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HomeMy WebLinkAbout10-24-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION n ,-- O.C. NO. ~~ - 1~ ~ IIa9 ~:~~- T -~ ,: ~ r'7 ESTATE OF ORVILLE C. ZEIDERS, ~ -,~ AN ALLEGED INCAPACITATED PERSON -' ~ ~ ~ ~ . ~ %i- PETITION UNDER §5511 OF THE PROBATE, ,~~-~' ESTATES AND FIDUCIARIES CODE TO ADJUDGE ORVILLE C. ZEIDERS TO BE TOTALLY INCAPACITATED AND APPOINT A GUARDIAN FOR HIS ESTATE AND HIS PERSON TO THE HONORABLE JUDGES OF SAID COURT: HCR ManorCare Carlisle ("Petitioner") respectfully represents that: ~, } S~"' -'-~ r, -- `~~ ~T c. 1. Petitioner is a skilled nursing facility wherein resides Orville Zeiders, an alleged incapacitated person. 2. Orville Zeiders was born on January 30, 1920 and is currently 91 years of age. 3. Orville Zeiders resides in a private nursing facility in Cumberland County, whose address is: HCR ManorCare Carlisle 940 Walnut Bottom Road Carlisle, PA 17015 4. Because Orville Zeiders resides in Cumberland County, this Court has jurisdiction pursuant to § 711 (10) of the Probate, Estates and Fiduciary Code and § 5512(a). 5. To Petitioner's knowledge, Orville Zeiders has the following living relatives: Name: Address: Relationship: Lois Soranno 403 Venice Avenue Daughter Carlisle, PA 17013 Helen Kramer 9 Jolee Drive Unknown Middletown, PA 17057 6. To the extent that your Petitioner has knowledge thereof, Orville Zeiders owns no assets of significant value. 7. Orville Zeiders receives a monthly income stream of $1,575.15. 8. To Petitioner's knowledge, Orville Zeiders was not a member of the Armed Services of the United States and therefore is not receiving any benefits from the United States Veterans' Administration. 9. Orville Zeiders receives Medical Assistance benefits to help pay for the cost of his skilled nursing care at HCR ManorCare Carlisle. 10. To Petitioner's knowledge, Orville Zeiders did not appoint an agent to act under power of attorney, nor has a guardian been appointed to act on his behalf. 11. Orville Zeiders' treating physician is: Dr. Darryl Guistwite, D.O. 56 Ashton Street Carlisle, PA 17015 12. Dr. Guistwite diagnosed Orville Zeiders as suffering from dementia, a condition which causes incapacity and requires that he receive 24-hour-a-day care. 13. Because of the lack of a representative willing to act on Orville Zeiders' behalf, and due to the onset of Orville Zeiders' dementia, there may be no less restrictive alternatives to the appointment of a Guardian of the estate and person of Orville Zeiders. 14. Because of Orville Zeiders' dementia, he is totally unable to manage or even appreciate the significance of his financial affairs, property and business and to make and communicate any decisions relating thereto, including the ability to communicate his need for assistance in these areas. 15. Because of Orville Zeiders' dementia, he lacks the capacity to make or communicate any responsible decisions concerning his person and is unable to attend to his personal hygiene or to keep himself properly nourished and hydrated or communicate to others his need for assistance in these areas. 16. Because of the severity of Orville Zeiders' dementia, the assistance of other persons or services would not enable Orville Zeiders to participate in the making of any decisions concerning his estate or person. 17. The severity of Orville Zeiders' dementia requires that a plenary guardian be appointed to manage his estate. Said guardian should be appointed to manage and handle all aspects of his estate, specifically including, but not limited to: all issues relating to his cash, checks in any bank or savings account held in his name, his stocks and bonds, his personal property, his real estate, his life and other insurance of which he is a beneficiary, his entitlement to any government ornon-government benefit plans, federal, state, local taxes, trust accounts of which he is the beneficiary, claims made or to be made on his behalf or against him, the execution of documents, the entry into contracts affecting him and the payment of reasonable compensation or costs to provide services for him. 18. The severity of Orville Zeiders' dementia mandates that a plenary guardian of his person be appointed to handle all issues relating to the person of Orville Zeiders, specifically including but not limited to: his living arrangements, his medical and psychiatric care, the administration of medication to him and the employment and discharge of physicians, psychiatrists, dentists, nurses, therapists, and other professionals for his physical and mental treatment and care. Date: / ~ ~ ~ /~ Respectfully Submitted, By: Jo nedy, Esqu~ e I.D. No.: 68 8 Benjamin J. Glatfelter, Esquire Attorney I.D. No.: 203935 KENNEDY, PCLAW OFFICES P.O. BOX 5100 Harrisburg, PA 1 7 1 1 0-01 00 (717) 233-7100 Attorneys for HCR ManorCare Carlisle 4818-11 VERIFICATION The undersigned hereby verifies the statements of fact in the foregoing document are true and correct to the best of his or her knowledge, information and belief. He or she understands any false statements therein are subject to the penalties contained in 18 Pa. C. S. § 4904, relating to unsworn falsification to authorities. Dated: r7 a ~ ~/~ Si ure Printed Name: ~gf'b~f ~~~JOQC,~ Printed Job Title: ~l~//'If~ ~~f~T~p ~1f7la~~~' HCR ManorCare Carlisle 4818-11 CONSENT OF PROPOSED GUARDIAN Good News Consulting, Inc. does hereby certify they are willing to act as permanent plenary guardian of the person and estate of Orville Zeiders, an alleged incapacitated person, if the Court shall so appoint. Further, Good News Consulting, Inc. hereby certifies they are not a fiduciary of any estate in which Orville Zeiders has an interest nor do they have any other interest currently adverse to Orville Zeiders' person or estate. Dated: I ~ f .5~ `/ ~ ~a'~~ ~ C~7 ~r~r%~ Signature Print: ~~ m ~ /C's.5 Title : J ~~ U ~- ~r ~'rGt ~o o n .s . Good News Consulting, Inc. Oct 05 2011 3:32PM CRRLISE MRIfV 7172490647 p. 10 ,`_ DECLARA TI01V I, Orville Curtis Leiders, being of sound mind, willfully arld voluntarily make this declaration to be followed if I become incompetent: This declararion reflects my firm and settled commitment to refuse life-sustaining treatment under the circumstances indicated below. I direct my attending physician to withhold or withdraw life-sustaining treatment that serves only to prolong the process of my dying, if I should be in a terminal condition. I also direct my attending physician to withhold or withdraw life-sustaining treatment that serves only to prolong the process of my dying, if I should be in a state of permanent unconsciousness. I direct that treatment be limited to measures to keep me comfortable and to relieve pain, including any pain that might occur by withholding or withdrawing life-sustaining treatment. If I have a condition stated above, it is my preference TO RECEIVE tube feeding or any other artificial or invasive form of nutrition (food} or hydration (water)_ If I have been diagnosed as pregnant and that diagnosis is known to my physician, this document shall have no force or effect during the course of my pregnancy. In addition, if I am in a condition or state described above, I feel especialh~ strong about the foliowing forms of treatment: I do not want cardiac resuscitation. I do not want mechanical respiration. I do not want blood or blood products. I do not want any form of surgery or invasive diagnostic tests. I do not want kidney dialysis. I do not want antibiotics. I do want to designate another person as my Surrogate to make medical treatment decisions for me if I should be incompetent and in a condition or state described above. 1 hereby designate Lois Murphy soranno, currently residing at 7073 Carlisle Pike Lot 214, Carlise, PA 17013, as my Surrogate. If that person is unable to serve I designate Helen Kramer, currently residing at 9 Jolee Drive, Middletown, PA 17457, as my Surrogate. If any provision in this document is held to be invalid, such invalidity shall not affect the other provisions which can be given effect without the invalid provision, and to this end the directions in this document are severable.