HomeMy WebLinkAbout04-08891N RE: : IN THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
An incapacitated person NO.
On the Petition of John E. Anderson
PETITION FOR APPOINTMENT OF GUARDIAN OF THE PERSON
AND ESTATE OF AN ALLEGED INCAPACITATED PERSON
TO THE HONORABLE JUDGE OF SAID COURT:
AND NOW COMES, Petitioner, JOHN E. ANDERSON, by and through his attorney,
Monica E. Baturin, Esquire, of the Law Office of Baturin & Baturin, and files the within Petition
for the Appointment of Guardian of the Person and Estate of an Alleged Incapacitated Person,
and in support thereof, avers as follows:
1. MARY KATHERINE ANDERSON, the alleged incapacitated person, currcntly
resides at 3903 Gettysburg Road, Camp Hill, Pennsylvania 17011. She is 77 years old, her date
of birth being July 3, 1927.
2. Mary Katherine Anderson was divorced from Edgar Herr Anderson on March 13,
1990. Edgar Herr Anderson predeceased Mary Katherine Anderson on March 16, 2001.
3. Mary Katherine Anderson is not a patient in a mental hospital.
4. The Petitioner is JOHN E. ANDERSON of 6312 Chesterfield Lane,
Mechanicsburg, Pennsylvania 17050, and he is the oldest son of Mary Katherine Anderson.
Mary Katherine Anderson has six (6) children.
5. The names and addresses of those persons who would be the intestate heirs (or
next of kin) of Mary Katherine Anderson are as follows:
Edward J. Anderson (Son)
6312 Chesterfield Lane, Mechanicsburg, Pennsylvania 17050;
John E. Anderson (Son)
6312 Chesterfield Lane, Mechanicsburg, Pennsylvania 17050;
Michael B. Anderson (Son)
304 Fireside Drive, Camp Hill, Pennsylvania 17011;
Martin A. Anderson (Son)
P.O. Box 113-160, New Kingstown, Pennsylvania 17072;
James M. Anderson (Son)
RR#1, Box 3366, East Berne, New York 12059; and
Timmee Suhr (Daughter)
8 Falcon Court, Wesley Apartments, Mechanicsburg, Pennsylvania 17055.
6. The names and addresses of the person or institutions providing residential
services to Mary Katherine Anderson are as follows: Cumberland County Office of Aging and
Community Services, 16 West High Street, Carlisle, Pennsylvania 17013.
2
7. The names and addresses of other service providers are as follows:
Her primary physician is: George H. Harhigh, D.O.
25 S. 35th Street, Camp Hill, Pennsylvania 17011
An Affidavit from George H. Harhigh, D.O. regarding the health and mental condition of Mary
Katherine Anderson will be forthcoming prior to the guardianship hearing.
8. Mary Katherine Anderson is not a member of the Armed Services of the United
States and is not receiving benefits from the United States Veterans Administration.
9. The Petitioner asks that he, John E. Anderson, be appointed as Guardian of the
Person and Estate of Mary Katherine Anderson. The proposed guardian is the son of Mary
Katherine Anderson.
10. The proposed guardian has no interests which are adverse to the interests of Mary
Katherine Anderson.
11. Petitioner believes, and therefore avers, that no Court has ever assumed
jurisdiction in a proceeding to determine whether Mary Katherine Anderson is incapacitated.
12. Petitioner believes, and therefore avers, that Mary Katherine Anderson has not
previously had a guardian appointed, nor is a guardianship hearing pending in any other
jurisdiction.
13. This present guardianship is being sought for the following reasons: Mary
Katherine Anderson is completely unable to manage her financial affairs or to make any
decisions whatsoever regarding her health care/medical decisions. She no longer knows how' to
write checks and is not capable of paying her bills or taking care of herself. One of her six (6)
3
children visits her at her home daily to pay her bills, to feed her, to oversee the household
maintenance and to check on her health and/or medical condition.
14. The functional limitations and physical mental condition of Mary Katherine
Anderson are: Mary Katherine Anderson is completely unable to manage her financial affairs,
nor is she able to make competent decisions as far as her welfare is concerned. Mary Katherine
Anderson is not able to perform any of her activities of daily living without total assistance.
15. A Power of Attorney had previously been discussed with Mary Katherine
Anderson, but was never executed. Mary Katherine Anderson at the present time is not
competent to execute a Power of Attorney. No less restrictive alternatives are available to
adequately provide for the physical and financial care of Mary Katherine Anderson.
16. The Petitioner requests that the guardian be granted powers to act for Mary
Katherine Anderson in the following specific areas: financial management and medical and
health care affairs including care and placement decisions, access to all medical records and
power to make all decisions regarding medical treatment and life support.
17. The proposed guardian has the following qualifications: The proposed guardian is
the oldest son of the six (6) children of Mary Katherine Anderson. The proposed guardian loves
and cares for his mother and has been tending to her daily needs for the past several years.
18. The approximate gross value of the Estate of Mary Katherine Anderson is
approximately One Hundred Thousand Four Hundred Dollars ($100,400.00); however, there are
approximately $20,000.00 - $30,000.00 of liens against the real property. Mary Katherine
Anderson's net income from all sources totals approximately Eight Hundred Thirty-eight Dollars
4
($838.00) per month. The Social Security Checks for Mary Katherine Anderson are made
payable to "John E. Anderson payee for Mary Katherine Anderson" and goes into a separatc
account at Commerce Bank, Mechanicsburg, Permsylvania, since August 2003.
WHEREFORE, Petitioner respectfully requests that the Court, under Section 5511 of
the Probate, Estates and Fiduciaries Code, issue a Citation to Mary Katherine Anderson, Mary
Katherine Anderson's next of kin, and to such other persons as the Court directs, to show cause
why Mary Katherine Anderson should not be adjudged to be an incapacitated person and plenary
guardian of her person and estate be appointed.
Respectfully submitted,
BATURIN & BATURIN
By:
2604 North Second Street
Harrisburg, PA 17110
(717) 234-2427
Date: ~ .3 0 ~' ~> >'j Attorney for Petitioner
VERIFICATION
I VERIFY THAT THE STATEMENTS MADE IN THIS PETITION ARE TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE, BELIEF AND INFORMATION. I
UNDERSTAND THAT FALSE STATEMENTS HEREIN ARE MADE SUBJECT TO THE
PENALTIES OF 18 PA.C.S. §4904, RELATING TO UNSWORN FALSIFICATION TO
AUTHORITIES.
Date: September 29, 2004 ,~¢::i~.~-- ?_ --~.f~-
JOHN E. ANDERSON
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF DAUPHIN
On this, the -%'1 day of September, 2004, before me, the undersigned officer,
personally appeared JOHN E. ANDERSON who, being duly sworn according to law, does
depose and say that the facts set forth in the foregoing Petition are tree and correct to the best of
his knowledge, information and belief.
1N WITNESS WHEREOF, I hereunder set my hand and official seal.
JOHN E. ANDERSON
Sworn to and subscribed
before me this '~]~ ~lay
of~, 2004.
· ct.
Notary Public
IN RE: : IN THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
An incapacitated person NO.
CONSENT TO APPOINTMENT OF GUARDIAN
1. The name of the proposed guardian of the person of Mary Katherine Anderson is
John E. Anderson.
2. The name of the proposed guardian o£the estate of Mary Katherine Anderson is
John E. Anderson.
3. The proposed guardian speaks, reads and writes the English language.
4. The proposed guardian does not have an interest adverse to the alleged
incapacitated person.
5. The proposed guardian is not a fiduciary, or officer or employee of a corporate
fiduciary of an estate in which the alleged incapacitated person has an interest; and is not the
surety, or officer or employee of a corporate surety of such fiduciary.
Date: SeP~ceraber 29, 2004 ".. /-~ ~.:~,~.~,..~_..
j(YHN E. ANDERSON
iN RE: : iN THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
An incapacitated person NO.
CERTIFICATE OF SERVICE
I, MONICA E. BATUR1N, ESQUIRE, certify that on September 30, 2004, I served a true
and correct copy of the within Petition on the parties named below, by depositing same in the
United States mail, certified mail, postage prepaid as follows:
Edward J. Anderson John E. Anderson
6312 Chesterfield Lane 6312 Chesterfield Lane
Mechanicsburg, Pennsylvania 17050 Mechanicsburg, Pennsylvania 17050
Michael B. Anderson Martin A. Anderson
304 Fireside Drive P.O. Box 113-160
Camp Hill, Pennsylvania 17011 New Kinstown, Pennsylvania 17072
James M. Anderson Timmee Suhr
RR#1, Box 3366 8 Falcon Court, Wesley Apartments
East Berne, New York 12059 Mechanicsburg, Pennsylvania 17055
Respectfully submitted,
BATURIN & BATURIN
MO~lca E. Baturin, Esquire
Attorney I.D. No. 73356
2604 North Second Street
Harrisburg, PA 17110
(717) 234-2427
Date: September 30, 2004 Attomey for Petitioner
IN RE: : 1N THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
An incapacitated person NO. '; "'
On the Petition of John E. Anderson
PRELIMINARY ORDER OF COURT
AND NOW, this
~ day of , · ~. ~s &.Lf2004, upon consideration of thc attached
Petition, IT IS ORDERED that a Citation be awarded and directed to be served personally on
Mary Katherine Anderson, the alleged incapacitated person to show cause why she should not be
adjudged an incapacitated person and why John E. Anderson should not be appointed as thc
Plenary Guardian of her Estate and Person.
A Hearing ~vill be held on-".~, ?~ i;? [~L~ /fl- ,2004,
at
in
Courtroom No. _'~) , Mary Katherine Anderson has the right to request the appointment of
counsel and the right to have such counsel paid for if it cmmot be afforded.
BY THE COURT:
~j/I ~f ' ] ~ Judge
IN RE: MARY KATHERINE ANDERSON : IN THE COURT OF COMMON PLEAS OF
An alleged incapacitated person : CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
:
: NO. 21-2004-889
IMPORTANT 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 your right to
manage money and property and to make decisions. A copy of the petition which has been filed by John
E Anderson by and through his attorney Monica E Baturin, Esquire, of the Law Office of Baturin &
Baturin is attached.
You are hereby ordered to appear at a hearing to be held in Court Room No. 3, Cumberland
County Courthouse, Carlisle, Pennsylvania, on November 12 ,2004, at 9:30 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
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.
Date:10-07-2004 By:,~'~o r-,elf, ~ ~,,~ -
Clerk, Orphans' Court Division v'-- ~..~ ~_
Cumberland County, Carlisle, PA '~ ~
My Commission Expires 1st Monday,
January, 2006
1N RE: : IN THE COURT OF COMMON PLEAS
MARY KATH]fi RINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANI
: ORPHANS' COURT DIVISION
An incapacitated person NO. 21-04-0889
On the Petition e ['John E. Anderson
AFFIDAVIT OF GEORGE H. HARHIGH, D.O.
IN SUPPORT OF PETITION TO ADJUDICATE
MAl~ KATHERINE ANDERSON AN INCAPACITATED PERSON
1. Myname is: George H. Harhigh, D.O.
2. My occu! ~ation is as a: Physician
My medi :al specialty is: /,~i~ ~1 ~// ~0~ t~'/c ~
3. My busi~ ess address is: 25 South 35th Street
Camp Hill, Pennsylvania
(717) 761-4317
4. My educ ,tional background is as follows:~'/~.
a. State nedical/GraduateSchool:De~ee: ~fl~/~}
b. State Under~aduate: ~ J~4 ~}0,~16
5. I am lic~ nsed by the Commonwealth of Pennsylvania as
6. I speciali: : in:
7. ! am affil ted with the } r"~ '~ J ~ as an attending physici m.
8. I have be :n affiliated with the ~ ~ ~1,: ~ ' since .
9. I first me: M~ Kathehne ~derson on: /~ ~/~ ~
10. I last rev5 :wed M~ Kathehne Anderson's medical cha~ on:
11. M~ Ka ~edne ~derson's pe~inent dia~oses are:
12. Mary Ka :herine Anderson currently receives the medications listed below:
13. Mary Kz herine Anderson's prognosis is
14. The exte of Mary Katherine Anderson's ability to communicate is as follows:
a. Verb: [lly: Poor
b. In W 'iting: Poor
c. Othel Means: {J(/°~/
15. The exte~ l of Mary Katherine Anderson's ability to receive information is as follows:
a. Readil tg: Poor
b. Heari~ tg: Poor
16. Mary Ka herine Anderson is incapable of independently performing most activities of
daily living. Sh~ is seemingly capable of going to the bathroom by herself, but needs assistanc
to take a batbJsh. )wer and to feed herself.
17. Mary Ka herine Anderson has emotional limitations in that she is not able to fully
comprehend her surroundings and does not always recognize her family when they visit she
cannot remember to eat or bathe on her own and cannot tell time nor remember what day fo th
week or month is. Her speech is often incomprehensible.
18. Mary K: .herine Anderson does not comprehend her surroundings. She requires daily
supervision and ~nonitoring.
19. Mary Ka Iherine Anderson is completely incapable of handling her financial and persot
affairs, however minor. She requires total assistance in these areas.
20. Mary K~ herine Anderson, if called upon to grant informed consent to any medical
procedure, how~ ~er minor or straightforward, would be unable grant to it because of her
complete inabili ~ to comprehend the nature of the procedure.
21. Mary K~ ~erine Anderson cannot in any way whatsoever participate in monitoring ant
managing her o' vn medical care and medication. She requires complete supervision in this ar ~a.
22. Mary K~ .therine Anderson's severe limitations relevant to this guardianship proceedin.
are not likely to ever improve. To the extent relevant change is likely, it will be, in my medic
opinion, expres: ;ed with reasonable medical certainty, for the worse.
23. I am awa :e of the statutory definition of"incapacitated person" under Pennsylvania lay
24. My profe ssional/medical opinion, based on my examinations of Mary Katherine
Anderson and m g review of her medical charts and records, expressed with reasonable medica
certainty, is that Mary Katherine Anderson is totally incapacitated as to matters affecting her
person.
25. My prof, ssional/medical opinion, based on examinations of Mary Katherine Anderson
and my review c fher medical records, expressed with reasonable medical certainty, is that she is
totally incapacit ,ted as to matters affecting her financial affairs.
26. My over ~11 medical opinion expressed with reasonable medical certainty, is that Mary
Katherine Ande 'son requires the immediate appointment of a guardian of her person and estat
27. My prof :ssional/medical opinion is that Mary Katherine Anderson would suffer sever~
medical harm if she were required to attend her guardianship heating, however, even if she w~
to attend Mary ] [atherine Anderson would not be able to contribute in any way to the hearing, nor
would she comt rehend in any way the proceedings regarding a determination of her capacity o
handle her own personal and financial affairs.
I, George H. Harhigh, D.O., being duly sworn according to law deposes and states that
make this Affid~ vit on behalf of Mary Katherine Anderson and that the facts set forth in the
foregoing Affid~ vit are true and correct to the best of my knowledge, information, and belief.
I verify t ~at the statements in this Affidavit are true and correct. I understand that false
statements herei ~ are made subject to the penalties of 18 Pa.C.S.A. §4904 relating to unsworn
falsification to ~thorities.
Date: /(J~'~- ~ Ge~/ge H. Harhig~. /
Sworn to and su )scribed
before me this , 7 - flay
of [.4'~')cJ,)r,.r ,2004.
~ry Public
My Commissio Expires:
1N RE: : 1N THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
An alleged incapacitated person NO. 21-004-0889 ~ ~ ~
PROOF OF SERVICE OF CITATION ~
I, PEGGY HOFFMAN, being duly sworn according to law, depose and state that service
of a copy of the Citation and Petition, a copy of which is attached, was made on MARY
KATHERINE ANDERSON, by reading a copy of it to her on October o~9~ 2004, at .~:/0 ~_.m.
at 3903 Gettysburg Road, Camp Hill. Pennsylvania 17011. I read the Petition and Citation to thc
alleged incapacitated person, and then explained the documents to her, to the maximum extent
possible, in language and terms she was likely to understand.
PEGGY Ht;~FF~JAN L:
Sworn to and subsc~ri~bed
before me this
of October, 2004.
~ota~ Public
I vefi~ that the statements maae ~n m~s froot or o~vtcc me tree ~d co~ect to the best of
my ~owledge, belief and info~ation. I underst~d that false statements herein are made
subject to the penalties of 18 Pa.C.S. ~4904, relating to ~swom falsification to authorities.
IN RE: : IN THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
An alleged incapacitated person NO. 21-04-0889
On the Petition of Jolm E. Anderson
AFFIDAVIT OF SERVICE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I, SHELLEY MCGAUGHEY, do hereby depose and state that on October [ $ , 2004,
at ~, Cl [7~m. I did personally serve upon Timmee Suhr, a certified, time-stamped copy of
the Preliminary Decree, Citation and Petition For Appointment Of Guardian Of The Person And
Estate Of An Alleged Incapacitated Person, in connection with the above-captioned matter, and
addressed to Timmee Suhr, by hand-delivering same, at 8 Falcon Court, Wesley Apartments,
Cumberland County, Mechanicsburg, Pennsylvania 17055, and informing him of the nature of
the pleading, guardian proceeding and the heating scheduled for November 12, 2004, at 9:30
a.m. in Courtroom #3, at the Cumberland County Courthouse, Carlisle, Pennsylvania.
Sworn and Subscribed to ~HEId~Y MCaAUgHI~
before me this ~Q__~_~ay
of October, 2004.
Public
My Commission Expires:
c~~ I
1N RE: : IN THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT D1VISION
An alleged incapacitated person NO. 21-04-0889
On the Petition of John E. Anderson
AFFIDAVIT OF SERVICE
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
I, SHELLEY MCGAUGHEY, do hereby depose and state that on October ,~/~ , 2004,
at :1; Ii' _..~_.m. I did personally serve upon Edward J. Anderson, a certified, time-stamped
copy of the Preliminary Decree, Citation and Petition For Appointment Of Guardian Of The
Person And Estate Of An Alleged Incapacitated Person, in connection with the above-captioned
matter, and addressed to Edward J. Anderson, by hand-delivering same, at 6312 Chesterfield
Lane, Cumberland County, Mechanicsburg, Pennsylvania 17050, and informing him of the
nature of the pleading, guardian proceeding and the heating scheduled for November 12, 2004, at
9:30 a.m. in Courtroom #3, at the Cumberland County Courthouse, Carlisle, Pennsylvania.
Sworn and Subscribed to 'khELk.~lftf~e~xIJaI~Y~----j-''~
before me this ~__~day
of October, 2004.
ary Public
My Commission Expires:
IN RE: : IN THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
An alleged incapacitated person NO. 21-04-0889
On the Petition of John E. Anderson
AFFIDAVIT OF SERVICE
COMMONWEALTH OF PENNSYLVANIA :
SS. :~
COUNTY OF CUMBERLAND -
I, SHELLEY MCGAUGHEY, do hereby depose and state that on October t'~ ,2004,
at _,4 ~ ¥5'- ~9 .m. I did personally serve upon George H. Harhigh, D.O., a certified, time-
stamped copy of the Preliminary Decree, Citation and Petition For Appointment Of Guardian Of
The Person And Estate Of An Alleged Incapacitated Person, in connection with the above-
captioned matter, and addressed to George H. Harhigh, D.O., by hand-delivering same, at 25
South 35th Street, Cumberland County, Camp Hill, Pennsylvania 17011, and informing him of
the nature of the pleading, guardian proceeding and the hearing scheduled for November 12,
2004, at 9:30 a.m. in Courtroom #3, at the Cumberland County Courthouse, Carlisle,
Pennsylvania.
Sworn and Subscribed to SHELI~Y MCGA~JCd~Y
before me this ,~6~ ~ day
of October, 2004.
~otary Public
My Cmn_mission Expires:
c~ o~ammn,~ I
1N RE: : 1N THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT D1VISION
An alleged incapacitated person NO. 21-04-0889
On the Petition of John E. Anderson
AFFIDAVIT OF SERVICE
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
I, SHELLEY MCGAUGHEY, do hereby depose and state that on October ? ) ,2004,
at ~ ' o I ~ .m. I did personally serve upon Michael B. Anderson, a certified, time-stamped
copy of the Preliminary Decree, Citation and Petition For Appointment Of Guardian Of The
Person And Estate Of An Alleged Incapacitated Person, in connection with the above-captioned
matter, and addressed to Michael B. Anderson, by hand-delivering same, at 304 Fireside Drive,
Cumberland County, Camp Hill, Pennsylvania 17011, and informing him of the nature of the
pleading, guardian proceeding and the hearing scheduled for November 12, 2004, at 9:30 a.m. in
Courtroom #3, at the Cumberland County Courthouse, Carlisle, Pennsylvania.
Sworn and Subscribed to SHELLEY MCGAErGHEY
before me this c~~ day
of October, 2004.
ary Public
Commission Expires:
iN RE: : IN THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
An alleged incapacitated person NO. 21-04-0889
On the Petition of John E. Anderson
AFFIDAVIT OF SERVICE
COMMONWEALTH OF PENNSYLVANIA :
~ SS.
COUNTY OF CUMBERLAND :
I, SHELLEY MCGAUGHEY, do hereby depose and state that on October [ ~, 2004,
at ] ~ c/C~ c4, .m. I did personally serve upon Martin A. Anderson, a certified, time-stamped
copy of the Preliminary Decree, Citation and Petition For Appointment Of Guardian Of The
Person And Estate Of An Alleged Incapacitated Person, in connection with the above-captioned
matter, and addressed to Martin A. Anderson, by hand-delivering same, at P.O. Box 113-160,
New Kingstown, Cumberland County, Pennsylvania 17072, and informing him of the nature of
the pleading, guardian proceeding and the hearing scheduled for November 12, 2004, at 9:30
a.m. in Courtroom #3, at the Cumberland County Courthouse, Carlisle, Pennsylvania.
~rX~; ~-~1. (SEAL)
Sworn and Subscribed to SHEI~L~/f MCGAUGrIlEY-
before me this ~)~¢7/~ day
of October, 2004.
y tarv Public
Commission Expires:
iN RE: : 1N THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT D1VISION
An alleged incapacitated person NO. 21-04-0889 :;"
7
On the Petition of John E. Anderson
CERTIFICATE OF SERVICE
I, Monica E. Batufin, Esquire, of the Law Firm ofBatufin & Baturin, attorneys for the
Plaintiff in the above-captioned matter, do hereby certify that on October 1, 2004, I deposited in
the United States Mail, Harrisburg, Pennsylvania, an article of Certified Mail, Return Receipt
Requested, a time-stamped copy of the Preliminary Decree, Citation and Petition For
Appointment Of Guardian Of The Person And Estate of An Alleged Incapacitated Person,
beating Article No. 7000 0520 0023 0131 8134, addressed to: Timmee Suhr, 8 Falcon Ct.,
Wesley Apts., Mechanicsburg, PA 17055.
The said article of Certified Mail, as shown by the Postal Return Receipt Card, was
received by the Defendant on October 13, 2004, and according to same, was signed, to wit: by
Timmee Suhr, which card is attached hereto and marked as Exhibit "A", along with the deposit
slip dated October 1, 2004, for said article of Certified Mail aforementioned.
Respectfully submitted,
BATURIN & BATURIN
tonica E. Baturin, Esquire
tomey I.D. No. 73356
2604 North Second Street
Harrisburg, PA 17110
Date: October 27, 2004 (717) 234-2427
Certified Fe~ .... 51 3~ f~'~ Postmark
Return Receipt Fee
~.dorsement Require~ ....
Here
Restricted Oelfvew Fee 09/3~
(Endorsement Required)
Total Postape & Fees $ ~ . 88
Recipient rs Name please Prln~ Clearly) (To be complefed by mallerJ
~ii;,']i;}g'[i~7~M~icsb~q. ..................................................................... PA 17055
· Complete items 1, 2, and 3. Also complete A, Signature
item 4 if Restricted Delivery is desired. ~~ <=~.t,t.,~,~.~_~ [] Agent
· Print your name and address on the reverse ,~ ~ ~f~'fy~.~ r-i Addressee
so that we can return the card to you. B. Received by ( Printed Name) I C. Date of
Delivery
· A'~ach this card to the back of the mailpiece,
or on the front if space permits.
D. Is delivery address diff ~; Yes
T:]-rcmee Su _,h_~ 3
8 Falcon Ct., W~l~y Apts.
M~chanicsburg, PA 17055 .?
Certified Mail [] Express Mail
~stered [] Return Receipt for Merchandise
[] h~sured Mail [] C.O.D.
4. Restricted Delivery? (Extra Fee) [] Yes
2. Article Number
(Transferfromse~lcelab~ '~ 7000 0520 0023 O131 8134
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
Exhibit "A"
1N RE: : IN THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
An alleged incapacitated person : NO. 21-04-0889
On the Petition of John E. Anderson : ..~.:
CERTIFICATE OF SERVICE .,
I, Monica E. Baturin, Esquire, of the Law Firm of Baturin & Baturin, attorneys for the
Plaintiff in the above-captioned matter, do hereby certify that on October 1, 2004, I deposited in
the United States Mail, Harrisburg, Pennsylvania, an article of Certified Mail, Return Receipt
Requested, a time-stamped copy of the Preliminary Decree, Citation and Petition For
Appointment Of Guardian Of The Person And Estate of An Alleged Incapacitated Person,
bearing Article No. 7000 0520 0023 0131 8196, addressed to: Martin A. Anderson, P.O. Box
113-160, New Kingstown, PA 17072.
The said article of Certified Mail, as shown by the Postal Return Receipt Card, was
received by the Defendant on October 14, 2004, and according to same, was signed, to wit: by
Martin A. Anderson, which card is attached hereto and marked as Exhibit "A", along with the
deposit slip dated October 1, 2004, for said article of Certified Mail aforementioned.
Respectfully submitted,
BATUR1N & BATURIN
I~onica E. Baturin, Esquire
Attorney I.D. No. 73356
2604 North Second Street
Harrisburg, PA 17110
Date: October 27, 2004 (717) 234-2427
r--~ Postage $
~ !Endo~m~nt Re~uir~c 09/30/04
~ Tot. I Pos~ge & Fee~ $ 4.88
~ ....... ~.A.._~o~ ............................................
~i;,'~}bT~7 4 ..................................................
N~ ~s~n PA 17072 ,, . ,
· Complete items 1, 2, and 3. Also complete A. Received b
item 4 if 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 of the mailpiece,
or on the front if space permits.
D. Is delivery address different from
1. Article Addressed to: If YES, enter delivery address below: ~ NO
Martin A. Anderson
PO Box 113-160
N~ Kingstown, PA 17072
3. ervice Type
ertified Mail [] Mail
Express
egistered [] Return Receipt for Merchandise
[] Insured Mail [] C.O.D,
4, Restricted Delivery? (Extra Fee) [--I Yes
2. Article Number (Copy from service label)
7000 0520 0023 0131 8196
PS Form 3811, July 1999 Domestic Return Receipt 102595-00-M-0952
Exhibit "A"
IN RE: : IN THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT D1VISION
An alleged incapacitated person NO. 21-04-0889
On the Petition of John E. Anderson ,~
?
CERTIFICATE OF SERVICE
I, Monica E. Baturin, Esquire, of the Law Firm of Baturin & Baturin, attorneys for the
Plaintiff in the above-captioned matter, do hereby certify that on October l, 2004, I/teposited-~n
the United States Mail, Harrisburg, Pennsylvania, an article of Certified Mail, Return Receipt
Requested, a time-stamped copy of the Preliminary Decree, Citation and Petition For
Appointment Of Guardian Of The Person And Estate of An Alleged Incapacitated Person,
bearing Article No. 7000 0520 0023 0131 8158, addressed to: James M. Anderson, RR#1, Box
3366, East Berne, NY 12059.
The said article of Certified Mail, as shown by the Postal Return Receipt Card, was
received by the Defendant on October 13, 2004, and according to same, was signed, to wit: by
James M. Anderson, which card is attached hereto and marked as Exhibit "A", along with the
deposit slip dated October 1, 2004, for said article of Certified Mail aforementioned.
Respectfully submitted,
BATURIN & BATURIN
~/4onica E. Baturin,
Esquire
Attorney I.D. No. 73356
2604 North Second Street
Harrisburg, PA 17110
Date: October 27, 2004 (717) 234-2427
Ce~ifled Fee 2.30
(Endorsement Required} 1 o 75
Restricted Defive~ Fee 09/30/04
TO~I Postage & F~S $4.88
Recipient s Name Please Print Clearly) (To be completed by meileO
~t Bede,
· Complete items 1, 2, and 3. Also complete
item 4 if 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 of the mailpiece, \gen
or on the front if space permits. ~see
1. Article Addressed to: D, Is delivew address different om item 1 ? [] Yes
If YES, enter delivery address below: [] No
Jaguars M. Anderson
RR#1, Box 3366
East B~rne, NY 12059
3. ce Type
~C~rtified Mail [] Express Mail
[] Registered [] Return Receipt for Merchandise
[] Insured Mail [] C.O.D.
4, Restricted Delivery? (Extra Fee) [] Yes
2. Article Number (Copy from service label)
7000 0520 0023 0131 8158
PS Form 3811, July 1999 Domestic Return Receipt 102595-00 M-0952
Exhibit "A"
IN RE: : IN THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT D1VISION
An alleged incapacitated person NO. 21-04-0889
On the Petition of John E. Anderson :;
CERTIFICATE OF SERVICE
I, Monica E. Baturin, Esquire, of the Law Firm of Baturin & Baturin, attorneys for the
Plaintiff in the above-captioned matter, do hereby certify that on October 1, 2004, I deposited in
the United States Mail, Harrisburg, Pennsylvania, an article of Certified Mail, Return Receipt
Requested, a time-stamped copy of the Preliminary Decree, Citation and Petition For
Appointment Of Guardian Of The Person And Estate of An Alleged Incapacitated Person,
bearing Article No. 7000 0520 0023 0131 8189, addressed to: John E. Anderson, 6312
Chesterfield Lane, Mechanicsburg, PA 17050.
The said article of Certified Mail, as shown by the Postal Return Receipt Card, was
received by the Defendant on October 5, 2004, and according to same, was signed, to wit: by
John E. Anderson, which card is attached hereto and marked as Exhibit "A", along with the
deposit slip dated October 1, 2004, for said article of Certified Mail aforementioned.
Respectfully submitted,
BATUR1N & BATURIN
By:/ '!~r'ilC~ ( ~__5_Ck-L4;../,_~
I~onica E. Baturin, Esquire
Attorney I.D. No. 73356
2604 North Second Street
Harrisburg, PA 17110
Date: October 27, 2004 (717) 234-2427
2.30
Certified Fee
<End ....... t Required) ..... 09/30/04
Jo~ E. ~e~on
M~ics~, PA 17050
· Complete items 1, 2, and 3. Aisc complete
item 4 if Restricted Delivery is desired. [] Agent
· Print your name and address on the reverse ,~"Addressee
so that we can return the card to you. C. Date of Delivery
· Attach this card to the back of the mailpiece,
or on the front if space permits. J<~ -~-- O~
D. Is delivery address d~ferent from item 1 ? [] Yes
1. A~icle Addressed to:
If YES, enter delivery address below: ~ No
John E. Anderson
6312 Ch~sterfield Lane
M~chanicsburg, PA
L-PRegiste~ed [] Return Receipt for Merchandise
[] Insured MAil [] C.O.D.
4. Restricted Deliver~? (Extra Fee) [] Yes
2, Article Number 7000 0520 0023 0131 8189
Exhibit "A"
IN RE: : 1N THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
An alleged incapacitated person NO. 21-04-0889
On the Petition of John E. Anderson
CERTIFICATE OF SERVICE
I, Monica E. Baturin, Esquire, of the Law Firm of Baturin & Baturin, attorneys for the
Plaintiff in the above-captioned matter, do hereby certify that on October l, 2004, I deposited in
the United States Mail, Hanisburg, Pennsylvania, an article of Certified Mail, Return Receipt
Requested, a time-stamped copy of the Preliminary Decree, Citation and Petition For
Appointment Of Guardian Of The Person And Estate of An Alleged Incapacitated Person,
bearing Article No. 7000 0520 0023 0131 8165, addressed to: Michael B. Anderson, 304
Fireside Drive, Camp Hill, PA 17011.
The said article of Certified Mail, as shown by the Postal Return Receipt Card, was
received by the Defendant on October 13, 2004, and according to same, was signed, to wit: by
Michael B. Anderson, which card is attached hereto and marked as Exhibit "A", along with the
deposit slip dated October 1,2004, for said article of Certified Mail aforementioned.
Respectfully submitted,
BATUR1N & BATURIN
~Aonica E. Baturin, Esquire
Attorney I.D. No. 73356
2604 North Second Street
Harrisburg, PA 17110
Date: October 27, 2004 (717) 234-2427
m ..... .83 ---
~ 2.30
1.75
D Total Postage & Fees $ 4.88 __j
ILl --
Michael B. Anderson
~- /ct~' s~+~ill, PA 17011
· Complete items 1,2, and 3. Aisc complete B. Date of Delivery
item 4 if Restricted Delivery is desired. ~ .~ ~j J~
· Print your name and address on the reverse
so that we can return the card to you. C. Signature
· Attach this card to the back of the mailpiece, r-I Agent
or on the front if space permits.
D. Is delivery address d~ferent from item l ? [] Yes
1. Article Addressed to:
If YES, enter delivery address below: [] No
Mr. Mich~el B. Anderson
304 Fireside Drive
Camp Hill, PA 17011
3. Service Type
R Certified Mail [] Express Mail
egistered [] Return Receipt for Merchandise
[] Insured Mail [] CO.D.
4. Restricted Delivery? (Extra Fee) [] Yes
2. Adicle Number (Copy from service label)
7000 0520 0023 0131 8165
PS Form 3811, July 1999 Domestic Return Receipt 102595 00-M-0952
Exhibit "A"
IN RE: : IN THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
An alleged incapacitated person NO. 21-04-0889 : ~ -~
On the Petition of John E. Anderson '
CERTIFICATE OF SERVICE
I, Monica E. Baturin, Esquire, of the Law Firm of Baturin & Baturin, attorneys for the
Plaintiff in the above-captioned matter, do hereby certify that on October 1, 2004, I deposited in
the United States Mail, Harrisburg, Pennsylvania, an article of Certified Mail, Return Receipt
Requested, a time-stamped copy of the Preliminary Decree, Citation and Petition For
Appointment Of Guardian Of The Person And Estate of An Alleged Incapacitated Person,
bearing Article No. 7000 0520 0023 0131 8172, addressed to: Edward J. Anderson, 6312
Chesterfield Lane, Mechanicsburg, PA 17050.
The said article of Certified Mail, as shown by the Postal Return Receipt Card, was
received by the Defendant on October 5, 2004, and according to same, was signed, to wit: by
Edward J. Anderson, which card is attached hereto and marked as Exhibit "A", along with the
deposit slip dated October 1, 2004, for said article of Certified Mail aforementioned.
Respectfully submitted,
BATUR1N & BATURIN
IM0nica E Baturin, Esquire
Attorney I.D. No. 73356
2604 North Second Street
Han'isburg, PA 17110
Date: October 27, 2004 (717) 234-2427
· Complete items 1, 2, and 3. Aisc complete A. Received by (Please Print Clearly) B. Date of Delivery
item 4 if Restricted Delivery is desired.
· Print your name and address on the reverse
so that we can return the card to you. c. Signature
· Attach this card to the back of the mailpiece, [] Agent
or on the front if space permits. ~ Addressee
1, Article Addressed to: , address different from item 17 [] Yes
If YES, enter delivery address below: ~], No
F~ward J. Anderson
6312 Chesterfield Lane
Mechanicsbur9, PA 17050
3. Service Type
Certified Mail [] Express Mail
Registered [] Return Receipt for Merchandise
[] Insured Mail [] C.OD.
4. Res rc ed Delivery? (E~tra Fee) [] Yes
2. Article Number (CoRy from service label)
7000 0520 0023 0131 8172
PS Form 3811, July 1999 Domestic Return Receipt 102595 00-M-0952
Exhibit "A"
IN RE: : 1N THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DiVISION
An alleged incapacitated person NO. 21-04-0889
On the Petition of John E. Anderson
CERTIFICATE OF SERVICE
I, Monica E. Baturin, Esquire, of the Law Finn of Baturin & Baturin, attorneys for the
Plaintiff in the above-captioned matter, do hereby certify that on October 22, 2004, I deposited in
the United States Mail, Harrisburg, Pennsylvania, an article of Certified Mail, Return Receipt
Requested, a certified, time-stamped copy of the Preliminary Decree, Citation and Petition For
Appointment Of Guardian Of The Person And Estate of An Alleged Incapacitated Person,
bearing Article No. 7003 0500 0004 0866 0562, addressed to: James M. Anderson, 692 Bear
Dam Road, East Berne, NY 12095.
The said article of Certified Mail, as shown by the Postal Return Receipt Card, was
received by James M. Anderson on October 26, 2004, and according to same, was signed, to wit:
by James M. Anderson, which card is attached hereto and marked as Exhibit "A", along with the
deposit slip dated October 22, 2004, for said article of Certified Mail aforementioned.
Respectfully submitted,
BATURIN & BATURIN
By: //
Monica E. Baturin, Esquire
. . Attorney I.D. No. 73356
2604 North Second Street
Harrisburg, PA 17110
Date: November 1 t, 2004 (717) 234-2427
Exhibit "A"
dames g, Anderson
692 Beaver Da~
Eas~ Berne, NY 12059
· Complete items 1,2, and 3. Also complete
item 4 if Restricted Delivery is desired,
[]
Agent
· Print your name and address on the reverse [] Addressee
so that we can return the card to you. B. Received by (Pdnted Name)
· Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to: D. Is delivery address different from item 1
If YES, enter delivery address below: [] NO
James
~. Anderson
692 Beaver Dam Road
East Berne, NY 12095
[] Express Mail
istered [] Return Receipt for Merchandise
[] Insured Mail [] C.O.D.
4. Restricted Delivery? (Extra Fee) [] Yes
2. Article Number 7003 0500 0004 0866 0562
~Fransferfromservicelabel) 7003 0500 0004 0866 0562
PS Form 3811, August 2001 D .......................
5
IN RE: : IN THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
:
An incapacitated person NO. 21-04-0889
On Petition of John E. Anderson
FINAL ORDER OF COURT APPOINTING PLENARY GUARDIAN
AND NOW, this 12th day of November, 2004, a hearing in this case having been held
on November 12, 2004, at 9:30 a.m., in Court Room Number 3, Cumberland County Courthouse,
Carlisle, Pennsylvania, and it appearing to this Honorable Court that Mary Katherine Anderson
was personally served with a Citation and Notice of this hearing on October 26, 2004, and that
the physical or mental condition of Mary Katherine Anderson would be harmed by her presence
at the said hearing, and further finds from the testimony:
1. That Mary Katherine Anderson suffers from the effects of Alzheimer's Dementia,
which totally impairs her capacity to receive and evaluate information effectively and to make
and communicate decisions concerning her management of financial affairs or to meet essential
requirements for her physical health and safety.
2. That there are insufficient supports available to assist Mary Katherine Anderson in
such decisions and that there exists no other less restrictive alternative mechanism for decision-
making.
3. That based on the total incapacity of Mary Katherine Anderson to receive and
evaluate information and to make or communicate decisions, a plenary Guardian of the Person
and a plenary Guardian of the Estate are required on a permanent basis.
NOW, THEREFORE, based on the clear and convincing evidence supporting the
foregoing findings it is ORDERED, ADJUDGED and DECREED that MARY KATHERINE
ANDERSON be and is hereby adjudged a totally incapacitated person and JOHN E.
ANDERSON is appointed Plenary Permanent Guardian of the Person and Estate. As Plenary
Permanent Guardian of the Person, John E. Anderson, has the authority to access all of Mary
Katherine Anderson's medical records, including but not limited to psychiatric records, and to
make all decisions regarding her health care, placement decisions, medical treatment, and life
support.
As the Plenary Permanent Guardian of the Estate of Mary Katherine Anderson, John E.
Anderson has the authority to make all of the decisions concerning her financial affairs.
An Inventory must be filed within ~ ( ~(~ ) days. A report by the
Guardian shall be filed within 12 months and annually thereafter.
Bond is hereby waived.
Mary Katherine Anderson, an incapacitated person, has the fight to appeal this Order of
Court by filing Exceptions within ten (10) days of this date or to Petition this Court for a review
hearing to modify or terminate the guardianship herein established.
2
If Mary Katherine Anderson was not present at this hearing on appointment of a guardian,
then petitioner shall serve upon and read to Mary Katherine Anderson the Statement of Rights, a
copy of which is Attached to this ORDER as Exhibit "A", and file proof of such service with this
Court within ten (10) days.
BY THE COURT:
3
1N RE: : IN THE COURT OF COMMON PLEAS
MARY KATHERINE ANDERSON: OF CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DiVISION
:
An incapacitated person : NO.
STATEMENT OF RIGHTS UPON APPOINTMENT OF A GUARDIAN
AN ORDER HAS BEEN ENTERED WHEREBY YOU HAVE BEEN ADJUDICATED
AN INCAPACITATED PERSON AND UNABLE TO CARE FOR YOURSELF AND/OR
MANAGE YOUR PERSONAL AFFAIRS. YOU HAVE THE RIGHT TO FILE EXCEPTIONS
TO THE COURT'S DECISION WITHIN TEN (10) DAYS OF THE DATE OF THE COURT'S
ORDER. IF YOU FAIL TO FILE EXCEPTIONS, THE ORDER WILL BECOME FINAL. IN
THE EVENT THAT YOU FILE EXCEPTIONS AND THEY ARE DENIED, YOU HAVE A
RIGHT TO FILE AN APPEAL TO THE SUPERIOR COURT WITHIN THIRTY (30) DAYS
OF THE DATE OF THE DENIAL OF THE EXCEPTIONS.
IN ADDITION, YOU MAY PETITION THE COURT AT ANY FUTURE TIME TO
MODIFY OR TO TERMINATE THE GUARDIANSHIP IF THERE IS A CHANGE IN YOUR
CAPACITY OR IF YOUR GUARDIAN FAILS TO PERFORM HIS DUTIES IN
ACCORDANCE WITH THE COURT'S ORDER.
IF YOU WISH TO APPEAL THE ORDER OR TO PETITION THE COURT TO
MODIFY OR TERMINATE THE GUARDIANSHIP, YOU HAVE THE RIGHT TO BE
REPRESENTED BY AN ATTORNEY. IF YOU DO NOT HAVE AN ATTORNEY, THE
COURT MAY APPOINT ONE TO REPRESENT YOU. IF YOU CANNOT AFFORD AN
ATTORNEY, THE SERVICES OF AN ATTORNEY WHOM THE COURT MAY APPOINT
FOR YOU MAY BE PROVIDED AT NO COST TO YOU.
EXHIBIT "A"
[,...
,~
't
IN THE COURT OF COMMON PLEAS OF CumberlandCOUNTY, PENNSYL VANIA
ORPHANS' COURT DIVISION
. 4,1/I.!-e..r$'^
IN RE: ,11/ dJ'l kclltt..uj,^~ , an incapacitated person
r
o~'il'l
FILE NO. 2 (-oLf- 6 is'?
GUARDIAN OF THE ESTATE ANNUAL REPORT
[20 Pa.C.S.A. 5521 (c)]
FROM AI cv-. J 7- , 200 I.f TO r ~I" .3
, 200 5"
I) I am the Limited ~nary Guardian of the Estate of my ward, named above.
I was apPointed~ian by Order of the Court dated N. >/' /2- UiJ,l(,.;. hich ".:
_was ~ as no modified by Court Order(s) dated)._ ;. .
-.-.'
I ."11
,
2) Is the incapacitated person still living? y'~ 5
If no, answer the fol1owing: '
(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
(,.)
.,
. ,
",
,
o
PLEASE ANSWER THE FOLLOWING QUESTIONS WHETHER THE
INCAP ACIT A TED PERSON IS LIVING OR DECEASED.
./
1.-3.0:'
3) My initial Inventory was filed on Me uJ and listed a total estate value of
$
The Inventory listed a total monthly income of $ g LfS-7~ comprised of the
following: :5 cG .5 e<... 0 ,,,\ v
,
4) JAt the beginning date of this reporting period, my initial balance on hand was
$ l;...Jt!XJ~ .
,
C.A.-28
'+,
.-F
t=t"'
~
\aw-,,,,,,IIf) '1/ $'~iv""er M..-rl, -rNe~y'S. III It (
3. :D. ( D,)'(..r-... Leve,.d .....-+~ S"'-f' . IV 0 V d.. U e
150 000 MJe!. ." d;.
4. )Q.uJ~II"J i Mo'^^ i ,.J.n \fUr r,t{),:../1 (~ o-
f . J.......I-ry' V oC'
5. (~e.c (<. 11A.C( 4<::<...-t- "fl'-t)<l, Jloo
6. '
LOu,,- rdl"",\.~~ T re'lSv,' e.. is -tke v",( ve.. I
TOTAL
W-<. pl<<.L< o'^ e<<c k. . t k".....
-
8) The present amount and sources of income for my ward are:
VJ () :, I CD ~
1.
_~.o. 5~cl See..
Amount ofIncome
(Indicate whether monthly,
quarterly, annual1y)
" 'B If, 5 .!!.!!-
Source ofIncome
2.
3.
4.
5.
6.
u"sc "rt..>iI'M4.~
Amount 0-
9) The regular monthly expenses of my ward which I pay are:
To Whom Paid
1.
2.
3.
4.
5.
6.
7
g
I:h
eJL
V -
~
., ~ 5~ I~ 4; ~~':: il5'O
rOD; Q5..tv..e..-, i 5,~h.:1r:.;:P, .{)
() I' ~ H~l...eJ "-~,,Q;
I (.1/'5'",,11. Net '5 B-D,,~/ G:lu "",clDt~< ~.
W~j
\{ a..v-J CIA V' ~
0; I
7 5' '!9-
30~
I.fO~
)qo~
{ 7 () ..!.!!.
5D~
4: () .~
7;- 00
rt=
't
5) During this reporting period, the following reflects all sources of income (other than
social security) received by me for my war~:.~dditional pages if needed)
Date Received Source of Income ~ Amount
I.
2.
3.
4.
5.
6.
TOTAL
6) During this reporting period, the following reflects all payments I have made for my
ward: (Add additional pages if needed)
Reason for Payment Amount
Date
To Whom Paid
1.
5 e-e=#= 1
2.
3.
4.
5.
6.
TOTAL
7) The present principal assets of my ward are:
I.
Descriotion of Asset Present Value
1+0 v5f' f1Joo ooD~ esT:.
. .f
.f 'L al' A I \ <lfP"""'(lS J r Jr..',~vl'( :{ lI.{)?I "P ~
r\Jrl\."VIf'~) ve.~w\l1.s ;;!O"iDyr( .!~. . T u- .
. Ve..-y V$"hk /,..t /JUt r<l~ lr,Jv~
P,d-I.U--.t5 o-t h..o\l~e liAslcRe C+b,Io"1'~i) 6vt.) ovitl?l-e Itr.f
<tl!tI.'(4.~I~ "f"A r",,~"i'.s-t,
.+
2.
:+.
I='"'
't
10) I hav..vhave n;;t'xcircle 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 orincioal:
To Whom Paid
Puroose
Amount
1.
2.
3.
4.
5.
6.
I I) I hav~ circle one) paid myself compensation for services I rendered as
guardian.
The amount I Paid myself totaled $
calculated at the following rate: $
D - and was
per week/month (circle one).
12) Check the correct response and complete, if appropriate.
1~
V 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.
V'B. I am the designated payee to receive my ward's social security benefits.
R,
rt'
~
_C. The designated payee of my ward's social security benefits is
whose address is
and is/is not ( circle one) related to my ward as
(insert relationship).
15) ILam
report is attached.
I certifY under the penalties of peIjury that the information contained in this report is
true and correct to the best of my knowledge, information and belief.
.
Name:
Address: b 3 / 2-
Me c.k .
'* (Cell)717.Q?'l-4<f43
Telephone No. (Home) 711 7(, (; 'toN, A..~ f1..c4.
1.-", . (Work) 717 - 4'13 -11(10 .
IN THE COURT OF COMMON PLEAS OR:umbsrland COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: .t1.ttN (4fA_~I,,(AJ~1I\, an incapacitated person FILE NO.1./-0l/.-o<$<jq
,
GUARDIAN OF PERSON ANNUAL REPORT
[20 Pa. C.SA 5521 (c)]
FROM Noll, i2 J ,200~ TO F.J- - ::> J ,200S-
I .-
I. I am the Limited .nlenarv Guardian of the Person of mv ward, named above.
- - "' ,oJ
2. I was appointed Guardian by Order of the Court dated tJ"".11- of, which
~odified by Court Order(s) dated . -,
3. Is the incapacitated person still living? V~ <S
Ifno, answer the following: (
(a) Date of Death?
(b) Place of Death?
(c) Name of Administrator or Executor?
(d) Date Guardian of the Person filed the last Annual Report?
was
r.",')
C.)
-,1
",)
.,.
o
4. If the incapacitated person is still living, answer the following questions:
(a) Date Guardian of the Person filed the last Annual Report? TIr,:s "s t,f..,;.'t
(b) Current address of the incapa,s;itated person
3Qo3 beti>/5~VJl KJ....
C"-",,,-p 1-1-. II fQ. /lOll
(c) Current age Date of birth of incapacitated person ..:J - ;) -' ').. 7
(d) The incapacitat<;.d person's residence is:
1 Ward's own residence
_ Nursing Home
_ Hospital or Medical Facility
_ My home/apartment
Relative's Home
_ Boarding Home
(e) The incapacitated person has been living there since i 9'-17
If moved within the past year, state from where and the reason for the change
C.A.-27
~ ~
(f) I rate his/her living arrangement as:
-L..' Excellent ~ Average _ Below Average
Explain: S'ke: 114<; VVI'~(,...,f) t-" lill~ Q..{ 1..-(01- flo"'le ~
(g) I believe he/she is:
vCOntent with the living situation
_unhappy with the living situation
_unaware of the living situation
5. Physical health
(a) Current physical condi!i_QD-Ofthe-m~erson is:
_ Excellen~ !/Go~_ v F~ Poor
(b) His/her major physical health problems are as follows:
(c) DuringJhe past year, his/her physical condition has:
~ remained about the same.
_ improved. Explain
_ worsened. Explain
(d) During the past year, he/she received the following medical treatment (include
check-ups and dental work): S'J.,c ,,/w..ys ,.....-l~jtJ' V,s-.:t ;"'f j),<t0l"5 fir-"l_
Date
Ailment
Type of treatment
Doctor's name
Jt.lV\.. ..J~'1S'1l4( eX<f~
j..tI\~Olf - Oc.tolf. AI-z.k",,,,us
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6. Mental Health
(a) The incapacitated person's condition is u.:t f\
AD. vue
excellent ...:L..-.. good
(b) His/her major mental health problems are as follows:
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i...~(. k,",^, M.~r'k..()vy
~ poor
-A \-z...k-e:~{'.....('
:t+.
~
(c) During the past year, his/her mental condition has:
remained about the same.
- Improved. Explain
7'" Worsened. Explain 1..fvDVY w,...-f<...../:r...r~^"'/kJo,><1A ove"":<cI/
uJ,Mev... ......J .-,... ...~sjds .-1:-.... ""~:c '-0;1.(: J D4I~ lZ"ftJ~,"'i'" "
(d) During the past year, treatment or evaluatIOn by a psychIatnst, psycholog~st or socIal
worker ~was _ was not provided. Such mental health services are bnefly
described as:
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7 S . I A . .. / S . (1=(..'M.~z<>er)
. OCIa ctIvItles ervlces c' L I' \! A J 1.1.
"'''6''- l....IS yea.ir" v~
(a) His/her current social condition is:
excellent _ good
J....y CAN: ..,-,11 t...e.lp ku,
fair _poor
(b) During the past year, his/her social condition has:
~ remained about the same.
_ improved. Explain.
_ worsened. Explain.
(c) During the past year he/she has participated in the following activities:
recreational
educational
v social CJ",l. ,*~vlt '$,,,/~
_ occupational .
no activities available.
_ he/she refuses to participate in any activities.
_ he/she is unable to participate in any activities.
u<d:; f4r 0.; + ~ f7' 311;~j{3
f.> 1<).-4.
,
S. Visitation
(al During the east year. I visited himlher as follows: M,;I'\;....,'~ 0+ (!)i\U' e...cL.. u.
\], ,~~ ~ tJ~'F~ 'M.:':"-,
(b) The average amount of time I spent on each visit was 2 ~ +
(c) The last time I visited was on 1-)4- -6S-
date
9. During the last year I have performed the following activities on behalf the incapacitated
:7:: :;:,;:t; E: '::~'JJE'~~:~ J:J .:J.1t;;~ ~
(
:j-'
't
10. I believe he/she has the following unmet needs:
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'-.' /'/
II. The guardianship '~hould _ should not be continued without modification
because:
.
12. Please note any concerns about the Incapacitated person's physical or mental well being or
the finances that the Court should know.
13. I Lam _ am not guardian of the incapacitated person's estate. If yes, my 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.
Date:
~('-~
Sig ature of the Guardian of the Person
Name: J ~ k V\ r -- .4....k r'D v-
Address: G3/L c~~~t(v.-f:IVJ.Lh.--
Me c.k. G. 1"7"1:)15
* c~tI In - nq-'fqlf 3
Telephone # (Home) 117. 7fr,(" ,+0:;'(. .~.~
(Work) '71l-~4.3'lq,o '
+.
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II