "C" IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MATTHEW BRINK, an ORPHANS COURT DIVISION Alleged incapacitated person NO. 09- GUARDIANSHIP-INCAPACITED PERSON CONSENT OF PROPOSED GUARDIAN I, Lisa A. Brink, do hereby certify that I am willing to act as the guardian of the person of Matthew Brink, if the Court shall so appoint me. Further, I do hereby certify that I am not a fiduciary of any estate in which the alleged incapacitated person has an interest, nor have I any interest adverse to him. The facts and opinions contained herein are true and correct to the best of my knowledge, information and belief. c Date: Lisa A. Brink, Petitioner COMMONWEALTH OF PENNSYLVANIA !. ) SS: COUNTY OF ~ ) On this, the ~da of ~ , 2009, before me a not ublic, the c~~ Y '~~ ~a-~ ~'Y P undersigned officer, personally appeared Lisa A. Brink, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. In witness whereof, I hereunto set my hand and offic' seal. Y o Pu lic Nola~l9ee~ Tammie~ Cu+ '~ C~ ~~,as 8~ ~1 ~ ~~~ MAC ~ ywsnts A~~~ °~ EXHIBIT "D"