HomeMy WebLinkAbout03-0954 NOV
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA - ORPHANS' COURT DIVISION
2 6 ~003
DECREE
AND NOW, this
day of ~ 0 _, 2003 upon consideration
of the within petition the Court appoints William and Beverly Shaffer guardians of the
person of Priscilla A. Shaffer.
By the Court:
Asst. Clerk of the Orphans' Court Division of Cumberland County, PA
COURT OF COMMON PLEAS OF .~umbgt]ad~ COUNTY__ ORPHANS' COURT DIVISION
COMMONWEALTH OF PENNSYLVANIA
Petitions shall be given
separate term and num- ~'i ~t.~,-. ~ See Supreme Court
bet under names of f%'~- Orphans' Court rules
~J,..~} ~~ Section 12. Rule 5.
minor/s and not term No. 19
and number of estates ~
in which minors have
...... " ORIGINAL
PETITION FOR APPOINTMENT OF GUARDIAN
for the following MINOR/S:
(b)
(c)
born
5,) '97q andisnow q yearsold,
I. State complete
post office address as
well as township, etc.
2. State relationship
to minor, and. where
applicable, whether ma-
ternal orpaternal as
"maternal aunt", etc.
3. Insert"surviving".
if applicable.
4. If parents, or
surwving parent, do not
join. state reason here.
5. If minordoes not
appear,statereason--
as thathe isunder 14
years, etc
6. If application is
for guardian of person.
insert "person". and
strike out "estate" and
references to assets:
and add explanation of
need for guardian of
person as to consent to
marriage, etc.
7. If minor pre-
viously had guardian
who diedor was re-
moved, etc.. state date
of death or refer to
record of removal.
8. If Petition is for
guardian of persoll,
state here religious per-
suasion of parents of
minor and of proposed
guardian.
TO THE HONORABLE, THE JUDGE OF SAID COURT:
The Petitio~n of ~kJ;~/~ o. ff~ C~ 6eve/3 S'ha4fe .
RESPECTFULLY REPRESENTS:
1. That Petitioner52 ~ ~ ~A~ ~t~d~t~ ~ the above-captioned minor/s.
2. The n~mes and addresses' of the parents of the minor/s are (Father/ ~m~? (~{~.
; (Mother) ~ICI ~ 4 h"~'e~)
'~ ~Z ~1~ ~p;g~ ~ 8~3~ The consent of the
35o~qi% parent/~ to the appointment of the guard}an herein prayed for is
evidenced by ~~ joinder hereto.4 ~t.K I,oe~ {a ~}OC'id~. ge .i, ~ceie&
3. The minor/s do/es not a~ar at the presentation of this petition because' 5 ~e ~X
4. The minor/s ha~ no guardian; and there is need for the appoint~nt of a guardian for
5. Petitioner/s propose/s ~ %e7 s'e¢
. .. years, and whose
relationship to the minor/s is: ~~ ~f~ce~ as guardian for said
minor/s. The proposed guardian has no interest~dversetto the minor/s and is not the fiduciary or
an officer or employee of the corporate fiduciary of an estate in which the minor has an interest nor
the surety or an officer or employee of the corporate surety of such a fiduciary.
RW-22
other.-,~antuky is }...j.o,~ ~u by .,. Uultcd States Veteran's Aamlnlstradon? or Its
~. lC m~.o~ ~ .o~ s ~ ' which nmicc, in [he form attached ~ereto, has been given of the intended presenta-
child of veteran. ~tc.,
strike out statement of ti~
notice to Veteran's Ad-
ministration.
J lalfl0 WHEREFORE, your Petitioner/s pray/s for the appointment of the propo rdian.
~o~$~ o~ ~, ss: ~~~~ ~~~
Affirmed and subscribed to by the Pe- ~ ~~, ~. ~~
titioner __ this day of
,19~.
Notary Public--Justice of the Peace
My commission expires
(Under 20 Pa. C.S.A. 761 a vertification may be taken in lieu of the above affidavit)
Joinder by Mother
Joinder by Father
SCHEDULE OF ASSETS
of minor/s named on reverse side,
references to relevant court proceedings.
Description and location:
(Indicat~ relation of minor to decedent
number of estate or suit in which n
property is to be received; and give references to court term and
Approx.
Year[
$ $
Approx.
Value:
ACC
BY GUARDIAN
agrees to accept the appointment
as guardian of the estate __ of
and certifies
trustee of any estate the minor __ ha __ an interst, nor surety
adverse ~e :minor__ whatsoever.
DECREE
__ is neither executor, administrator, nor
such fiduciary, and ha __ no interest
NOW - , A.D.
appoints
guardian of the person of
Attest:
19 on consideration of the within petition the Court
By the Court
Asst. Clerk of the Orphans' Court Division of,t~Ala[~c~County, Pa.
Judge
(counsel should complete Decree) Attorney
VERIFICATION
I, William Shaffer, herby affirm, subject to the penalties of 18 Pa.C.S. § 4904 (relating to
unswom falsification to authorities) that the factual averments in the foregoing Petition
for Appointment of Guardian are, to the best of my memory and understanding, tree and
correct.
Date:
VERIFICATION
I, Beverly Shaffer, herby affirm, subject to the penalties of 18 Pa.C.S. § 4904 (relating to
unswom falsification to authorities) that the factual averments in the foregoing Petition
for Appointment of Guardian are, to the best of my memory and understanding, true and
correct.
I, Pa~ricia 8barfer, la~rby affnm, subj~t ~o tl~ l~nalti~s of 18 Pa.C.S. § 4904 (r~latiag to
unsworn fatsifieation to amhori~s) tt~ ~h~ faotual averrn~nt~ fin th~ foregoing Petition
for Appointment of (3uardlan am, ~o tl~ b~,t of my m~aory and u~d~rstanding, tr~ and
corr~t~L
~OV-~7-L:~03 09:q7 F~OI~I:P~LU OF PA 7~7~3~cj5 T0:~30333639~9
P.4
VERIFICATION
I, Patricia Shaffer, herby affirm, subject to the penalties of 18 Pa.C.S. § 4904 (relating to
unswom falsification to authorities) that the factual averments in the foregoing Petition
for Appointment of Guardian are, to the best of my memory and understanding, true and
correct.
Patricia Shaffcr