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Home My WebLink About02-0385 FEATHER AND FEATHER. P C. ATTORNEYS AT LAW 22 WEST MAIN STREET PHILIP H. FEATHER ANNVILLE, PENNSYLVANIA 17003 JOHN E. FEATHER, JR. feather@featherlaw.com CHARLES A. RITCHIE, JR. (717) 867-1200 FAX (717) 867-5074 April 25, 2002 The Honorable George E. Hoffer ~(~ President Judge Court of Common Pleas, Cumberland County 1 Courthouse Square Carlisle, P A 170 Frank N. Yurcisin, an Alleged Incapacitated Person Orphan's Court Division No. 21-02-385 Dear Judge Hoffer: I am the attorney for the Petitioner, United Church of Christ Homes, Inc. in the above-listed case. A guardianship hearing has been scheduled before you for May 20, 2002 at 10:30 a.m. I do not expect either the Respondent or any family member to challenge this Petition Requesting Appointment of Guardian for the Estate of Frank N. Yurcisin. I spoke with your staff and was advised that you do not require the presence and testimony of the attending physician, George P. Branscum, Jr., M.D., under such circumstances. Rather, a physician's affidavit as to the Respondent's condition, as well as the fact that it would not be in his best interest to attend the hearing will suffice. Likewise, the proposed guardian, Neighborhood Services, Harrisburg, need not attend the hearing so long as the guardian's consent is part of the record. That has been attached to the petition. If either of these assumptions are incorrect and you expect the physician or the guardian to attend this hearing, please advise me immediately so I can make those arrangements. Very truly yours, FEATHER AND FEATHER, P.C. . Esq. nited Church of JEF /cmd cc: Mary Jane Walker ,--",~ ;...../ \. .. d ;;;::; L' -: r.........., -'--.' -r:':: I -' " ...[.::-:::0. t'.....) I,.F; I F t- oln : FE.A.THER I~ND FE.~ THER P. C . 71781375074 05/13/2002 13:37 #378 P.OO3 i *~~f~~.. PHYSICIAN'S AFFIDAVIT REGARDING FRANK N. YURCISIN . 5 ..,~j", George P. Branscum, Jr., M.D., being duly sworn according to law, deposes and says the following: I am a medical doctor licensed to practice medicine in the Commonwealth of Pennsylvania since 4-/ 19 7~ am currently practicing medicine through Belvedere Medical Center, Family Practice, 850 Walnut Bottom Road, Carlisle, PA 17013, since 17 -'" 191~ In addition to my Family Practice at Belvedere Medical Center, I have been the Medical Director for the Sarah Todd Memorial Home since 19 il. Based upon my training and experience in evaluating individuals with incapacities such as those which I am about to describe, I found the following. One of my patients at the Sarah Todd Memorial Home is FrankN. Yurcisin, DOB 2/20/1923, SSN 140-14-1920. Mr. Yurcisin has been a resident at the Sarah Todd Memorial Home and my patient since June 27, 2001. Mr. Yurcisin has multiple medical problems including post-op carcinoma ofthe colon and dementia. As a result ofms multiple medical problems, the exact etiology of his dementia is not able to be determined -vvith current testing. Mr. Yurcisin is severely mentally impaired with a Mini Mental Status of 3 out of29, which would indicate severe cognitive impairment. The lower a patient's score, the more severe the impairment. He is not able to commwricate in any meaningful fashion with other individuals. Since admission, this impainnent.has been stable at best or slowly worsening, and I would not expect it to improve. He requires total care including help with feeding, bathing, dressing and all other essential personal hygiene activities. He is wheelchair-boWld. This requires close observation of Mr. Yurcisin, because of the danger offalling and suffering injuries. Because of his requirement of total care, he could not be cared for in a less restrictive environment. The nursing staff at the Sarah Todd Memorial Home provides the selVices essential for Mr. Yurcisin's physical health and safety. ~5-13-~2 14:24 RECEIVED FROM:717S575~74 P.~3 F t- 0111 : FE~ THER ,~ND FE,; THER P. C . 7178fi75074 U::: / 1-::' /'')00'--;' 10 . -:'7 #:, 7Q F' l-n4 . ,,,)/ ,j/ L L ..) . ,....1 } '..) .. U . "_" "_ Mr. Yurcisin's condition is expected to slowly worsen, since this is the natural history of the diseases at this point, and there is almost no likelihood of his improving in his cognitive skills or ability to provide for his own care. .. Based upon Frank N. Yurcisin's conditions described above, I am of the opinion that his ability to receive and evaluate information effectively and communicate decisions, in any way, is impaired to such a significant extent that he is totally unable to manage his financial resources or meet the essential requirements for his physical health and safety. Based upon the conditions described above, I am also of the opinion that the physical and mental condition of Frank N. Yurcisin would be harmed by his presence at the hearing to decide if a guardian should be appointed for his Estate. Respectfully submitted, ~ (JJ '3 ~ ~ '------ George P. Branscum, Jr., M.D. COMMON\VEAL TH OF PENNSYLVANIA ) ) SS: COLTNTY OF CUMBERLAND ) ON THIS, the ~ day of 1J1 '!tJi. . 2002, before me, the undersigned officer, personally appeared GEORGE P. BRAN . UM, JR., M.D.. known to me (or sattsfactonly proven) to be the person whose name is subscribed to the within Physician's Affidavit, and acknowledged that he executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal. ~,t~ Not Public Notarial Seal Joan L. Stouffer, Notary Public Carlisle Boro,Cumberland Cou~ My Commission Expires Nov. 9, 3 Member, Pennsylvania Association ot Notaries 05-13-02 14:25 RECEIVED FROM:7178675074 P.Q4 "- Cuniculum Vitae . . George P. Branscum, Jr. MD SSN# 429-84-2285 OFFICE ADDRESS Belvedere Medical Center 850 Walnut Bottom Road Carlisle P A 17013 OFFICE PHONE (717) 243-1515 COLLEGE 1. Gra.siuated, Little Rock University, with B. S., June 1967 2. Graduated, University of Arkansas, with MD, June 1971 ~ 3. Residency, complete June 30,1972, Saginaw Cooperative Hospitals Inc. _ 1" year Family Practice Residency MILIT AR Y Entered active duty July 1972, U. S. A. R. Medical Corps USDAWC, Carlisle Barracks PA, July 1972 - June 1975 LICENSURE, CERTIFICATION, MEDICAL A WARDS 1. Pennsylvania State License 2. Diplomate, American Board of Family Practice 3. PA Academy of Family Physicians 4. American Academy of Family Physicians PROFESSIONAL Belvedere Medical Center Family Practice July 1975 to present. ;". 06/23/2001 MS2 0202 W 697824 Dementia. ..'HISTORY.OF PRESENT ILLNESS: This is a 78-year-old gentleman resident of Shippensburg who . .....'apparently.has been having bizarre behavior of last. The police and the Office of Aging had brought him . in. They tried to psychiatrically admit this patient but he is really just simply an elderly demented man in my opinion and he cannot be legally be placed under a 302. He is a veteran and they attempted to admit him to the dementia unit at the local veteran's hospital but they not do weekend intakes so I am consulted 'to admit this patient essentially for social reasons until they can get him transferred on Monday. There is family around~p;Tt1ere are no police who know about him at this point and so I know essentially very little. He is confused. He is not reliable. He says he lIas rectal cancer or that is what he eludes to but he is . really not sure. He is disoriented but pleasant and cooperative. - MEDICATIONS: Unknown. PAST MEDICAL HISTORY: Unknown. SOCIALHJSTORY: Unknown. REVIEW OF SYSTEMS: Unknown, unobtainable. PHYSICAL EXAMINATION GENERAL - He has extremely poor hygiene. He has feces on his pants. He has a horrendous smell and evidence of self neglect. He is really not aware of what is happening here. VITAL SIGNS - Blood pressure is 136/60. Respirations 16. Pulse 76. Temperature 980. HEENT - Pupils equal, round and reactive to light. Extraocular movements full. He has no lesions in his / hair. Heh?s some mild bitemporal wasting. Nose midline. Nares clear. Pharynx is benign. Moist buccal . mucosa. NECK ..:No JVD or adenopathy. No carotid bruits. CHEST- Lung sounds are clear to auscultation bilaterally. HEART - Regular rate and rhythm with a soft systolic murmur heard. No S3 or S4. ABDOMEN - Soft and nontender. No masses. No HSM. ~";;EX1"REMrrf~$ - No ~ower extremity edema. He has some evidence of some mild swelling of his knees. He does not have erythematous or hot joints, however. He has no asterixis. He is cooperative. NEUROLOGIC - Cranial nerves II-XII were intact. Power is 5/5 upper and lower extremities. He has a slow slightly_unst~9ygait but he is able ambulate and actually bend over without falling. LABORATORY STUDIES - ACT of head was negative. Sodium was 141 ,potassium 3.1, chloride 103, bicarb 24, BUN 21, c~atinine 1 ;0, giucose 103, TSH noncontributory. White count 6.3, hemoglobin 13, hematocrit 39.5, platelets 282, LFTs were unremarkable. ---iMPRESSION: Dementia. .... ... .. II IXH,.., 1 ~ YURCISIN, FRANK N MS2 0202 W 697824 , s-. J.D /.), "" tf 06/23/2001 02/20/1923 J FRANKE, PAUL M Page 1 Qf2, OR1G1NAL --..------"'~----------'.-~-------,--.. CARLISLE HOSPITAL HISTORY & PHYSICAL EXAMINATION '.' '--,...._.,.-...._"~_....-.-...._-~..~.._...- , 06/23/2001 YURCISIN, FRANK N MS2 0202 W 697824 PLAN: Complete the workup by obtaining RPR, B 12 folate and transfer the patient to the V A when they I can accept him. PF/sap 0: 06/23/2001 22:55:03 T: 06/24/2001 09:55:35 This document was authenticated by Gerald E. Franko, M.D., Ph.D. for Paul Franke, M.D. on 06/24/2001 12:39:35. Paul Franke, M.D. C: Paul Franke, M.D. \ J ) . YURCISIN, FRANK N MS2 0202 W 697824 J 06/23/2001 02/20/1923 FRANKE, PAUL M Page 2 of 2 ORIGINAL CARLISLE HOSPITAL HISTORY & PHYSICAL EXAMINATION '"%j tti~~ tti~~ > -~ tti~~ _"t:l ::j ~ g; tI.l Gl 0 ....., ~ ~f: ffi~ (') ~ ffia;: ~ &2 ~ Ct.l 0 NS::O Wns:: t-Ja;:0 'S ~ '-'0 (')>0 "::;0 '-' ::c c:;l.:.(j III .. 0 rn IT" '-'t"'" 0....., '-'~ '-' t"'" .. c::: t"'" ~~ t""'el ~ el....., ~ t' ( n n ~ ....... 0 .. t:rj .;:.. ~ ~ "t:l <:> t-J 0 <:> \C A t-J rn v. 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Todd Memorial Home Petition, by and through its attorneys, Feather and Feather, P.c., respectively presents the following: 1. The Petitioner, United Church of Christ Homes, Inc. t/a Sarah A. Todd Memorial Home, is a Pennsylvania not-for-profit corporation which operates a continuum of care facility, including a nursing home, at 1000 West South Street, Carlisle, Cumberland County, PA 17013. 2. Frank N. Yurcisin, the alleged incapacitated person, is an adult individual, who was admitted to the Sarah A. Todd Memorial Home (hereinafter Todd Home), 1000 West South Street, Carlisle, P A 17013 on June 27, 2001. Yurcisin was born February 20, 1923. 3. Frank N. Yurcisin is married to Laura Yurcisin, whose address is 807 Hearthstone Drive, Lakewood, New Jersey 08701; however Frank and Laura Yurcisin's marriage relationship is estranged. Laura Yurcisin is not willing to act as Guardian of the Estate of Frank N. Yurcisin. 4. Frank N. Yurcisin has a son, Rich Yurcisin, who is an adult individual residing at 807 Hearthstone Drive, Lakewood, NJ 08701. Rich Yurcisin is not willing to act as Guardian of the Estate of Frank N. Yurcisin. To the best of Petitioner's knowledge, Frank N. Yurcisin has no other children. 5. Frank N. Yurcisin has a brother, Rudy Yurcisin, who is an adult individual residing at 603 Willow Avenue, Roselle Park, NJ 07204. Rudy Yurcisin is not willing to act as guardian for the Estate of Frank N. Yurcisin. To the best of Petitioner's knowledge, Frank N. Yurcisin has no other siblings. 6. On or about June 27, 2001 Frank N. Yurcisin was admitted to Todd Home where he has been a resident to the present time. Since his admission to the Todd Home, he has been under the primary care of his personal physician, George P. Branscum, Jr., M.D., whose address is Belvedere Medical Center, 850 Walnut Bottom Road, Carlisle, P A 17013. 7. The personal physician of Frank N. Yurcisin has made an examination of him and prepared a written report regarding the incapacity of Frank N. Yurcisin as provided in 20 Pa C.S.A. 5518, a copy of which is attached hereto, made a part hereof, and identified as Exhibit "A." 8. The assets of Frank N. Yurcisin, are as follows: a. Real Estate: None, except for a modular home located at 191 Shippensburg Mobile Est., Shippensburg, P A 17257-9508: Value - $ Unknown. b. Personal Property: 1. Household goods: Value - $ Unknown 11. Motor Vehicle: None 111. Bank accounts: M&T Bank, Basic Bank Account #882422034 with a balance as of July 18,2001 of$4,249.12 9. The income of Frank N. Yurcisin is as follows: a. Social Security: $1,030.00 per month. b. Lincoln National Life Retirement: $31.62 per month. 10. The Petitioner proposes to appoint as plenary guardian of the Estate of Frank N. Yurcisin, Neighborhood Services, Capital Region, a Pennsylvania not-for-profit corporation with offices at 931 North Front Street, Suite F, P.O. Box 5315, Harrisburg, P A 17110-0315. Neighborhood Services has no interest adverse to the Alleged Incapacitated Person. Neighborhood Services consents to this appointment and its written consent is attached hereto, made a part hereof and is identified as Exhibit "B." 11. Petition has filed this Guardianship Petition because Frank N. Yurcisin suffers from organic brain syndrome/dementia to a degree that his ability to receive and evaluate information effectively and communicate decisions in any way is impaired to such a significant extent that he is totally unable to manage his financial resources or to meet essential requirements for his physical health and safety. 12. Petitioner sought the assistance of Frank N. Yurcisin's wife, Laura Yurcisin, and their son, Richard Yurcisin, both of whom refused to act as guardian of the Estate of Frank N. Yurcisin. In particular, they have refused to assist in the preparation and filing of an application for medical assistance so that Frank N. Yurcisin can qualify for medical assistance and receive those benefits for his care as defined in 20 Pa. C.S.A. 5501. 13. As a result of the incapacity of Frank N. Yurcisin, Petitioner requests this Court appoint Neighborhood Services the plenary guardian ofthe Estate of Frank N. Yurcisin. 14. No other court has assumed jurisdiction in any proceeding to determine the capacity of the Alleged Incapacitated Person and the Alleged Incapacitated Person has no guardianship already appointed for his estate or person. WHEREFORE, you Petitioner requests that a Citation be issued directed to the Alleged Incapacitated Person, Frank N. Yurcisin, with notice of the same to his next of kin to show cause why the said Frank N. Yurcisin should not be adjudicated an Incapacitated Person and a guardian of his estate be appointed. Petitioner also requests this Court schedule a hearing to consider this petition. Respectfully submitted, FEATHER AND FEATHER, P.C. ESQ. DATE:~ ~LSJ0~ VERIFICATION I, Mary Jane Walker, Administrator at Sarah A. Todd Memorial Home, being authorized to do so, verify that the statements made in the foregoing Petition Requesting Appointment of Guardian for the Estate of Frank N. Yurcisin are true and correct to the best of my knowledge, information or belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. S 4904, relating to unsworn falsification to authorities. ~\ (},.\ lc'-"2., tirf ))a) ~) , BELVEDERE MEDICAL CENTER . 850 WALNUT BOTTOM ROAD CARLISLE, PENNSYLVANIA 17013 PHONE 243-1515 FAX 243-7171 FAMILY PRACTICE BRUCE O. BAILEY, M.D. ~ JEFFREY N. POTTER, M.D. GEORGE P. BRANSCUM, JR., M.D. BRUCE G. KIPP III, P.A. Your Kpy To BPIIP' HPollh April 2, 2002 Feather & Feather PC John E. Feather, Jr., Esquire 22 West Main Street Annville, PA 17003 RE: Frank N. Yurcisin Dear Mr. Feather; Frank N. Yurcisin is presently a patient at the Sarah Todd Nursing Home with multiple medical problems including post-op carcinoma of the colon and dementia. with his multiple medical problems the exact etiology of his dementia is not able to be determined with current testing. He is severely impaired with a Mini Mental Status of 3 out of 29 which would indicate severe cognitive impairment. This has been stable or slowly worsening and would not expect it to be improved. He requires total care including help with feeding. Also requires close observation because of the danger of falling with injury. Because of his requirement for total care he could not be cared for in a lesser restrictive environment. His condition is expected to ~lowly worsen since this is the natural history of the disease at this point and there is almost no likelihood of him improving in his cognitive skills or ability to provide his own care. Sincerely, Geor~~~. ~;a~u~J~ ~ GPB/alb EXHiBIT -,4 PAGE ' I Froo:FEATHER AND FEATHER P.C. 7178672fJ74 03/07/2002 14:36 #065 P.003 . . INRE: FRANK N, YURCISIN, ; IN THE COURT OF COMMON PLEAS An Alleged Incapacitated Person : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHAN'S COURT DIVISION : NO. CONSENT OF NEIGHBORHOOD SERVICES TO ACT AS GUARDIAN OF THE ESTATE OF FRANK N. YURCISIN Neighborhood Services, a Pennsylvania non-for-profit corporation, with its Capital Region Office at 931 North Front Street, Suite F, P.O. Box 5315, Harrisburg, PA 17110-0315, hereby consents to act as the Guardian of the Estate of Frank N. Y urcisin. The undersigned, Vemon Fisher, Director of Neighborhood Services, consents on behalf of this not-for-profit corporation. Neighborhood Services has no adverse interest to Frank N. Yurcisin, the alleged incapacitated person. NEIGHBORHOOD SERVICES, Date: 3 -/rP-t?cJ.. A;~ A . VERNON FISHER, DIRECTOR EXHIBIT - () PAGE f . . . ..,~ . (. ~ .0 .,' \ " 't . --. \ : U .. _., \. E\' '~' J ,/~ j \- """. , c!!Y' Uc " ';':~ . .\"1:' . '.i' .:1-' ... " - ~ "...,) I I ,..........-. _. ...,~ INRE: FRANK N. YURCISIN, : IN THE COURT OF COMMON PLEAS An Alleged Incapacitated Person : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHAN'S COURT DIVISION : NO. al-oa-03Ks ORDER OF COURT -f1^- AND NOW TillS )) day of April 2002, upon Petition of John E. Feather, Jr., Esq. attorney for Petitioner, United Church of Christ Homes tla Sarah a. Todd Memorial Home, it is hereby ordered and decreed that a hearing on said Petition to determine whether Frank: N. "/-fA ~ ~/.20ff2.t Yurcisin is an Incapacitated Person shall be held on the tl 0 day of I ~'clock AM. in Court Room No~ , Cwnberland County Court House, Carlisle, P A. The Clerk of the Orphan's Court shall issue a Citation with Notice upon the alleged Incapacitated Person pursuant to 20 Pa. C.S.A. ~764 et seq. with service to be made by the Sheriff of Cumberland County. Notice of said hearing shall be served upon Laura Yurcisin, Rich Yurcisin, and Rudy Yurcisin by certified or registered mail. BY THE COURT, '2U.ll~} < J. ~ <, 6\7: [J ~ l HeN ZOo SHERIFF'S RETURN - REGULAR Q- CASE NO: 2002-00385 0 COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND UNITED CHURCH OF CHRIST HOMES VS YURCISIN FRANK N BRYAN WARD , Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within ORDER AND PETITION was served upon YURCISIN FRANK N the RESPONDENT , at 1030:00 HOURS, on the 26th day of April , 2002 - at SARAH TODD MEMORIAL HOME 1000 WEST SOUTH STREET CARLISLE, PA 17013 by handing to MARY JANE WALKER, ADMINISTRATOR a true and attested copy of ORDER AND PETITION together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: So Answers: Docketing 18.00 ~ all Service 3.45 rJ ~?~~ Affidavit .00 Surcharge 10.00 R. Thomas Kline .00 31.45 04/29/2002 FEATHER & FEATHER before By: i~;~~/) vJ~ / me this of puty Sheriff U\.)~J - :) -" (" \ m: B J\l ZOo t...~. t~. (\ l .!U:l , I FEATHER AND FEATHER, P.C. 0 ~ ATTORNEYS AT LAW 22 WEST MAIN STREET oC.......__..__._.J ANNVILLE, PENNSYLVANIA 17003 ~."----,-.;.;;.:. (717) 867-1200 FAX (717) 867-5074 IN RE: FRANK N. YURCISIN, : IN THE COURT OF COMMON PLEAS An Alleged Incapacitated Person : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHAN'S COURT DIVISION : NO. 21-02-385 CERTIFICA TE OF SERVICE I, Carol M. Daugherty, a secretary in the offices of FEA THER AND FEATHER, P.C., Attorneys for Petitioner, United Church of Christ Homes, Inc., in the above-captioned case, hereby certify that I served a certified copy of the Order of Court, Citation With Notice, and Petition Requesting Appointment of Guardian for the Estate of Frank N. Yurcisin, in this case upon Laura Yurcisin of 807 Hearthstone Drive, Lakewood, NJ 08701, by United States first class mail, certified Article No. 7001 1940 0004 7182 6134. The certificate of mailing is attached hereto. On May 1,2002, I received the domestic return receipt for said Article which indicates that on April 27, 2002 Michael Yurcisin signed for Laura Yurcisin and received the certified copy of the Order of Court, Citation With Notice, and Petition Requesting Appointment of Guardian for the Estate of Frank N. Y urcisin The domestic return receipt is attached hereto. ! ~ '''\ Dated: ....5-d- Odl-.. .' ..{ -;"YJ, ~ CAROL M. DAUGHERTY, Secetary ..". ,I O' I .' , --~. -:~..:;;.... _d::...;l ::T fTl ...-'l .JJ ru cO M . g'U r"- G ,j '" . 0, ,. ,;{JU (,,~ ", ", DO< ,,, , "' " " ,'.' D . /, "'" " ,,,' ' D . ", ~ API" ") I. l"ji'tO"" D ~",."" "./,<', ' ", I.U I '" ",,, "',," f- \ ' cr ,____. 7 I' ". . )' ~ ,"no _.__.. ." ., -_: ."- L' C. '" / ", ~ __.. m "..' <,' ....... J.. ti-U., A. Y --- ._:~)b> ~ -: 'f>";' a ;~~~:::.::..:._...:.... ,,~ c, " ' ~ __::: ,=-1-/- CJ ""t _m 8' J 1 liE- f J ' .--. r"- ." y. State:z;;'P;-;j---""-' ..tr.~.~_C_...~~.tiJ 71 e.. j),." -. ...'n_.......... . it)... K..e' .. -'-"---" II /I t. ~ N J c:!;'~"'i....mmmm-i _.I"'~~'I'!I!f!II':' . ' Ijlij _:~I~:.'~nPl'I!lIlt"."ill, ii6l.tMi6llIl' ::!f complete items i. 2, and 3. Also complete Item 4 1\ Restricted Delivery IS desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back 0\ the mailpiece, or on the lrant il space permits. -- i. Article Addressed to: ), (.uJfGL 'I urC J j I n '1;01 JI,,{Uf;'~ru- J)r'v'- MY 0 }1DOl /-,~ke~ J'..,J., N iT D S70) 3. service Type iii certified Mail 0 ExpresS Mail I 0 -"'" 0 _m .""", '" M""h""'. o Insured Mail 0 C.O.D- 4. Restricted Delivery? (Extra Fee) ii<{es 2. Article Number ~,,""~ ""m _.. _" 7 001 1 '1q 0 000 q 71&C b 13 q pS Fo>m 3811, Au9'" 2001 ""'""',. -" -'" _..,.. FEATHER AND FEATHER, P.C. /'. L./ ATTORNEYS AT LAW Ii'"'=~:;:::;;;:"~-;:';;"'~ 22 WEST MAIN STREET ~ ANNVILLE. PENNSYLVANIA 17003 (717) 867-1200 FAX (717) 867-5074 IN RE: FRANK N. YURCISIN, : IN THE COURT OF COMMON PLEAS An Alleged Incapacitated Person : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHAN'S COURT DIVISION : NO. 21-02-385 CERTIFICATE OF SERVICE I, Carol M. Daugherty, a secretary in the offices of FEATHER AND FEATHER, P.c., Attorneys for Petitioner, United Church of Christ Homes, Inc., in the above-captioned case, hereby certify that I served a certified copy of the Order of Court, Citation With Notice, and Petition Requesting Appointment of Guardian for the Estate of Frank N. Yurcisin, in this case upon Richard Yurcisin of807 Hearthstone Drive, Lakewood, N J 08701, by United States first class mail, certified Article No. 7001 1940 0004 7182 6141. The certificate of mailing is attached hereto. On May 1,2002, I received the domestic return receipt for said Article which indicates that on April 27, 2002 Michael Yurcisin signed for Richard Yurcisin and received the certified copy of the Order of Court, Citation With Notice, and Petition Requesting Appointment of Guardian for the Estate of Frank N. Yurcisin The domestic return receipt is attached hereto. I I Q [A ~ Dated: __?-Ol.-ocfl.. /2~ -,rl. ~~"I-- CAROL M. DAUGHERT ,Secretary -. - .': r ! . -- I -~ I , I ~~ '~,... r-'I :::r r-'I ...lI ru P'Y3~~'q~ ,~':'I <:Q .-=I I ("'- <~er1:ified F':~E~ i,. '1 /.- t .. \. - Q\. l..' - .. ,~, ,I .:r R"tu'" R"c"ipt F"." ' .. -, I ' CJ (Endor31,rr.,.n! Requi",cI) L-- 1,...::>-0 "::" ""I, Cl ",",'""" "';'"~ '00 ~" 'Ii, I CJ (Er,dors.,m"nl Requ"f><l) __~ . ~_c..,'1 .- "., , 'j f ~", Cl ""'"...,.,,... $ ,. I ' /,:10, .:r _._____ ____]._f:,..f> J ' ,\C~,'''/' 0" $e""0 r--' -.,-.' " " r"I " j -.--..--.--... ------ ...-... ....."_.>/ ._____......__ "c1ardY .' -.------ .-=I Street, tll't:~io:;----.------..---.'-.--'1-:.C-~ ' .~-'- 11......_.. CJ or PO flOK No. gOo H - -hI' --- ................. .__,.m_n_...______. U I r ,- :;: C.", ~,.., z<P, ,--"t"'---- ""'. L. J 1:".,,:;,, i"" ,.."""---,,, ~G!' u.Lo_.u 0(/7;( /'-I;J' oS 7 D I D~I1I..f"iTiTIlm!fmIII.I.I'1 . I . I 'Ii !lllit:rliI~=r:'ll~lrmll!D! . complete Items 1. 2, and 3. Also complete item 4 if Restricted Delivery is desired. X . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mail piece, or on the front if space permits. "------- D. Is delivery address different from item 1? 1. Article Addressed to, If YES, enter delivery address below: 17 J . '-/ 1(' c. lord. ().r.:.~/5111 {),iv ~ ",~'t () 1 -- ~ ro7 ;-1 efh rJ,~./()--,u, I I A.. C1J'2.JJ(n:;;-Jj N r () .,,'10/ ~ M 3_ ~e Type Certified Mail o Express Mail o Registered o Return Receipt for Merchan' o Insured Mail o C.O.D. 4. Restricted Delivery? (Extra Fee) Yes 2. Article Number 7001 1940 0004 (Transfer from service label) 71&2 6141 PS Form 3811, August 2001 Domestic Return Receipt 102595-01 ~. SHERIFF'S RETURN - REGULAR e CASE NO: 2002-00385 0 COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND UNITED CHURCH OF CHRIST HOMES VS '02 i'iilY 1 D p 1 :;,7 YURCISIN FRANK N \,. . BRIAN BARRICK , Sherif:lC\woc Deputy Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law, says, the within ORDER AND PETITION was served upon YURCISIN FRANK N the RESPONDENT , at 1449:00 HOURS, on the 7th day of May , 2002 - at SARAH TODD MEMORIAL HOME 1000 WEST SOUTH STREET CARLISLE, PA 17013 by handing to FRANK YURCISIN a true and attested copy of ORDER AND PETITION together with and at the same time directing His attention to the contents thereof. Sheriff's Costs: So Answers: Docketing ~ 18.00 .r~~<~ Service 3.45 Affidavit .00 Surcharge 10.00 R. Thomas Kline .00 31.45 ,05/08/2002 FEATHER & FEA~ Sworn and Subscribed to before By, J;;)~, me this I D TI4 day of Deputy Sheriff r - FEATHER AND FEATHER. P C. (C -- --", 7 .-, \ . - '. ATTORNEYS AT LAW V !.;.:)' ", 22 WEST MAIN STREET o iJ U PHILIP H. FEATHER ANNVILLE, PENNSYLVANIA 17003 JOHN E. FEATHER, JR. feather@featherlaw.com CHARLES A. RITCHIE, JR. <717> 867-1200 FAX (717) 867-5074 May 10, 2002 Clerk of the Orphan's Court Cumberland County One Courthous Carlisle, 7013 Frank N. Yurcisin, An Alleged Incapacitated Person No. 21-02-385 Notification of Counsel Pursuant to S5511 , s Court: Enclosed is my Notification of the Court as required by S5511 of the Probate Code indicating, to the best of my knowledge, counsel has not been retained by or on behalf of the Alleged Incapacitated Person, Frank N. Yurcisin. Very truly yours, FEATHER AND FEATHER, P.C. ~ JEFlblm cc: The Honorable George E. Hoffer, President Judge w/enc. Mary Jane Walker FEATHER AND FEATHER, P.C. WE DO HEREBY CERTIFY THAT THE . ATTORNEYS AT LAW ,- WITHIN IS A TRUE AND CORRECT COPY OF _._~..,,-_... '-- - --~~ 22 WEST MAIN STREET THE ORIGINAL FILED IN THIS ACTION. ANNVILLE, PENNSYLVANIA 17003 BY~tu~,J.LI./nJ (717) 867-1200 -C\\d ' - 'ATTORN~f' / FAX (717) 867-5074 5- \;3- O~ I IN RE: FRANK N. YURCISIN, : IN THE COURT OF COMMON PLEAS An Alleged Incapacitated Person : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHAN'S COURT DIVISION : NO. 21-02-385 NOTIFICATION OF COUNSEL PURSUANT TO Q5511 OF THE PROBATE CODE WHEREAS, Petitioner filed a Petition Requesting Appointment of Guardian for the above-named alleged incapacitated person; and WHEREAS, a hearing has been scheduled for the 20th day of May, 2002 at 10:30 o'clock A.M. in Courtroom #3 of the Cumberland County Court House, Carlisle, PA to determine whether or not a guardian shall be appointed; and WHEREAS, Chapter 55 of the Probate, Estates and Fiduciaries Code provides in Section 5511(2) that "Petitioner shall be required to notify the Court at least seven (7) days prior to the hearing if counsel has not been retained by or on behalf of the alleged incapacitated person." NOW, THEREFORE, Petitioner hereby gives notice to the Court that, to the best of Petitioner's knowledge, counsel has not been retained by or on behalf of the alleged incapacitated oerson. 1 Respectfully submitted, 0 E. FEATHER, JR., ES 1. . #1 756 22 Main Street Annville, P A 17003 (717) 867-1200 DATE: Attorney for Petitioner r -- ..--------- IN RE: FRANK N. YURCISIN, : IN THE COURT OF COMMON PLEAS An Alleged Incapacitated Person : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHAN'S COURT DIVISION : NO. 21-02-385 PROOF OF SERVICE I hereby certifY that I am this day serving the Notification of Counsel Pursuant to ~5511 of the Probate Code upon the person and in the manner indicated below: Service by U.S. first class mail addressed as follows: The Honorable George E. Hoffer President Judge, Court of Common Pleas Cumberland County One Courthouse Square Carlisle, PA 17013 FEATHER AND FEATHER, P.C. Dale: ~\~ 2S:5-J 1-- By: JO ID# 22 W t Annville, A 17003 (717) 867-1200 Attorney for Petitioner FEATHER AND FEATHER, P.C. C~ ATTORNEYS AT LAW ~- ~ "---,------ 22 WEST MAIN STREET ANNVILLE, PENNSYLVANIA 17003 (717) 867-1200 FAX (717) 867-5074 IN RE: FRANK N. YURCISIN, : IN THE COURT OF COMMON PLEAS An Alleged Incapacitated Person : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHAN'S COURT DIVISION : NO. 21-02-385 NOTIFICA TION OF COUNSEL PURSUANT TO ~5511 OF THE PROBATE CODE WHEREAS, Petitioner filed a Petition Requesting Appointment of Guardian for the above-named alleged incapacitated person; and WHEREAS, a hearing has been scheduled for the 20th day of May, 2002 at 10:30 o'clock A.M. in Courtroom #3 of the Cumberland County Court House, Carlisle, P A to determine whether or not a guardian shall be appointed; and WHEREAS, Chapter 55 of the Probate, Estates and Fiduciaries Code provides in Section 5511 (2) that "Petitioner shall be required to notify the Court at least seven (7) days prior to the hearing if counsel has not been retained by or on behalf of the alleged incapacitated person." NOW, THEREFORE, Petitioner hereby gives notice to the Court that, to the best of Petitioner's knowledge, counsel has not been retained by or on behalf of the alleged incapacitated person. Respectfully submitted, FEATHER AND FEATHER, P.C. 0 E. FEATHER, JR., ES I. . #1 756 22 Main Street Annville, P A 17003 (717) 867-1200 DATE: Attorney for Petitioner r ----_.__.~--_.__._~- r", IN RE: FRANK N. YURCISIN, : IN THE COURT OF COMMON PLEAS An Alleged Incapacitated Person : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHAN'S COURT DIVISION : NO. 21-02-385 PROOF OF SERVICE I hereby certify that I am this day serving the Notification of Counsel Pursuant to 95511 of the Probate Code upon the person and in the manner indicated below: Service by U.S. first class mail addressed as follows: The Honorable George E. Hoffer President Judge, Court of Common Pleas Cumberland County One Courthouse Square Carlisle, P A 17013 FEATHER AND FEATHER, P.C. Date: ~\~ 200 L-- By: JO qUIre ID# 22W t .. Annville, A 17003 (717) 867-1200 Attorney for Petitioner r _.~-- r> . r , d N --- -< ---" V-.I '-' j',-,j ,~d -.J '.' . S .::--- INRE: FRANK N. YURCISIN, : IN THE COURT OF COMMON PLEAS An Alleged Incapacitated Person : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHAN'S COURT DIVISION : NO. 21-02-385 CERTIFICATE OF SERVICE I, Carol M. Daugherty, a secretary in the offices of FEATHER AND FEATHER, P.C., Attorneys for Petitioner, United Church of Christ Homes, Inc., in the above-captioned case, hereby certify that I attempted to serve a certified copy of the Order of Court, Citation With Notice, and Petition Requesting Appointment of Guardian for the Estate of Frank N. Yurcisin, in this case upon Rudy Yurcisin of 603 Willow Avenue, Roselle Park, NJ 07204, by United States first class mail, certified Article No. 7001 1940000471826110. The certificate of mailing is attached hereto. On May 6, 2002, I received the unopened envelope containing the certified copy of the Order of Court, Citation With Notice, and Petition Requesting Appointment of Guardian for the Estate of Frank N. Yurcisin which was refused by Rudy Yurcisin. A copy of the envelope with the United States Postal Service's notation "Refused" is attached hereto. Dated: .5'- / J- t:J;l.. ~ -yvJ. ~ CAROL M. DAUGHERTY, *retary --: d :: N ::;: --' ,c::,.. -0 .:..::..'). .-'0 c: . . . CERTIFIED MAIL - - I I '"- FEATHER AND FEATHER, P. C. ATTORNEYS AT LAW 22 WEST MAIN STREET ANNVILLE, PENNSYLVANIA 1700.3 7001 I C;,L:, "$ ~ --' ./ t <:> V'.J .,. \ ~. \.J' ~ \._---~"". ~ . '",,,,,,,,,,;,#""~IU.itM~,k" - U.S. Postal ServIce CERTIFIED MAIL RECEIPT (Domestic Me1/1 Only: No Insurance Coverage Provided) t:J r-"l r-"l ..D ru Postage $ CO r-"l 1 ~FM f'- .:r Return Receipt Fee t:J (E orsement Required) t:J R strlcted Delivery Fee t:J (Endorsement Required) t:J Total Postage a Fees $ 0 .:r IT" Sent To p. .1). '/urCI,ji/1 r-"l r-"l Si;;';;;;A;;Ciio~i--'--~--'----'------------'-------------'--------------------..--------. or PO Box No. (/;, 0 J W; l/o-c.A.J A enu..-e t:J _nn .. U t:J clty,.State:ZtP;.ii-l~-_:;~.i/~---71;.;k---:.i;y:-6-:7~__;:;.--...--. f'- . :.. .. a.. ... .. . . . r FEATHER AND FEATHER, P.C. I ATTORNEYS AT LAW 22 WEST MAIN STREET ..._ .__~'._ _____':J ANNVILLE. PENNSYLVANIA 17003 ~ --~-'----- ... (717) 867 -1200 FAX (717) 867-5074 INRE: FRANK N. YURCISIN, : IN THE COURT OF COMMON PLEAS An Alleged Incapacitated Person : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHAN'S COURT DIVISION : NO. 21-02-385 ;:-.. FINAL DECREE AND NOW THI~day of May 2002, based upon the evidence received and the record, this Court finds by clear and convincing evidence that Frank N. Yurcisin is a totally incapacitated person. The Court finds that Frank N. Yurcisin, date of birth February 20, 1923, social security number 140-14-1920, suffers from organic brain syndrome, post-op carcinoma of the colon and dementia, a series of conditions or disabilities which totally impair his capacity to receive and evaluate information effectively, and to make and communicate decisions concerning his management of financial affairs, or to meet essential requirements for his physical health and safety. Neighborhood Services, a Pennsylvania not-for-profit corporation, with its capital region office at 931 North Front Street, Suite F, P.O. Box 5315, Harrisburg, Pennsylvania 17110-0315, is hereby appointed Plenary Permanent Guardian of the Estate of Frank N. Yurcisin. This Guardian of the Estate shall not be required to post a court approved bond. The Guardian shall file reports with the Court as required by 20 Pa. C.S.A. S 5521(c). r ...-- The Guardian of the Estate shall have authority and duty to manage and use Frank N. Yurcisin's property for his benefit, liquidate any and all of his assets, apply them to the expenses of his care, and make application on behalf of Frank N. Yurcisin for any benefits, including but not limited to, medical assistance and as otherwise provided in 20 PA C.S.A. S5521(b). The aforementioned judicial determinations have taken into consideration the matters required by 20 Pa. C.S.A. S 5512.1. The Court's Finding of Fact and Conclusions of Law are based upon the testimony presented and the exhibits offered into evidence together with the record in this case. Costs of these proceedings shall be paid from the Estate of Frank N. Yurcisin. BY THE COURT, J. sident Judge c: John E. Feather, Jr., Esq., Attorney for Petitioner Frank N. Yurcisin Richard Yurcisin ~ Rudy Yurcisin Laura Yurcisin _ ~~~,.~...c~~ I i -~ ,; ':) .""\ ll: l d E - t1nr ZOo r . . FEATHER AND FEATHER. P C. ATTORNEYS AT LAW 22 WEST MAIN STREET PHILIP H. FEATHER ANNVILLE, PENNSYLVANIA 17003 JOHN E. FEATHER, JR. - CHARLES A. RITCHIE. JR. (717) 867-1200 feather@featherlaw.com FAX (717) 867-5074 April 9, 2002 Clerk of Orphan's Court ~ Cumberland County Court House 1 Court House Square Carlisle, P A 17013 In Re: Frank N. Yurcisin, an Alleged Incapacitated Person Petition Requesting Appointment of Guardian for the Estate of Frank N. Yurcisin Petitioner - United Church of Christ Homes, Inc. Dear Clerk: Enclosed is the original and five (5) copies of my petition on behalf of United Church of Christ Homes, Inc. t/a Sarah A. Todd Memorial Home for the appointment of a guardian for the Estate of Frank N. Yurcisin. Please docket the original and deliver one copy to the Sheriff of Cumberland County for service. Attached to that copy is a check payable to the Sheriff for costs in the amount of $1 00.00. Return the other four copies to me in the enclosed envelope. Attached to the petition is a Citation with Notice and Order of Court. Please present the order to the Court for its signature scheduling a hearing for this petition. Please execute the Citation to the alleged incapacitated person. Enclosed is my check in the amount of $38.00 which represents your fees of $15. the etition, $10.00 for the Citation and $5.00 for the JCPC, plus $8.00 for you t ify four of the enclosed copiesJ Also enclosed is a return mailing envelope, postage pre-paid for the four copies once they have-been conformed and certified. If you have any questions, please contact me or my assistant, Carol Daugherty. Thank you for your assistance. Very truly yours, FEATHER AND FEATHER, P.C. IN RE: FRANK N. YURCISIN : IN THE COURT OF COMMON PLEAS OF AN ALLEGED INCAPACITATED PERSON : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : NO. 21-2002-0385 IMPORT ANT 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 our right to manage money and property and to make decisions. A copy of the petition which has been filed by UNITED CHURCH OF CHRIST HOMES T/A SARA A. TODD MEMORIAL HOME is attached. You are hereby ordered to appear at a hearing to be held in Court Room No.1, Cumberland County Courthouse, Carlisle, Pennsylvania, on MA Y 20 , 2002, at 10:30 A.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 w 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. \. By: Cler ans' Court Divi ion Cumberland County, Carlisle, P A My Commission Expires 1 st Monday, January, 2006 , ~w(; , IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: Frank N. Yurcisin, an incapacitated person FILE NO. 21-02-385 GUARDIAN OF THE ESTATE ANNUAL REPORT [20 Pa.C.S.A. 5521 (c)] FROM May 31, 2002 TO May 31, 2003 1) I am the _Limited _X_ Plenary Guardian of the Estate of my ward, named above. I was appointed Guardian by Order of the Court dated May 31, 2002, which _ was _X_was not modified by Court Order( s) dated 2) Is the incapacitated person still living? Yes If no, answer the following: (a) Date of Death (b) Place of Death (c) Name of Administrator/trix or Executor/trix (d) Date Guardian of the Person filed the last Annual Report PLEASE ANSWER THE FOLLOWING QUESTIONS WHETHER THE INCAPACITATED PERSON IS LIVING OR DECEASED. 3) My initial Inventory was filed on and listed a total estate value of $ The Inventory listed a total monthly income of$I,ll5.62 comprised of the following: $1084.00 S.S., $31.62 pension 4) At the beginning date of this reporting period, my initial balance on hand was $ -0- rf:h r-f ~ l' 't 5) During this reporting period, the following reflects all sources of income (other than social security) received by me for my ward: (Add additional pages if needed) Date Received Source of Income Amount 1. 2. 3. 4. 5. 6. TOTAL 6) During this reporting period, the following reflects all payments I have made for my ward: (Add additional pages if needed) Date To Whom Paid Reason for Payment Amount 1. 2. 3. 4. 5. 6. TOTAL 7) The present principal assets of my ward are: Description of Asset Present Value 1. 2. I=h rf- a:r Lt 3. 4. 5. 6. TOTAL 8) The present amount and sources of income for my ward are: Source of Income Amount of Income (Indicate whether monthly, quarterly, annually) 1. 2. 3. 4. 5. 6. 9) The regular monthly expenses of my ward which I pay are: To Whom Paid Amount 1. 2. 3. 4. 5. 6. ria rl= L. ::f-I 't 10) I have not petitioned the Court for permission to invade principal to meet the needs of my ward. (If applicable) The following expenses of my ward have been paid from principal: To Whom Paid Purpose Amount 1. 2. 3. 4. 5. 6. 11) I have not (circle one) paid myself compensation for services I rendered as guardian. The amount I Paid myself totaled $ and was calculated at the following rate: $ per week/month (circle one). 12) Check the correct response and complete, if appropriate. _ There will be no need for extraordinary expenditures on behalf of my ward in the next (12) months. There well be a need for extraordinary expenditures on behalf of my ward in the next (12) months because: 13) Check the correct response and complete, if appropriate. _A. My ward receives monthly social security benefits directly. _B. I am the designated payee to receive my ward's social security benefits. ria r+ ~ Lf: J . . . _x_c. The designated payee of my ward's social security benefits is Sarah Todd Memorial Home whose address is 1000 West South St Carlisle P A 17013 and is not related to my ward as (insert relationship). 14) Please note any concerns about the incapacitated person's physical or mental well being or the finances that the Court should know. 15) I _ am _X_ am not guardian of the incapacitated person's person. If yes, report is attached. I certify under the penalties of perjury that the information contained in this report is true and correct to the best of my knowledge, information and belief. Name: Telephone No. (Home) Address: (Work) ;ri, ~JJ ~ . . . . , . 7l r:rv nJ. c... 1, I, ' I ........... . , fT' IN THE COURT OF COMMON PLEAS OF ~u.~\~ COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: 'tflmK fJ ~U (( l' 5; fl ' an incapacitated person FILE NO. QJ '-O~ -385 GUARDIAN OF THE ESTATE ANNUAL REPORT [20 Pa.C.S.A. 5521 (c)] FROM~,2003TO m~31 ,200d 1) I am the _Limited -X- Plenary Guardian of the Estate of my ward, nam~d above. I was appointed Guardian by Order of the Court dated ~ 31 Joo ~, which _was ----/Lwas not modified by Court Order(s) dated I :~ . 2) Is the incapacitated person still living? yes . , If no, answer the following: (a) Date of Death --....:>. (b) Place of Death (c) Name of Administrator/trix or Executor/trix -'..j (d) Date Guardian of the Person filed the last Annual Report PLEASE ANSWER THE FOLLOWING QUESTIONS WHETHER THE INCAP ACIT A TED PERSON IS LIVING OR DECEASED. 3) My initial Inventory was filed on and listed a total estate value of $ The I~ventory listed a total m~nthly income of $. ,I, j \5 . L1 ~ comprised of the followmg: JI 'IO~Y. O() S()Lir~ 3..e<..u r'\~ ) -.$31 .(o~ fU11JotJ 4) At the beginning date of this reporting period, my initial balance on hand was $ ~ . ri ~ - -' ..c' rf ..- . ~ ~ 5) During this reporting period, the following reflects all sources of income (other than social security) received by me for my ward: (Add additional pages if needed) Date Received Source of Income Amount 1. Oc~+ q ;tQ3 ~ O~ -\rail!L ~ 41Lj~L(9. 81 I 2. - . · c( rro..i l<ct -ID ' (jf.~ l)ou~ c.m rev s ~ -to u 1-- 3. 4. 5. 6. TOTAL # 4(-1q. S<{ 6) During this reporting period, the following reflects all payments I have made for my ward: (Add additional pages if needed) Date To Whom Paid Reason for Payment Amount 1. 2. 3. 4. 5. 6. TOTAL ~ , 7) The present principal assets of my ward are: Description of Asset Present Value 1. 2. Iii .+ 1::1-' ~ 3. 4. 5. 6. TOTAL ~ 8) The present amount and sources of income for my ward are: Source of Income Amount of Income (Indicate whether monthly, quarterly, annually) 1. Sou'Ct1 3CM(~~ ~f)5{p 2. ~n:==)1 Ol) --.l ( '3 L(o 2., 3. 4. 5. 6. 9) The regular monthly expenses of my ward which I pay are: To Whom Paid Amount 1. ,u\A 2. 3. 4. 5. 6. fR-. ..+ ::t-' 't 10) I have~ circle one) petitioned the Court for permission to invade principal to meet the needs of my ward. (If applicable) The following expenses of my ward have been paid from principal: To Whom Paid Purpose Amount 1. 2. 3. 4. 5. 6. 11) I have/have not (circle one) paid myself compensation for services I rendered as guardian. The amount I Paid myself totaled $ and was calculated at the following rate: $ per week/month (circle one). 12) Check the correct response and complete, if appropriate. X- There will be no need for extraordinary expenditures on behalf of my ward in the next (12) months. _ There well be a need for extraordinary expenditures on behalf of my ward in the next (12) months because: 13) Check the correct response and complete, if appropriate. _A. My ward receives monthly social security benefits directly. _B. I am the designated payee to receive my ward's social security benefits. r =h rf , ~ -A- C. The designated pay~e of my ward's social security benefits is 9u (C\..h A. d9dd ffiLmo(1 oJ ~me, whose address is ~DC\. e 5-\- cJau..4--\-1 ~ ( e. e....+ _ 'n ( \ ~ ~)" .f>A 11013 and il'is no~ (circle one) related to my ward as - (insert relationship). 14) Please note any concerns about the incapacitated person's physical or mental well being or the finances that the Court should know. J-.b Con(e(~S 15) I_am X am not guardian of the incapacitated person's person. If yes, report is attached. I certify under the penalties of perjury that the information contained in this report is true and correct to the best of my knowledge, information and belief. Nam(Qb~ ~ ~elePhOne No, (Home) daS~ ~1~~ ';:. \~~1l-r;q3U"'-~ 15((3 (Worktin)5(51- '~Ol(J :j., .+ ., 'AGE 2 700. TOTAL SALESI8ROKFR'S COMMISSION: PAID FROM PAID FROM ] I BASEDONPRlCE S @' %= BORROWER'S SELLER'S Division of Commission (line 700) as follows: FUNDS AT FUNDS AT 701. S 1,600.00 to Sailhamer Real Estate,Inc. 102. S to SETTLEMENT SETILEMENT 703. Commission paid at Settlement 1."nn.oo 704. 800. ITEMS PAYABLE IN CONNECTION wrTH L.C:V.N " 801. Loan OriginAtion Fee ~ . 802. Loan Discount ~ 803. Appnlisal Fee to 804. Credit Report to 805. Lender's Inspection Fee to 806_ 1IIJ7. Assumption Fee to 808. . 809. .' 810. 811. 812. ..~, , ,k=rrrpr Fee POC 813. Commonwealth of pa 'Ul; 814. 900. ITeMS REQUIRED BY LENDER TO BE PIllD IN ADVANCE 901. mterest from to @S /<hy ( <hys) 902. Mortgage mswance Premium for months to 903. Hazard Insurance Premium for yeus to 904. 905. . 1000. RESERVES DEPOSITED wrTH LENDER . 1001. Hazard Insunnce months@ S per month , 1002. Mortgage Inswan<e months@ S per month 1003. Oty property taxes months@ S per month 1004. County property taxes months@ S ~r month 1005. Annualassessments months@ S per month 1006. months@ S per month 1007. months@ S per month 1008. months@ S per month - noo. TI1U CHtlRCES 1101. Settlement or dosing fee to ,,_' ,m=r " .. " " T__ ,nn nn 1102. Abstract CJ< title seudllO 1103. TItle examination to 1104. TItle inswut<e binder to 1105. Document preparation to 1106. Notary fee to 1107. Attorney's fee 10 filfdlUks obow ilmrs numbors; J 1108. TItle insuranCe to (j1fd1Uks //bow il..... numbors; ) 1109. Lender'scoverage S 1110. Owner'scoverage S 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES l2ll1. Recordingfees: Deed S : Mortgage S : Release S 12ll2. Oty/county tax/stamps: Deed S : Mortgage S 1203. State taxlstamps: Deed S : Mortgage S . 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. 1302. ...., __= U_k' ,_ - ~ - '1 ..,~" nn f ,~ 1304_ShippensburQ Mobile Estates Proceeds f~r T.n" ~=n" 1305. Mis c ex n ens e s 4 , ,5 4 9 . 8 4 1306. . 1307. t- 1400. TOTAL SETTLEMENT CHARCES (mler on Ii.... 103. S<<liow '_nd 502. 5<</iow KJ 6 , , 3 4 . 8 4 : ,..._"....."y .....w...,... HUD-I s..,......,SU........nd. 101....... 01 my .-......:.1..'..' "...,ro..nd <<'0.............,01." ",""".nd d'............".......... my """'., 0'''' ... 'nlhb..._I....lhut...'~ ....~Y..."O,.,.oIHUD-Is...k:'St.......... eller 18 responsible tor repor1;1ng any gains/losses - to sa .t ~ ....i:i... SE~ . 1 i' /_, ."--:" 'J . r 5 ER2 SELLE~ A- ~ T' -' /'.jI/,./"v,/"'~ . I ~ -_ ~~ -~ ~ ~ i~ BUYER 3 To tM bnI of my kno....kd~l!. 1M HUl).l S.1I~nwnt SutflMnt whICh II' .. prepnect ,...Iru.and a(cur.lf' .ccoun. nil"" runas wntcn ~'I!" rK""~ 8nd "'n' ~"or will br di.rwd by tt'll! U, undftsipwd.. part 01 Uw Iftltfonwnt 01 thiS tr..MACtion. - ~.- HUD-l PAGE 1 OMB No. 2502-0265 ; JD A. U_S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT B. TYPE OF LOAN I. FHA 2. FMHA 3. - CONY. UN INS. 4. - VA 5. -CONY. INS. 6 Filt' Num~r 7. Lo..n Numbrr 8 Mortgage Ins Cas~ No. t SETTLEMENT STATEMENT C. NOTE: This form is fur"ish~d to g;w you a staltmtnt of actual stilltmtnt cas's. Amf1llllts paId to any /7y thr ~tfllrmtnt QKin' art shoum IItms mArUd "(P.D.c.r Wtrt paid olllsldr thr closing: thty art shoun1 h,.rr Jar mformatlortQJ purpoStS and art not inc/udtd '11 lhr tolals D. NAME AND ADDRESS OF BORROWER: Brandon Robinson E. NAME. ADDRESS AND TIN OF SELLER: Frank Yurcisin 191 SME Shippensburg,Pa. 17257 Nei.ghborhood Services of Lancaster , I nc. F. NAME AND ADDRESS OF LENDER: G. PROPERTY LOCATION: 191 SME lit Principal Residence &hi~penSburg, Pa 17257 Other eal Estate H. SETTLEMENT AGENT: Sai1hamer Real Estate, Inc. PLACE OF SETTLEMENT: 494 East King Street Shippensburg, Pa 17257 I. SETTLEMENT DATE: 9 2003 . : . . . . fOIl. GROSS AMOUNT DUE TO SElLER: 101. Contr.ad wlrs price 401. Contract s~les price 10,900.0 102. Pe-noMI Property 402. Pf'cson..1 pro~rry 103. Settlement ch.ugn to bonower lIiM 1400) 403. 104. 404 105. 405. Mil.lftmtnU IDr lttms peril by ~Ilt,. In 124ttffICt 406. Ciryltown lues 10 09/0310 6/30/04 111.30 101. 407 County I.... 1 0/0 9/ 0 3 10 12/31/0 10.08 108. As5<tssments ,. .w8 AS$essmenls 10 109. WI 110. .10 III. .11 - 112. 03 163.30 412 113. .13 114. .1. 115. <IS 116. 416. 120. GROSS AMOUNT DUE F/lOM BORROWER 420. GROSS AMOUNT DUE TO SEUEII 11,184.68 . . I . . . 201. Deposil or e.arnesl rnonry SOl. Ellcess deposll fHl' InJlrllcliunsl 202. Prind~l.amou"t of new ICMn(s) 502. Settlement ch.ugcs to seller llint 1400J 203. Exisnng JCMneS) r.aken subjm to 503. Elli'sting 10iln(sl t.k~n subject 10 204. 504. PAyoff of lirsl mortg.ge loan 205. 505 Pilyoff of ~cond mortgage IOiln 206. 506. 201. 507 208. 508. 209. 509 Adiu$tm~"'$ for ilunll Ilnp",d by KlI,r Ad,u$'m,rtls for "t",~ Ilrtpald t1y stUtr 210. City/town lues ,. 510 Cityllown l.lles to 211. County tu~ I. 511 County tilxes 10 212. A5S<tSsm~nts 10 SU. Assessments 10 213. 513 214. 514 'I' '" 216. 5'. 217. t 51~ 218. 518 219. 51' TOT.<L P.<ID BY/FOR TOT.<L REDUCTION MfOUNT ? ' 34.84 uo. BORROWER 300.00 520. DUE SELLER 100 C 4.,1/ AT .,F.:1TLl \IL ~T FROMnu BORROWER 600 C,lSI/ 4T SF.:1TLEME,~T TO FROM ,ELLER 301. Cross .Jmounl duf' from borrowf'r (f'1II 120' 1 1 184.68 601. Cross .mount due' 10 Sfll.r 1Ii"t' 4101 11 184.6E 302. Less .mounlS p.aid bv/for borTower (/jltt' 120' 300.00 602. Lus reduction in .mounr due Klier fl,nt 5101 6.634.8 303. CASH (XX FROM) ( .TO) BORROWER 10,884.68 603. CASH (X X TO) ( FROM) SELLER u4,549.8 TAXPAYER IDENTIFICATION NUMBER SOUCITATIOS; SELLEK ;:.~~;~:fi~~~:.1,::'.~: ~~~~;.'~..~~ molY bf lub",CI 10 ci,'il ~ (Tlfl\ln&l ~n"l..:t,::'';..::'/ :;'1::'1 i~~r..~~"~.:~.~:,'I~~~~:~:. nA~:~': i~:,.~~',~,,~,~It~~'IIl~~~~~/ ,.. 'kt...." ,n ,t..no F...... ol...t ~h<,uld tot (~'C~:~h tor~;((:::::i Undu p.n.lli" 01 p.q....rV', I (nutV' Ih411h. numb,,"r shoo..." on .his JI.'lI'f1U'IU II mV' (()lr.., I 1."rA\ ,'r ,d,'"",,(.'"U'" ,,"n'~..r . . . ~ , ; .' 60-1503 -"'" ... JadAamo-- i7{eaI &cau, 5"", "'jf,"'3 .Ill!. 6 5 9 5 -, , _ 194 &." ~.fA 717-6.J.9-6IM,J "'""." _ '_" ~ ~ 171107 liJS dJ4 ? ,,)003 ~~~f_ -;::;;-9"-i:. ;pr(!J,sltU, I $ ~</;? t;f ~~IJ:,v9nc1J,.tJt!.Al/d,.-.ttI/r)ur~/J//7~~ ~ t:~=- ~ I ~~~AArOAJ) ~~ ________ M' I I I I: 0 j ~ j ~ SO j b I: 0 0 0 ~ ~ j... 2 Sill (5 ~ ~,.nOvf ,.J /' I /f IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA ORPHANS' COURT DIVISION fNRE: ) ) FRANK YURCISfN ) NO. 21-02-385 An incapacitated person ) .~.. ~'. -. PETITION TO VACATE APPOINTMENT OF A GUARDIANSHIP ,- AND NOW comes Lisa Jo McCoy, of Nikolaus & Hohenadel, LLC. on behalf of Neighborhood Services, Inc. to file the within Petition. 1. Petitioner is Neighborhood Services, Inc., a nonprofit organization with the principal place of business located at 134 South Prince Street, Lancaster, Pennsylvania 17608. 2. By an Order of Court dated May 31, 2002 Petitioner was appointed as plenary permanent guardian of the estate of Frank N. Yurcisin based on his impaired ability to receive and evaluate information effectively. 3. The purpose of the guardianship of the estate of Frank N. Yurcisin was because he owned property at the time that needed to be disposed of. 4. The property has since been sold with the proceeds applied toward Mr. Yurcisin's estate. 5. Mr. Yurcisin has no other assets. Mr. Yurcisin is a resident at the Sarah Todd Memorial Home located at 1000 W. South Street. Carlisle, Pa., 17013. His sole source of income is social security benefits that are paid directly to the Memorial Home. Sarah Todd Memorial Home is the rep payee for Mr. Yurcisin's social security benefits. 6. As Mr. Yurcisin has no other assets or sources of income, there is no need for Neighborhood Services to continue acting as the plenary permanent guardian of the estate of Frank N. Yurcisin. WHEREFORE, Petitioner respectfully requests the appointment of Neighborhood Services of the plenary permanent guardian of Frank N. Yurcisin be vacated. Respectfully submitted, NIKOLAUS & HOHENADEL, LLP Date: 0&/0.> By: VERIFICA nON J. the undersigned, verify that the statements made in the attached PETITION TO V ACATE APPOINTMENT OF GUARDIANSHIP are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. section 4904 relating to unsv,orn falsification to authorities. Neighborhood Services, Inc. .' \"' Z ,-\ - \..) S )\0-;-,d:>.. .-~- DATE: BY: f. ' (SEAL) , Gilbert Abney, Asst. Director ').- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA ORPHANS' COURT DIVISION IN RE: ) ) FRANK YURCISIN ) NO. 21-02-385 An incapacitated person ) ORDER AND NOW thiS.J.J day of J(...L, . 2005 upon consideration of the within Petition, the guardianship appointment of Neighborhood Services, Inc. is hereby vacated. BY THE COURT: J. A TrEST: Copies to: The Honorable George E. Hoffer ) , ' -- 1\,1'." i~ , , ;'>'. . , } '--'" 4 ~-' j.' "-'" '. ~ . , ,:,: " !i-,:,'; \ -:. i Jr- ,-- F;' , " :,,'\,1 ~:. ," -- ~,\ , H:':I ,'-, ,- \ i , -..' . , L