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Home My WebLink About02-07-110 (Rev. 10/04) ~... IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, n =~' PENNSYLVANIA ORPHANS' COURT DIVISION ~ ~ .. i ~ `- J ~6,.~. No.'~l - 11 - C` f $ T ~`~ ~?' rn i In re: BRITTANY NICOLE PALMER, an alleged incapacitated person '~° v ~ "! '-~ ~ <~ -~ '.~~~~ .. PETITION FOR ADJUDICATION OF INCAPACITY AND APPOINTMENT OF GUN ._._ --r .. This petition is filed to request an adjudication of incapacity and the appointment of a guarder for an alle~'d incapacitated person under section 5511 of the Probate, Estates and Fiduciaries Code, 20 Pa.C.S. § 5511: Parti General Information 1. The name and address of the petitioner and the petitioner's relationship to the alleged incapacitated person, or, in the absence of relationship, the nature of the petitioner's interest in the welfare of the alleged in capacitated person, are: Name: Denise Palmer Address: 1089 West Trindle Road, Mechanicsburg, PA 17055 Relationship or interest: Mother 2. The name, date of birth, residence, and post office address of the alleged incapacitated person, together with other vital information relating to the alleged incapacitated person, are: Name: Britlany Nicole Palmer Date of birth: 05/27/1988 Residence: 1089 W. Trindle Rd. Mechanicsburg, PA 17055 Height: 5' Social security number. 2108-2789 Sex: Female Marital status: Single Maiden name: N/A Race: Caucasian Post office address: 1089 W. Trindle Rd Mechanicsburg, PA 17055 Weight: 150 lbs. Hair color. Sandy Light Brown Eye color. Blue 3. The names and addresses of the spouse, parents, and presumptive adult heirs of the alleged incapacitated person and their relationship to the alleged incapacitated person are: Name: William A Palmer Address: 699 E. Simpson Street Mechanicsburg, PA 17055 Relationship: Father Name: Megan R. Palmer Address: 51 Mountain Street -Lot 4 Mt. Holly Springs, PA Relationship: Sister 4. The names and addresses of the persons or institution, if any, providing residential services to the alleged incapacitated person (e.g., caregiver at his or her home, hospital, or nursing home) are: Name: Denise Palmer (mother) Address: 1089 West Trindle Road, Mechanicsburg, PA 17055 ~~ r r~ :`', ~ x .• t < 7 _' a.Y~` _-, ~..~ -~ _"~'1 ~T ?~ :`r~ C-fi 5. The names and addresses of the persons or entities, if any, providing other support services to the alleged incapacitated person (e.g., attending physician, agent under power of attorney, bookkeeper, etc.) are: 1. Name: Tara Witrner Address: Pollock Centerfor Industrial Training, 262 Silver Spring Road, Mechanicsburg, PA 17055 Service provided: Employer 2. Name: Dr. Julienne Fahnestodc Address: 910 Century Drive, Suite 150, Mechanicsburg, PA 17055 Service provided: Family Doctor 3. Name: Dr. Scott Trayer Address: 816 Belvedere Street, Carlisle, PA 17013 Service provided: Psychiatrist (med management) 4. Name: Joni Fulkerson, LSW Address: 816 Belvedere Street, Carlisle, PA 17013 Service provided: Behavior Therapy 5. Name: Kimberly Williams, Supports Coordinator Address: 16 W. High Street, Suite 301, Carlisle, PA 17013 Service provided: Supports Coordinator 6. Name: Dr. John McGlaughlin Address: 4760 Union Deposit Road, Suite 100, Harrisburg, PA 17111 Service provided: Gastroenterology 6. The alleged incapacitated person suffers from the following conditions, which necessitate the appointment of a guardian: Cerebral Palsy; Mild Retardation ~If the appointment of a guardian of the estate is requested, complete Part ll. If the appointment of a guard- ian of the person is requested, complete Part lll. If the appointment of both a guardian of the estate and a guardian of the person are requested, complete both Part 11 and Part lll.J Part II Request for Appointment of Guardian of Estate 7. To the extent known by the petitioner, the alleged incapacitated person's assets and the approximate value of each asset and the alleged incapacitated person's sources of income and the estimated annual amount of income from each source are: Asset Approximate Value Personal Property: Clothing, Video Games, Compact Discs, TV and stereo $ 1, 500.00 Savings Bonds $ 1,277.00 Bank Accounts: Personal A/C SSI Payee A/C Trust Fund Total Personal Property Real Property: N/A Source of Income SSI CIT Total Estimated Annual Income $ 30.00 $ 250.00 $ 410.00 $ 3,467.00 Estimated Annual Amount $5,760.00 $2, 000.00 $7,760.00 8. Because of the alleged incapacitated person's mental and/or physical condition, the alleged incapacitated person is: • Unable to manage her financial affairs; • Unable to make and communicate responsible decisions relating to her financial affairs; • Unable to communicate her need for assistance with regard to her financial affairs; 9. The alleged incapacitated person: • Did not sign a power of attorney and did not, in any other way, designate someone or some entity to serve as her agent over her financial affairs; or 10. No other guardian of the estate of the alleged incapacitated person has been appointed by any court. 11. All less restrictive alternatives to the appointment of a guardian of the estate have been considered. The petitioner believes that such alternatives will be ineffective. 12. The type of guardian of the estate that the petitioner asks be appointed is: • Plenary 13. The name, address, and qualifications of the person or entity that the petitioner asks be appointed as guardian of the estate of the alleged incapacitated person are: Name: Denise Palmer Address: 1089 West Trindle Road, Mechanicsburg, PA 17055 Qualifications: The proposed guardian of the estate is the mother of the alleged incapacitated person, has been the alleged IP's primary caretaker for her entire life and has no interest adverse to the alleged incapacitated person. The consent of the proposed guardian of the estate is attached to this petition. Part III Request for Appointment of Guardian of Person 14. Because of the alleged incapacitated person's mental and/or physical condition, the alleged incapacitated person is: .Unable to make responsible decisions concerning her person, health, welfare, and safety; .Unable to communicate her needs conceming her health, welfare, and safety; .Unable to reside alone; .Unable to provide for her personal safety; .Unable to care for her residence; .Unable to keep herself properly nourished and hydrated; • Unable to tend to her personal hygiene; • Unable to clothe herself; • Unable to medicate herself; • Unable to make responsible decisions with regard to her medical care, including, but not limited to, obtaining health-care services and entering herself into a hospital, convalescent home, skilled care facility, residential care facility, or similar institution; 15. The alleged incapacitated person: • Did not sign any power of attorney or advance health-care directive and did not, in any other way, designate someone or some entity to serve as her agent over her person or as her surrogate over her medical care; or 16. No other guardian of the person of the alleged incapacitated person has been appointed by any court. 17. All less restrictive altematives to the appointment of a guardian of the person have been considered. The petitioner believes that such alternatives will be ineffective. 18. The type of guardian of the person that the petitioner asks be appointed is: • Plenary 19. The name, address, and qualifications of the person or entity that the petitioner asks be appointed as guardian of the person of the alleged incapacitated person are: Name: Denise Palmer Address: 1089 West Trindle Road, Mechanicsburg, PA 17055 Qualifications: The proposed guardian of the estate is the mother of the alleged incapacitated person, has been the alleged IP's primary caretaker for her entire life and has no interest adverse to the alleged incapacitated person. The consent of the proposed guardian of the estate is attached to this petition. Therefore, the petitioner respectfully requests that the Court award a citation directed to the alleged inca- pacitated person, and to such other persons as the Court may direct, to show cause why the alleged incapaci- tated person should not be adjudicated an incapacitated person and why the proposed guardian of the estate and guardian of the person should not be appointed. Date: l„ ~ ~J" ~ i Respectfully submitted, ,~ Michael C. Giordano Attorney for Petitioner Supreme Court I.D. No.: 204699 Office Address: 5000 Lenker Street Suite 202 Mechanicsburg, PA 17050 Telephone Number. 717-745-4160 I, Denise Palmer, hereby acknowledge that I have read the foregoing petition and verify that the facts stated therein are true and correct to the best of my knowledge, information, and belief. I understand that false statements made herein are subject to the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsification to authorities. Date: ~j ~~ Lc~. ~ ~ a o ~ ~ Denise Palmer Peti6bn forAdjudication of Incapaaty and Appointment of Guardian IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION No. In re: BRITTANY NICOLE PALMER, an alleged incapacitated person CONSENT OF INDNIDUAL TO APPOINTMENT AS GUARDIAN I, Denise Palmer, hereby consent to my appointment as guardian of the estate and guardian of the person of Brittany Nicole Palmer, an alleged incapacitated person, and certify that: 1. I am 18 years of age or older. 2. I reside at 1089 West Trindle Road, Mechanicsburg, PA 17055. 3. My occupation is Management Analyst at the Naval Support Activity Mechanicsburg. 4. I speak, read, and write the English language. 5. I am a citizen of the United States. 6. I do not have any interest adverse to the alleged incapacitated person. 7. I am not a fiduciary, or an officer or employee of a corporate fiduciary, of an estate in which the al- leged incapacitated person has an interest, or a surety, or an officer or employee of a corporate surety, of such a fiduciary. Date: ~ ~ ~G ii Denise almer