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HomeMy WebLinkAbout12-8-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO. 21-11-0011 ORPHANS' COURT ESTATE OF LEWiE B. ANDERSON PETITION OF DAREN D. ANDERSON TO WAIVE GUARDIAN BOND REQUIREMENT TO THE HONORABLE JUDGE OF SAID COURT: The Petition of Daren D. Anderson, Guardian for the estate and person of his father, Lewie B. Anderson, represents that: 1. Petitioner, Daren D. Anderson, is an adult individual who resides at 691 South 82nd Street, Harrisburg, Dauphin County, Pennsylvania 17111. 2. On March 9, 2011, after a hearing, The Honorable J. Wesley Oler, Jr, issued an Order appointing Daren D. Anderson as guardian of the estate and person of Lewie B. Anderson, an incapacitated person. 3. Lewie B. Anderson, age 82, is a resident at the Frey Village Senior Living Community, 1020 North Union Street, Middletown, Pennsylvania and possesses little assets, all from the sale of his former residence. 4. Pursuant to the March 9, 2011 Order, Petitioner was required to post a bond in the amount of One. Hundred Twenty Thousand Dollars ($120,000.00), subject to waiver by this Court upon a showing of difficulty in obtaining such bond. A copy of said Order is attached hereto as Exhibit A. 5. On May 5, 2011, Petitioner Anderson .posted a $120,00.00 bond through American Insurance Administrators, Inc. ("AIA") with Traveler's of Connecticut acting as surety. Attached hereto as Exhibit B. r..,3 ..p ~ Y~"1 .. CIJ~ GX~ ~-.~ L:i ' O ~Z 7 _ ' _ C~ 3 ~` 6. The bond was rejected by the Register of Wills and Clerk of Orphans' Court because the bond was issued in the name of the Court of Common Pleas as obligee rather than the Commonwealth of Pennsylvania. 7. Petitioner made numerous attempts to have the bond reissued in the name of the Commonwealth, but was unsuccessful as Traveler's refused to issue a bond in any name other than the Court of Common Pleas of Cumberland County. A copy of this correspondence is attached hereto as Exhibit C. 8. .Petitioner made yet another attempt to obtain a satisfactory bond by applying for a bond with a second company, CNA Surety. A copy of the application is attached hereto as Exhibit D. 9. CNA Surety will charge Petitioner $740 in annual premiums, requires a personal recommendation letter from Petitioner's attorney, and will require continued involvement and supervision by Petitioner's attomey throughout the guardianship. 10. After paying expenses and medical bills of the ward, the Estate's funds are very limited. Approximately $36,000.00 remain in the estate since the residence of the ward was sold. See Exhibit A, a copy of the court order approving the sale. This figure is barely more than one quarter of the $120,000 security required by the Order. 11. All available estate funds are needed for the ongoing twenty-four (24) hour medical. care, treatment, and board for Lewie B. Anderson at Frey ~Ilage Senior Living Community. 12. The time, money, and attorney's fees spent attempting to obtain a satisfactory bond, in addition to the limited estate assets and the desperate need for funds to be used for the care of Lewie B. Anderson, make obtaining a bond extremely difficult and impracticable. 13. Despite numerous good faith attempts by Petitioner, all efforts have proven to be expensive, burdensome, and ultimately unsuccessful. 14. Thee time spent and expenses incurred have and wilt continue to take money away from the estate which is needed for the continued care of the incapacitated, Lewie B. Anderson. 15. Daren D. Anderson petitions this Court to waive the bond requirement, as permitted by the March 9, 20111 Order. 16. Based upon the information provided, Petitioner prays that this Honorable Court find the efforts made to obtain a satisfactory bond have proven too difficult and the bond requirement is waived. 17. Simultaneous with filing this Petition, a copy of this Petition and a proposed Decree was mailed to all persons in interest. WHEREFORE, Petitioner, Daren D. Anderson, respectfully requests this Court to Waive the Bond requirement and authorize your Petitioner to continue to act as Guardian for the estate and person of his father, Lewie B. Anderson. Respectfully submitted, JOHNSON, DUFFIE, STEW~ART & WEIDNER By: /.~~~----- Ulysses S. Wilson Attorney I.D. No. 312598 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Daren D. Anderson Date: -December 7, 2011 :470202 VERIFICATION I, Daren D. Anderson, verify that the statements made in the foregoing Petition .are true -and correct to the: best of my knowledge, information and belief.. 1 understand that .false statements herein. are made subject_to the penalties of 18` Pa.C.S. §4904 relating to unswom falsification to authorities. Daren D. Anderson Dated: lZ~ l-~ll EXHIBIT A IN RE: IN THE COURT OF COMMON PLEAS OF LEWIE B. ANDERSON CUMBERLAND COUNTY, PENNSYLVANIA An alleged Incapacitated ORPHANS COURT DIVISION Person NO. 21-i1-0011 ~a ~~ IN RB: PETITION PURSUANT TO SECTION 5SlI OF THE PROBATE4-; = BSTAT83 AND FIDUCIARIgB CODE TO ADJUDICATE '- ~ ~ LE9~2S B . ANDERSON TO BE INCAPACITATED AMID TO AP1~~T A •:;,;, ym ~ a' m PL~RY GUARDIAN FOR HIS PERSON AND ESTAT~•';~,n- ^' r_ T ~m,~ ~ ~ Befare Oler J. U~ `~' ~ ~ ~ ORDER OF COURT ~ ~ -, ~. ~ ~ ~•=• ~ ~ ~ rn AND NOW, this 9th day of March, 2 011, upon `-' ~~c ~r ~ ~ consideration of the Petition Pursuant to Section 5511 of v the Probate, Estates, and Fiduciaries Code To Adjudicate Lewie B. Anderson To Be Incapacitated and To Appoint a Plenary Guardian for His Person and Estate, and following a hearing held on this date, at which the allegedly-incapacitated person was not present due to his current physical and mental conditions, and with the Court's waiver of his presence, at which the Petitioner was represented by Elizabeth D. Snover, Esquire, at which evidence was presented by the Petitioner in support of the petition, including the testimony of the allegedly-incapacitated person's treating physician, Thomas Paul Kunkle, D.O., and based upon the Findings of .Fact ~~ contained in the accompanying opinion, the Court finds that the aforesaid Lewie B. Anderson is an incapacitated person, he is consequently adjudicated as such, and his son, Daren D. Anderson, who resides at 691 South 82nd Street, -r_~ ~T, n ~ -~ O _'`~', •,-~ ~f c~o p Harrisburg, Dauphin County, Pennsylvania, 17111, is appointed plenary guardian of his person and estate. A bond in the amount of $120,000 shall be required of the guardian; however, the Court will entertain a petition to waive this requirement in the event that the guardian finds it difficult to obtain such a bond. Any Power of Attorney executed by Lewie B. Anderson is hereby declared null and void and shall have no legal effect. A report by the plenary guardian shall be filed with the Court as required by law. The plenary guardian is hereby authorized to make decisions on Lewie B. Anderson's behalf concerning his medical care and treatment, including his admission to nursing homes, personal care facilities, hospitals, and other healthcare providers, as well as to consent to and authorize medical treatment, and the plenary guardian herein appointed is further authorized to handle all of the assets of his estate, including the principle and interest, and to conduct his business affairs on his behalf, including the sale or transfer of any of his assets, including the sale of real property jointly owned by him at 32 Southmont Drive, Enola, East Pennsboro Township, Cumberland County, Pennsylvania, payment of his medical bills and expenses, investment of assets and all matters related thereto. r The allegedly-incapacitated person is hereby notified of his right to appeal to the Pennsylvania Superior Court from the adjudication of incapacity herein within 30 days of its entry, and to getition at any time for a modification or a termination of the order. By the Court, Elizabeth D. Snover, Esquire 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 For Petitioner Dwayne D. Anderson 8422 Timber Crest San Antonio, TX 78250-4406 Deborah D. Nissley 59 East Main Street Mechanicsburg, PA 17055 Diane D. Coombe 744 Trevor Drive Garner, NC 27529 Damond D. Anderson 927 W. Trindle Road, Lot 6 Mechanicsburg, PA 17055 Violet M. Anderson Golden Living Center 770 Foplar Church Road Camp Hill, PA 17011 Daren D. Anderson 691 South 82nd Street Harrisburg, PA 17111 Lewie B. Anderson Golden Living Center _. 770 Poplar Church Road Camp Hill, PA 17055 :mae EXHIBIT B GUARDIAN'S BOND IN THE ORPHANS COURT FOR CUMBERLAND COUNTY, PENNSYLVANIA In re: Estate of LEWIE B. ANDERSON No. 21-11-0011 KNOW ALL MEN BY THESE PRESENTS, Bond # 105608402 That we, DAREN DEAN ANDERSON of HARRISBURG, PA as principal and the TRAVELERS of CONNECTICUT as Surety, are held and firmly bound unto the COURT in the sum of ONE HUNDRED AND TWENTY THOUSAND *** 00/100 ($120,000 )Dollars, lawful money to be paid said COURT their certain attorneys or assigns: to which payment, well and tnily to be made, we bind ourselves and each of us, our heirs, executors and administrators, jointly and severally, firmly by these present. ~h SEALED WITH OUR SEALS, dated the tJ day of MAY , 2011. NOW THE CONDITION OF THEIR OBLIGATION IS SUCH, That if the above DAREN DEAN ANDERSON guardianlguardians of LEWIE B. ANDERSON an alleged incompetent shall file a just and correct inventory of the REAL ESTATE property with the COURT and shall account to the COURT for ~ his guardianship in accordance with the provisions of the Court, and shall also deliver up the said property and estate, agreeably to the decree and order of the said court, or the directions of the law, and shall in all respects faithfully perform the duties of guardian, then this obligation shall be void and of no effect, or else remain in full force and virtue. Principal DAREN DEAN ANDERSON Sealed and delivered in the presence of i ~'h Lf.t 5-6141.102 TRAVELERS J~ POWER OF ATTORNEY Farmusgton Casualty ~p~y St. Pahl Mercury Insm~ance Company Travelers Casualty and Surety Company Travelers Casualty and Sm+ety Company of America United States Fidelity and Guaranty Company Fidelity and Guaranty Insurance Company Fidelity and Guaranty Insurance Underwriters, Inc. St. Pans Fire and Marine Insurance Company St. Pahl Guardian Insurance Company Attorney-Ia Fact No. 218183 Certificate Na. X 0 3 6 3 4 318 SNOW ALL MEN BY THESE PR,ESIIVTS: That St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company and St. Paul Mercury Insurance Company are corporaions duly organized under the laws of the State of 1vGnnesota, that Farmington Casualty Company, Travelers Casualty and Surety Company, and Travelers Casualty and Surety Company of America are corporations duly organized under the laws of the State of Connecticut, that United States Fidelity and Guaranty Company is a corporation duly organized amder the laws of the State of Maryland, that Fidelity and Guaranty Insauance Company is a corporation duly erganized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized undea the laws of the State of Wisconsin (herein coIlectiveky called the "Companies', and that the Companies do hereby make, constitute and appoint Alson O. Wolcott, Jr., Beth A. Beamer, James R. Gould, and Joseph G. Buyakowski of the City of CamrHill ,State of Pennsylvania ,their true and lawful Attomey(s}-in-Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the notate thereof on behalf of the Companies in their pusiaess of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing m guaranteeing bonds and undertakings required or permitted in any actions or. proceedings allowed by law. IN WiTNF~S~~_VHEREOF, the Comp 2010 ve caused dais instrument to be signed and then- corporate scats to be hereto affixed, this 29th day of , Farmington Casualty Company Fidelity and Guaranty insurance Company Fidelity and Guaranty InsW~ence Underwriters, Inc. St. Pad Fire and Marvde Insurance Company St. Pad Guardian Insurance Company St. Pahl Mercury Insurance Company Travelers Casualty sad Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company G~V,1~~ ~~~ ~ O~'M 'MS49 JP/f'•^s.OR~, •~~'~ ~~ ~,1/~^M~p.j o • ~ _~>;~, irl~MOWTFio s NMrRnRD, < = t'weet' ~ 11~~ t,,~ `SEAL~ao° 3 SS1LL=t° ~~ ANN. 8 ~o~t i 86 Air !6`r . ~'!a' ~ 1~ "zc~acE °1S . AN~a si=,,,,.....+f~ rsi ~ '~+ic State of Connecticut City of Hartford ss. sy: TLomps~, 'ar rce President On this the 29th day of April 2010 ~~ me 1~o~Y ~pe~ George W. Tiaompson, who aclatowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company. Tiavelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executod the foregoing instrument for the purposes therein contained by signing oa behalf of the corporations by himself as a duly authorized officer. ~p,TEf ~ C . ~1fL~R~ In WI4ieas Whereof, I krereamto set my hand and official seal. My Commission expires the 30th day of June, 2A11. # p~~p t Marie C. Teueadt, Notary Public 58440-4-09 Printed in U.S.A. THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER EXHIBIT C Ulysses S. Wilson From: jbuyakowski cQaiaworid.com Sent; Tuesday, October 04, 2011 12:51 PM To: Ulysses S. Wilson Subject: Re: Bond Certificates Ulysses, No he insists on something in writing. Joe ------Original Message------ From: Ulysses S. Wilson To: jbuyakowski~aiaworld.com Subject: FW: Bond Certificate Sent: Oct 4, 2011 12:42 PM Joe, I got a call from the Register of Wills inquiring into the status of the Bond Certificate. Was the statutory authority enough to appease the Travelers guy? Thanks. Ulysses S. Wilson Law Clerk Johnson, Duffie, Stewart, & Weidner, P.C. 301 Market Street Lemoyne, PA 17043 (717) 761-4540 x144 usw~jdsw.com This communication, along with attachments, contains information that is protected by the attorney/client and/or other privileges and is considered confidential. Receipt by anyone other than the intended recipient (a) is not a waiver of any attorney/client or other privilege. It constitutes non-public information intended to be delivered only to the designated recipient. This communication is also protected from disclosure under applicable law. If the reader or recipient of this communication is not the intended recipient, an employee or agent of the intended recipient or you believe that you have received this communication in error, please notify the sender immediately by return a-mail. The email should also be promptly deleted. Any review, retransmission, dissemination or duplication of this a-mail and/or attachments, will be considered unauthorized use and is prohibited. -----Original Message----- From: Ulysses_S. Wilson Sent: Thursday, September 22, 2011 4:42 PM To: 'jbuyakowski~aiaworld.com' Subject: Bond Certificate Joe, The Register of Wills cannot provide a writing stating that the bond must be made out to the Commonwealth. However, Title 20, section 4521 of the Pennsylvania Statutes states the following: "Any bond of a fiduciary shall be in the name of the Commonwealth for the use of those interested in the estate." (20 Pa.C.S. 4521) If this is not enough to convince Traveler's, the Register of Wills will have to see if their solicitor is willing to provide the writing they requested. Thanks, Ulysses 1 JERRY R DUFFIE RICHARD W.STEWART EDMUND G. MYERS DAVID W. DELuCE JOHN A. STATLER JEFFERSON J. SHIPMAN JEFFREY B. RETTIG KEVIN E. OSBORNE MARK C. Dt7FFIE JOHN R. NINOSKY MICHAEL J. CASSIDY MELISSA PEEL GREEVY WADE D. MANLEY ELIZABETH D. SNOVER LAW O F F I C E S ANDREW P. DOLLMAN , T SARAx E. HoFFMAN 0~~ ~ ~~ \ ' CAROLYN B. MCCLAIN v MARTIN L. WADE t~FFIE OF COUNSEL HORACE A, JOHNSON C. ROY WEmNER, JR. CONSTANCE P. BRUNT ~ ~ ~ ~ ~ o P ~ F. LEE 96IPMAN WRITER'S EXT. NO. 116 - E-MAIL dwdC~ljdsw.com October 4, 2011 Steve J. Mongelli Travelers Bond Express 770 Pennsylvania Drive, Suite 110 Exton, Pa 19341 Re: Bond Certificate In Re: Guardian Lewie B. Anderson Dear Mr. Mongelli: Enclosed please find a copy of a Court Order dated March 9, 211. The order requires appointed Guardian Daren D. Anderson post a bond in the amount of one hundred twenty thousand dollars ($120,000.00). Pursuant to 1"itle 20, Section 4521 of the Pennsylvania Consolidated Statutes, the bond shall name °The Commonwealth of Pennsylvania' as beneficiary. A copy of the statute is enclosed for your reference. ~~ Please issue a bond for the above stated amount with the l~phin-County Register of Wills pursuant to the enclosed Court Order and 20 Pa.C.S. § 4521. - Once you have issued the bond, please provide notice to the undersigned either by e- mail or standard mail. Very truly yours, H SON, I T RT t~ WEIDNER vid e u USW:462493 Enclosures 301 MARKET STREET P.O. BOX 109 LEMOYNE, PENNSXLYANL4 17043-0109 WWW.JDSW.COM 717.761.4540 FAX: 717.761.3015 MAIL~JDSW.COM JOHNSON, DUFFIE, STEWART &WEIDNER., P.C. ~'A ST 20 Pa.C.S.A. § 4521 Page 1 of 1 20 Pa.C.S.A. § 4521 Purdon's Pennsylvania Statutes and Consolidated Statutes Currentness Title 20 Pa.C.S.A. Decedents, Estates and Fiduciaries Refs & Annos) "® Chapter 45. Sureties ~® SubchaQter B. Enforcement of Bond *§ 4521. Suits on bonds Any bond of a fiduciary shall be in the name of the Commonwealth for the use of those interested in the estate. Suit may be brought thereon by any person interested therein, as provided by law. CREDIT(S) 1972, June 30, P.L. 50$, No. 164, § 2, eff. July 1, 1972. HISTORICAL AND STATUTORY NOTES 2005 Main Volume http://web2.westlaw.com/result/docuznenttext.aspx?rp=%2fFind%2fdefault.wl&scxt=Wl,&rlti=l ... 10/4/2011 ~ECElVED~ OCT ~ 7 ~~11 ~^~-~~r~~1t~4 DUFFIE I 4550 Lena Drive • Mechanicsburg, PA 17055 717-591-8280 • FAX 717-59i-8193 www.aiaworid.com ~~~~~ Insurance Administrators, tnc. October 14, 2011 David W. DeLuce Johnson, Duffle, Stewart & Weidner 301 Market Street, Y. Q. Box 1t Lemoyne, PA 17043 RE: Bond # 105608402 Guardian of Incompetent Bond Lewie B. Anderson Dave; The Travelers Surety on the above referenced will not issue the bond in any other obligee's name other than The Court of Common Pleas of Cumberland County. If the bond is not acceptable as issued, please return the original for a flat cancellation. I also need to know how you or the Court wants me to proceed. Very Joe Bu owski Attorney-in-Fact r ~~~ ~;:~~ .~ rr~:=~.~~r ~°~f ~~~ #~~a~~.er~~~~~ .~~fi~~~f~=~ s~~ :::~fra F~~r?~s~/vaa~E~; lr~~;, EXHIBIT D JERRY R DUFTTE RICHARD W.STEWART EDMUND G. MYERS DAVID W. DELUGE JOHN A. STATLER JEFFERSON J. SHIPMAN JEFFREY B. RETTIG MARE C. DUFFIE )oHN R NIrtOSgY MICHAEL J, CASSIDY MELISSA PEEL GREEVY Joy-tiwsoN DUFFIE WADED. MANLEY ELIZABETH D. SNOVER ANDREW P. DOLLMAN SARAH E. HOFFMAN CAROLYN B. MCCLAIN OF COUNSEL HORACE A. JOHNSON C. RoY WEIDNER, JR. CONSTANCE P. BRUNT E LEE SHIPMAN (1965-2006) WxtTE>~'S Exr. No. 144 E-MA17, usw@jdsw.com Mr. Joseph Buyakowski AIA, Inc.. 4550 Lena Drive Mechanicsburg, PA 17055 October 25, 2011 Re: Daren Anderson Bond Cert~cate Joe, :~. ~~" Enclosed please find the original Bond issued in the Guardian of Lewie B. Anderson matter, returned for a flat cancellation. A new bond naming The Commonwealth of Pennsylvania as obligees will be issued by another bonding company. No further action is required of you at this time. Thank you for all your help in trying to obtain a satisfactory bond in this matter and I apologize for all of the inconvenience. Very truly yours, :465630 Enclosure JOHNS~O'/N~, DUFFIE, ~ AR/T &WEIDNER Ulysses S. Wilson 301 MARKET STREET P.0. Box 109 LEMOYNE, PENNSYLVANIA 17043-0109 WWW.JDSW.COM 717.761.4540 FAX: 717.761.3015 MAIL®JDSW.COM JOHNSON, DUFFIE, STEWART &WEIDNER, P.C. JERRY R. DUFFIE RICHARD W. STEWART EDMUND G. MYERS DAVID W. DELUGE JOHN A. STATLER JEFFERSON J. SHIPMAN JEFFREY B. RETTIG MARK C. DUFFIE JOHN R. NINOSKY MICHAEL J. CASSIDY MELISSA PEEL GREEVY WADE D. MANLEY ELIZABETH D. SNOVER LAW OFFICES ANDREW P. DOLLMAN Tnu ~TCn ~T CA ORLYN B MCCIMAIN ' UFFIE OF COUNSEL IIORACE A. JOHNSON C. ROY WEIDNER, JR. CONSTANCE P. BRUNT F. LEE SHIPMAN (1965-2006) WRITER'S EXT. NO.144 E-MAIL usw~jdsw.com Melinda Kem Christian Baker Company 26 North 9th Street Lemoyne, PA 17043 Re: Bond Application Ms. Kem: November 8, 2011 Attached please find the Application for Bond of Daren Anderson and a copy of a Court, Order dated March 9, 2011. The order requires appointed Guardian Daren D. Anderson post a bond in the amount of one hundred twenty thousand dollars ($120,000.00). Also attached is an explanation of the over six month delay between the date of the court order and the date of this application. I look forward to hearing from you. Please don't hesitate to contact me with any questions or concerns. Very truly yours, JOHNSON, DUFFIE E,,WA/RT &WEIDNER G~'~ V Ulysses S. Wilson, Esq. :465652 Enclosures 301 MARKET STREET P.O. BOX 109 LEMOYNE, PENNSYLVANIA 17043-0109 WWW.JDSW.COM 717.761.4540 FAX: 717.761.3015 MAIL~JDSW.COM JOHNSON, DUFFIE, STEWART &WEIDNER, P.C. ' ~ COMPLETE APPLICAi3LE SECTfON ON AEYEASE : '.. ' PuCgc OEiciel •`...». • S~ctior+,: . Probate ... _.._: 8. Rafsree, flatxivar, eta' ...._._ 4'• • ' Court:..._...:..:..._..:._:.........._ 5 .; . Lleensa ..............:.......».....:....6 \s . .._.... .. 7. For Office Use Only CHASURETY •~ ~ ~ • Form'•10 ecu~ Iij~eTiinN FnR Rc~ND .~ Q-NY KIND Individual Lg' • Partnetslrip D . _ Corporation D Limited Liability Company Q Limited Liability Parinetship ^ Applicant (For parmerahip, give full Hama of panners and trade names) Please print or type Social Security # = l Age Maned ~ ~ of 2 - r Sy y Residence Address (Street and Number) (~4') (S~l ~ip> (7tiiep~ ~ (Strcet and Number) nesS Addres ~ Si Bu (City ) ' .5 1/{tr~~\ (State) s (lip) tephae Y) ~, aa f A o `` ~~ ,, ( t 1~(i on or business Occupati How long so engaged? Previous Surety ^ Ya No,fyea,pvei~uttecdrowttforehrge. ~ cT at sa' 20 Ty of Bo d Amount of Bond Effective Date ©. t E G r J4o.,/ ~ I Zd QvO. oo ii 1/ Complete name and address of Obligee ,v E c r-,~~f v~} ~/} . FINANCIAL STATEMENT as of NaJ• ~ Zo 1( . Check applicable si.....:,.'t on the reverse side to see whether a financial statement is necessary. Check one: pBusiness Financial Statement O Personal Financial Statement; :' •• •~••.•••'• •~ • ' b btxaaua surety ty Company or any affiliated canpaay (with such coatpwy/companies refemd to hercia a tho"Cmtpaay'~ m theapptication, authorise the Com~ny torerify this mfo-mation ark to~caia additionalwfonoatimfimmmy source, inctuc al, at the tune of any potentid'a saaal claim, ~ for any other legitimate purposes at detetmiaed by the Com9uty is its ttasom 3 To fttreiahl 5~ ' ( shall 6e prit (~ Th~it he ~ 8 Tlu if a ea ( 9) Attha tsa (!0) eriu (ll) tna ~ ~ ~ Agency b anpanqy or iu ttgatu, when due, y Ifabalty, loo, east, attornry'a fees and ex whatsoever which the Company slap at say time arrears a:•retY a red for applleaay or for tla trsforcameat of thk agreemeet, or fs obtafalat! telesre or erldeace dteraiaatlon sailer s R attorneys' fee aed exptasa are cussed, or alleged N be eased. by tle~arrea of tlrf CrmpaeJ. ton ev+deaee dtu there is no farther fiabitity an this 6md or any, other bind i tx s~~t, resfon of arch surctys at current funds wiilt the Company in an amount sutFcient to uasfy any claim apaa~st the tampsny by ~ ~t in soil faith. M iteantted sttuanentaf loss and expense iacttrred by the Compatry, swum to by sa oifixr of the Comp: geed b dte Company rosy carat or amend an bona without unse and without any liability which might arise thtsefmm, penalty temu and cond~iotu of say bond iuued for undersigned, sad this agratnertt dull apply m say salt altered bond kmve~' l,e+ebv auien to the Canwm any monies Hour due or hereafter becaning dtx Hader rile cattraet, iselud'mg ap def'e t written notice to the Company at Sioux tau, ~oum uaxtxa ~,, w, r:++ccu.o w, t,~r ~.~....~....~..-.. licant, Signed this S 'r N say of f~ 0%mete , 2oI SigaatuR k BusinesyCotporate Titre ~ ~ ~ "Itdemnitor" ~ "Itttkrfmitor" ~ - - / / ll iJiJ • Vf "lndcmnitor" ~_ ~ ~ ~ Note: personal indemnitors should sign their names before the word "indemnitor" in thdr own Agent's Code Mndwriting, e.g. S..-maemt'Iwr' AGENT'S RECOMMENDATION Your recommendation will be helpful and may be the difference between getting a refusal or having the bond written. Tell us what you know and think of the applicant. AGENT: Check here if this correspondence was previously faxed to CNA Surety. F...... 1h0_1/YM wWCI`.. '.M~ Crross Sales -Two Years Ago Last Year Net income -two rears Ago •-+~~ _~ iN~ORTANT NOTICE Please discuss with the principal the ptttettdal use of personal rxedit history to facilitate the ttttdetwrittttq revistst process. PUBLIC Nu WO~~ Elected ^ Daa: Term of Offi«: Premium will be paid: OFFICIAL s Appo;nted ^ ^ Annaeuy? ^ for teen? 1 NO FINAI~tO~A'[>~BN[' NECESSARY. HAVE PRINC~AL SIGN aPPLICATION >F rs.ooo OR MORE FIDELITY Z NO FINANCIALSfATEMENT NECESSARY. ~...~ PROBATE ;~ 3N IIAVEPRIN(~ALSIGN THIS APPLICATION. Trtk of Position Main Sources of Organization's Funding Purpose w Function of Organization Armuil Salary Will applicant sign cheeks? ^ Yes ^ No Is camtersignature required? ^ Yes ^ No By whom? Regular audits? ^ Yea ^ No EY whom? Are bank accounts reconciled by sonreoae slot authorized to deposit w withdraw from!the accowua7 ^ Yes ^ No Eva discharged from any employment? ^ Yes ^ No Why? Lsat position held? p;~ for leaving? How tong in present position? Applicant's net worth: s Name of deceased (Warti) Daa of death Date of appoinmtest (ff b applicant' a the cabs ~ Es/I E '$_ ./~,//D E Si„/ over 6 raordhs, please ex Im dcla . 3 ~ 1t or trrrat? ^ Yes No (If oa m Nana: and address of attorney (If twee, do not aria the bond: submit it to our underwriters) 30 i JN• ike~- Telephone # e .~tfo ' F / w ~ ~! Na Lcwt i o 1~ }6/-YS`l0 7~ir~r ~•k • n~~i+~br~t~ f alas w tout (rler;cribe) ,ga.c~e~ ' o Will the attomeyransirt' olvaf the Attda t , / ~ / durmort Of rhi{ galas? ~C: ^ NO /~ke~r SK.'9 ! Jrr CMh ~ ~ wort ><f y ~M~ ~ ~ArJ PAS APIA ~~ ~/ attte, age, and status [ E~,~ g AN P E!U'~N ~ rp to S Geaat trm worth: s ac 8z •s. Rce„c.~s ~1r ~~~~~ art oN ~d(a) ~$S oao. p to .support o Yes ^ No Approtdmataty bow rmrcb per rnoruh? is source tawrance senlentem, do nor exxna the bond; instead refer it to an under ° ' E seed copy of court order authorizing momlily er~eadiprres.) writez) ~,, . ,f T are rs o a estate ~Y~ a Gam's E E t!N E Gw E t'tAlt,!` 9 Yes No Will any btuirren (exc frame) of the eataa ba 7 Is tles bond ~gpued an the daaatrd of an imaeased person? Wh ? CT ^ • No by f (If yes, armd a copy of court order:) ^ Ya E o No Yes Name and r~rldress of oourt: E6/1 TER o F W! tom' ~ C ou/t T • f ~ eM m iN p1 EAt Ga rte G Ty! .1 COy.tTNoyf~r SdtM~4 C G!f / O/ What is the applianYs ertperieax is handling ftdr-ciary responsibilities? Of oltN a~ ~`' -~` ^ REFEREE'S ^ RECEIV S'R'S ^ TRUSTEE'S No FR~iiBiCOIAL~ATFJIlBNT HAVB PRII~ALSKIN 'CFIIS APPLICATION. COURT BOND OTHER TAA.N 5 ~3~ND 4 FIN SGNT HAVE PRII~AL SIGN TIIIS APPLICATION. LICENSE AND PERMIT BOND PINANCIAI.STAtBM¢NT N~s~ s'raTE HAVE PRJNCBAL SIGN THIS APPLICATION. LOST SECURITIES/ 7 CERTIFICATE OF TITLE BOND Fn~ANfaAI, sTATENIENT NECBSSARY. HAVEPRINCQ~ALSIGN THIS APPLICATION. Piairrtiff Name and address of principal's attorney pefp~m Name and location of Court ~licam's fret worth: Name sad location of Court Narne of Defendant s o attorrrcy ~ J, w cam ennc;pue a foredoarte w colleafon aeelea agarnst him? ^ Yes ^ No iF so, submit for msderwritiog. ExpLin purpose of hood (submit Dopy of relevant docurnurts) SfOUX FALLS OFFICE: P.O. Box 5077 Sioux Falls, South Dakota 57117-5077 1-600-331-6053 FAX 1-805-335-0357 www.cnasuretv.corn C/VA SURETY DALLAS OFFICE: P.O. Box 655808 Dallas, Texas T5265-5908 1-800-331-6053 FAX 1-972-980-1115 vwvw.crtasurety.txsn Nd worth: General liability insurance carried? ^ Yes ^ No s (Give limits) Explanation of six month delay: The date of appointment of Daren Anderson as Guardian of his father, Lewie B. Anderson, was March 9, 2011. The reason more than six months have elapsed between that date and the date of this application is that a bond was originally obtained naming The Court of Common Please as obligee. The Register of Wills now requires Guardian's bonds name The Commonwealth of Pennsylvania as oblige. The original bonding company refused to comply with our request to reissue the bond naming the appropriate oblige. Page 1 of 2 Ulysses S. Wilson From: Malinda Kem [MalindaK~buybestins.com] ~ Sent: Tuesday, November 22, 2011 3:27 PM To: Ulysses S. Wilson Subject: RE: Bond App for Daren Anderson Ulysses, Please see the attached request CNA and email me back your written recommendation. Malinda Kem Christian Baker Co u From: UWServices (UWServioes@cnasurety.com) [mailto:UWServices2@cnasurety.rnm] Sent: Tuesday, November 22, 2011 11:14 AM To: Malinda Kem Subject: Recent inquiry ~ CNA Surety #71198609 ~~~~ PO Box 5077 Sioux Fells SD 57117-5077 1-800-331-6053 Fax 1 X05-335-0357 www.cnasuretv.com Email: uwservioes asurefy.com DATE: November 22 2011 AGENT CODE: 37 19494 TO: Christian-Baker Company P. O. Box 158 Fax: 717-761-5810 Camp Hill, PA 17001-0158 ATTENTION: Malinda Kern NUMBER OF PAGES: 1 FROM: Eric Kirchner Underwritin S ecialist RE: File #71198649 - Dazen D. Anderson $120,004.00 -Guardian Lewie B. Anderson Incompetent Comnanv Code: 601 -Western Surety Company _ - We received the information you submitted electronically. Thank you for thinking of CNA Surety. To consider your request, please send us the following information in writing: 1. Your personal recommendation. If you are unfamiliaz with the applicant, have the attorney provide a written recommendation. Include details on the applicant's experience and qualifications to properly handle their fiduciary duties. 2. Written verification from the attorney that they will remain actively involved and continue to supervise the guazdianship. IF this bond is approved, the annual premium assigned to this risk is $740.00. If you have any questions, please contact our office. IIVIPORTANT NOTICE 11 /23/2011 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO. 21-11-0011 ORPHANS' COURT ESTATE OF LEWIE B. ANDERSON PETITION OF DAREN D. ANDERSON TO WAIVE GUARDIAN BOND REQUIREMENT TO THE HONORABLE JUDGE OF SAID COURT: The Petition of Daren D. Anderson, Guardian for the estate and person of his father, Lewie B. Anderson, represents that: 1. Petitioner, Daren D. Anderson, is an adult individual who resides at 69,1 South 82nd Street, Harrisburg, Dauphin County, Pennsylvania 17111. 2. On March 9, 2011, after a hearing, The Honorable J. Wesley Oler, Jr. issued an Order appointing Daren D. Anderson as guardian of the estate and person of Lewie B. Anderson, an incapacitated person. 3. Lewie B. Anderson, age 82, is a resident at the Frey Village Senior Living Community, 1020 North Union Street, Middletown, Pennsylvania and possesses little assets, all from the sale of his former residence. 4. Pursuant to the March 9, 2011 Order, Petitioner was required to post a bond in the amount of One Hundred Twenty Thousand Dollars ($120,000.00), subject to waiver by this Court upon a showing of difficulty in obtaining such bond. A copy of said Order is attached hereto as Exhibit A. 5. On May 5, 2011, Petitioner Anderson posted a $120,00.00 bond through American Insurance Administrators, Inc. ("AIA") with Traveler's of Connecticut acting as surety. Attached hereto as Exhibit B.