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HomeMy WebLinkAbout03-0969IN THE MATTER OF THE PERSON AND ESTATE OF Scott F. Mulholland an alleged incapacitated person · IN THE COURT OF COMMON PLEAS · OF CUMBERLAND COUNTY · OF PENNSYLVANIA · ORPHANS' COURT DIVISION · NO. PETITION TO ADJUDICATE INCAPACITY PURSUANT TO 20 P.S. 5511 AND FOR THE APPOINTMENT OF A GUARDIAN OF THE PERSON AND THE ESTATE The petition of James J. Mulholland, residing at 72 Covered Bridge Road, Newburg, Pennsylvania 17240, brother of the alleged incapacitated person, respectfully states: 1. The alleged incapacitated person is SCOTT F. MULHOLLAND, who is 49 years of age, (DOB 6-13-54). He resides with his brother. 2. Besides your petitioner, the adult potential heir of Mr. Mulholland is: Robin A. Mulholland c/o Robert Malesic 281 Deaven Road Harrisburg, PA 17112 4. Mr. Mulholland's income is $684.00/month from Supplemental Security Income and $357.91/month Civil Service benefit. He has a checking account (#8801105746 - 504) and savings account (#8801105746 - 501) at Pennsylvania State Employees Credit Union. His income is deposited into his checking account and those funds are used for living expenses and needs. His savings account holds a balance of $100.31. 5. Mr. Mulholland was never a member of the armed services and is not receiving any benefits from the U.S. Veterans' Administration. 6. Less restrictive alternatives are unavailable. 7. Guardianship is sought because Mr. Mulholland, though diagnosed with' Schizophrenia since he was 20 years old, now carries an Axis I diagnosis of Psychotic Disorder NOS, Obsessive/Compulsive Disorder and R/O Mental Disorder Due to Medical Condition (mercury poisoning). A copy of the May 4, 2000 Psychiatric Evaluation is attached and marked Exhibit "A". Mr. Mulholland requires assistance to perform daily physical and mental tasks. His brother monitors his medications and helps him when walking. He cannot effectively follow instructions, has memory problems which prevent him from following a routine or schedule, and has difficulty communicating. These conditions affect his capacity to enter into a Power of Attorney so a Guardian is necessary to protect and prevent future harm to his person and property. 8. Mr. Mulholland's ability to receive and evaluate information effectively and communicate decisions is impaired to such a significant extent that he is unable to manage his financial resources or to meet essential requirements for his physical health and safety. 9. The name and address of the proposed guardian of the person and guardian of the estate of the alleged incapacitated person is: James J. Mulholland 72 Covered Bridge Road Newburg, PA 17240 James J. Mulholland, is the brother of the alleged incapacitated person. No consent of the proposed guardian is attached to this document since the proposed guardian is the petitioner in this matter. 10. The name and address of the proposed alternate guardian in the event the proposed guardian is no longer able to perform his duties is: Cecilia B. Jankura 72 Covered Bridge Road Newburg, PA 17240 11. The proposed guardian has no interest adverse to the alleged incapacitated person and is agreeable to serving as guardian of the person and guardian of the estate. 12. No other Court has assumed jurisdiction in any proceeding to determine the competency of Scott F. Mulholland. 13. No guardian has already been appointed. WHEREFORE, your petitioner prays this Honorable Court to grant the following relief: A. That a citation be issued directed to Scott F. Mulholland, the alleged incapacitated person, to show cause why he should not be adjudged an incapacitated person; and B. A guardian of Scott F. Mulholland person and estate be appointed. Date: Respectfully submitted, ,/'I-~NDSAY I~E BAIR~, ESQUIRE Attorney for the Petitioners ID # 72083 37 South Hanover Street Carlisle, PA 17013 (717)243-5732 I verify that to the best of my knowledge and belief, the statements in the foregoing document are true and correct. I understand that false statements herein are made subject to the penalties of 18 PaCS {}4904 relating to unsworn falsification to authorities. fan~s J. Mulholl~nd, Petitioner 7826,51-~, # 2/ 8 PinnacleHealth Psychological Associates Harrisburg, PA Psychiatric Evaluation Name: MULHOLLAND, SCOTT SS~: 006-13-1954 Date of Evaluation: 05/04/2000 Date of Birth: 06/13/1954 IDENTIFYING INFORMATION: Scott Mulholland is a 45 year old Caucasian male seen with Dee Boyer at Milestones for a psychiatric evaluation. HISTORY OF PRESENT ILLNESS: It should be stated from the outset that apparent history from Mr. Mulholland was extremely difficult as he was distractible, scattered and unable to provide a coherent history. The patient began by stating that he claims to have been on Clozaril since in high school. Currently he denies auditory or visual hallucinations or paranoid delusions. He admits to "crazy thoughts". It was extraordinarily dilficult to distinguish obsessive thoughts from perhaps bazaar delusions or hallucinations. When asked how he contends with these "crazy thoughts" he states that he is able to keep them away with various rituals such as he will say "Sharon Tats Manson murders" 4 times. He also states to alleviate these difficulties he will "make the sign of a cross". In addition, he puts his hands in front of himself about once every few minutes. He also has speCial movements of his hands that designate certain things. He has one movement which are bilateral supination of his upper extremities to indicate 'reality". He also makes lateral movements with his hands with the palms of his hands perpendicular to the floor and states that "this means high school" and stated "school, school, school". He also made whirling figures with his hands with his fingers and Indicated that this means "home mom". He then went on to state that his mom died 3 years ago and when asked specifically how she passed away he stated "she fell on the floor". The patient then interjected by stating that he felt he did better on Prozac in the past and currently lives in Lykens at a group home. Affempts to investigate anxiety difficulty, frank psychosis as stated above, depression were unsuccessful due to thought disturbance. Of note from staff is that apparently in the past Scott Mulholland has allegedly stolen mercury and swallowed mercury. PAST HISTORY: Past Psychiatric History: He has been admitted to Hershey Medical Center. He was at Woodsworth 4 years ago. He has 2 previous suicide affempts of aspirin in an overdose. Allergies: No known drug allergies. EXHIBIT "A" MULHOLLAND, SCO'rT 2 Tobacco, Alcohol and Drug Exposure, Tobacco usage: He smokes approximately % packs per day for an unknown duration. Alcohol and drug usage is denied. Past Medical History: Notable for a "spastic stomach" and currently his medications are Pepcid only. Academic History: He is a high school graduate. Family History: As stated previously, his mother passed away approximately 3 years ago. It is suspected that perhaps she may have died of a sudden heart attack. Family Psychiatric History: Unknown. MENTAL STATUS EXAMINATION: Scoff Mulholland is a 45 year old Caucasian male that appears his stated age if not 5-10 years older due to weathered appearance. He was alert and oriented x 2-3 as currently he stated the date was May 3 of 2000 which is acceptable for a current date. He was rather tall, well over 6 feet, at 6'2' and his weight is approximately 170 and slightly disheveled. He had 0/10 errors on the Mini Mental Status Exam. He was able to recall 3/3 objects at 5 minutes. General appearance was notable for lack of dentition, Affect was appropriate. Mood was anxious, He denied suicidal or homicidal ideation, Strong evidence with regard to hallucinations or delusions. Stream of thought was perseveratlve with clanging of associations. There was evidence of a frank thought disorder. There was also loosening of associations, Insight and judgment were intact despite frank psychosis, Intelligence was estimated to be Iow intellectual functioning. Attempts at serial 3's, proverbs and similarities were unsuccessful. DIAGNOSTIC FORMULATION: Discussion: Scott Mulholland is a 45 year old Caucasian male seen with Dee Boyer at Milestones for a psychiatric evaluation. Biologically, it is unknown at this time if there is any genetic predisposition for psychopathology. Of concern is the apparent history of him having ingested mercury In the past. This certainly could be contributing to his presentation. Psychologically, due to frank thought disorder, it is quite obvious that Mr. Mulholland is consumed with rituals to get through his day. Unfortunately it is unclear at this time whether or not these are rituals due to obsessive/compulsive disorder or rituals due to psychosis. Socially, currently he is receiving services through Milestones as well as other community mental health assistance which ultimately bodes well for his prognosis. MULHOLLAND, SC(., ,"r 3 DSM IV Diagnosis: Axis I Axis II Axis III Axis IV Axis V Psychotic Disorder NOS Obsessive/Compulsive Disorder R/O Mental Disorder Due to Medical Condition (mercury poisoning) RIO Borderline Intellectual Functioning "Spastic stomach" Disruption of primary support system, death of biological mom approximately 3 years ago suddenly. Currently is a 40-45. RECOMMENDATIONS: Non-educational: 1. As patient is not suicidal or homicidal, not in need of inpatient psychiatric stay. 2. As patient continues to have difficulties with frank psychosis and obsessive/compulsive disorder, would continue with services through Milestones at current level of treatment. 3, Discussion with Mr. Mulholland to possibly institute an antipsychotic to address frank psychosis was unsuccessful and declined. 4. The patient did agree to reinstituting Prozac for suspected obsessive/compulsive disorder. As such will implement it at 20 mg 1 PO q. AM. Number dispensed 30 with 1 refill. Side effects of medication discussed. 5. Would continue medications for "spastic stomach". 6. Will obtain baseline laboratory studies with complete blood count, Comprehensive metabolic panel, mercury level, thyroid stimulating hormone, Depakote level, RPR and HIV. 7. Would return back to clinic in ~, ~ weeks to assess efficacy of treatment plan. G. MICHAEL GOMEZ, M.D. CHILD, ADOLESCENT AND ADULT PSYCHIATRIST DD: 07/17/2000 DT: 07/1712000/Imf D#: 684864 NOV 2 1 2003 ~'~ ~' IN THE MATTER OF THE PERSON AND ESTATE OF Scott F. Mulholland an alleged incapacitated person IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : OF PENNSYLVANIA ORPHANS' COURT DIVISION : NO. PRELIMINARY ORDER NOW, this /..~-~ day of ~.~z o/~_J]~,~,~,/ , 2003, upon motion of Lindsay ~-,'r-~. -r'/~ ~ Dare Baird, Esquire, and upon consideration of the attached petition, a r.,ate'i~-issued upon Scott F. Mulholland to show just cause why a guardian of her person should not be appointed. A hearing on this matte!.shall be held i~ Cou~room No. z./ of the Cumberland County Courthouse, on '~,r~j~,~,~ ..~' 2QO~, at _~ :2~ o'clock//- .M. Petitioner, James J. Mulholland is appointed temporary guardian of the person of Scott F Mulholland pending a final ruling by the Court follow!ng the hearing. At least ,'~ days notice of the hearing~shall be given to the next-of-kin listed in the petition by personal service or by regular or certified mail. By the Court, / IN THE MATTER OF THE PERSON AND ESTATE OF Scott F. Mulholland an alleged incapacitated person IN THE COURT OF COMMON PLEAS · OF CUMBERLAND COUNTY · OF PENNSYLVANIA ORPHANS' COURT DIVISION NO. ORDER AND NOW, this /,~ by James J. Mulholland, day of /j~/_/.l,,~ /~.J ,2003, upon petition filed A HEARING WILL BE HELD ON THE ~-M'~ DAY OF (~f_/~LL/~/Z~/,~- 2 AT O'CLOCK,4 M iN COURTROOM NO. OFTHE CUMBERLAND COUNTY COURTHOUSE, I COURTHOUSE SQUARE, CARLISLE, PA 17013, AT WHICH TIME THE COURT WILL CONSIDER THE ISSUE OF THE CAPACITY OF SCOTT F. MULHOLLAND. Personal service of the within Notice, Order and Petition shall be made by the Petitioner upon Scott F. Mulholland no less than 20 days before the date of the hearing. The contents and terms of the within petition shall be explained to the maximum extent possible in language and terms Scott F. Mulholland is most likely to understand. Notice of the within Petition and hearing shall be given by Petitioner by certified mail, return receipt requested to all persons residing within the Commonwealth who are sui juris and would be entitled to share in the estate of the alleged incapacitated person if he died intestate. BY THE COURT: 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.- Clerk, Orphans Qourt Division ~ ~ Cumberland County, Carlisle, PA ~L( [/J My Commission Expires 1st Monday, January, 2006 IN RE: SCOTT F. MULHOLLAND: An Alleged incapacitated person · IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-2003-969 ORDER AND NOW, this 4'~ ~ day of December, 2003, at the request of counsel for the petitioner, hearing in the above captioned matter set for January 5, 2004, is continued to Thursday, February 5, 2004, at 9:30 a.m. in Courtroom Number 4, Cumberland County Courthouse, Carlisle, PA. BY THE COURT, 'u"l Ke{,in~. Hess, J. ' / Lindsay Dare Baird, Esquire . For the Petitioner :rlm iN RE: Scott F. Mulholland an alleged incapacitated person IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION · NO. 21-2003-969 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 tights will be affected, including our tight to manage money and property and to make decisions. A copy of the petition which has been filed by James J. Mulholland is attached. You are hereby ordered to appear at a heating to be held in Court Room No. 4, Cumberland County Courthouse, Carlisle, Pennsylvania, on January 5 ,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 heating, you have the tight to appear, to be represented by an attorney, and to request a jury trial. If you do not have an attorney, you have the tight 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 tight 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.. Cumberland County, Carlisle, PA ~ [ ] My Commission Expires 1 st Monday, January, 2006 IN RE: SCOTT F. MULHOLLAND. An Alleged incapacitated person · IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-2003-969 ORDER AND NOW, this ~" day of December, 2003, at the request of counsel for the petitioner, hearing in the above captioned matter set for January 5, 2004, is continued to Thursday, February 5, 2004, at 9:30 a.m. in Courtroom Number 4, Cumberland County Courthouse, Carlisle, PA. Lindsay Dare Baird, Esquire For the Petitioner :rim BY THE COURT, Kev/~. Hess, J. · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. Print y~pur name and address on the reverse so that we can return the card to you. Attac~l this card to the back of the mailpiece, or on, the front if space permits. 1. Article Addressed to: A. Signature [] Agent [] Addm~_-ee B. Received by (Printed Name) I C. Date of Delivery D. Is delivery address different from item 17 [] Yes If YES, enter delivery address below: ~,No 3. Service Type ertified Mail egistered [] insured Mail 2. Article Number []_Express Mail ......... r ~'~r ~c::handise [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes (Transfer from service label) PS Form 3811, August 2001 7001 2510 0006 5891 6009 DC.T,e~{iC Return Receipt 102595.02.M- 1035 TEL. (717) :~43-573.2 LINDSA¥ DARE BAIRD ATTORNEY' AT LAW 37 SOUTH HANO~ER CARLISLE, PENNSYLVANIA 17013-3307 FAX ~717) '243-8110 January 12,2004 Mr. Robin Mulholland cio Mr. Robert Malesic 281 Deaven Road Harrisburg, PA 17112 Dear Mr. Mulholland: Enclosed please find Notice and a copy of the Petition to Adjudicate for the Appointment of a Guardian of the Person and the Estate regarding your brother, Scott Mulholland and.filed by your brother James Mulholland. There is a hearing in the matter scheduled for February 5, 2004 in Courtroom 4 of the Cumberland County Court of Common Pleas at 9:30 A.M. If you have no objection to James Mulholland assuming this responsibility, there is no need to attend the hearing. If you contest this, you will want to attend. If you are in favor of the proceeding, you are certainly welcome to attend and tell the Court that in person. Thank you for your time and attention. Sincerely, ~ , ~.. indsay Dare"B'aird, Esquire LDB/nfa Enclosures CC: Mr. James IN THE MATTER OF THE PERSON AND ESTATE OF Scott F. Mulholland an alleged incapacitated person IN THE COURT OF COMMON PLEAS · OF CUMBERLAND COUNTY · OF PENNSYLVANIA ORPHANS' COURT DIVISION NO. c~/' d~- ?~'~ AFFIDAVIT OF SERVICE I, James J. Mulholland, being duly sworn according to law do depose and state that an original Citation and Notice in the above-captioned matter was personally served~on Scott F. Mulholland, at his home_, by personal service. Said service being on ~./,~n#~>, /b ,2004 at /-' ~'o o'clock .~'M. - Sworn and Subscribed to before me this .2/-~/'day of January, 2004 ary Public :,.~ Notarial Seal Lindsay D. Baird, Notary Public Carlisle Bom, Cumberland County My Commission Expires Oct. 21, 2006 Member, Pennsylvania Associa~on ot Notanes IN THE MATTER OF THE PERSON AND ESTATE OF Scott F. Mulholland an alleged incapacitated person · IN THE COURT OF COMMON PLEAS · OF CUMBERLAND COUNTY · OF PENNSYLVANIA ORPHANS' COURT DIVISION f FINAL DECREE AND NOW, this 5'''~'' day of /~--t,,0~,,ut,? ,20~, upon consideration of the Petition to Adjudicate Incapacity and for the Appointment of Guardian of the Person and Estate, and based upon the record and evidence received, this Court finds, by clear and convincing evidence, that Scott F. Mulholland is adjudged a totally incapacitated person· The Court finds that Scott F. Mulholland suffers from a condition or disability which totally impairs his capacity to receive and evaluate information effectively and to make and communicate decisions concerning his management of financial affairs and to meet essential requirements for his physical health and safety. James J. Mulholland, is hereby appointed Plenary Permanent Guardian of the PERSON and ESTATE of Scott F. Mulholland· The Guardian need not file a Report as required by 20 Pa.C.S.A. § 5521 (c). Insofar as there are minimal liquid funds, the Guardian need not post a Court approved bond. As Guardian of the PERSON, James J. Mulholland, shall have the authority and responsibility to decide where Scott F. Mulholland shall live and how meals, personal care, transportation and recreation will be provided· The Guardian shall also have the authority to authorize and consent to medical treatment and surgical procedures necessary for the well being of Scott F. Mulholland. As Guardian for the ESTATE, James J. Mulholland shall have authority and responsibility to manage and use Scott F. Mulholland's property primarily for Scott F. Mulholland's benefit. The aforementioned judicial determinations have taken into consideration the matters required by Pa.C.S.A. §5512.1. The Court's findings of fact and conclusions of law have been placed on the record at the evidentiary hearing. ./~BY THE COU;~,~ cc: Lindsay Dare Baird, Esquire Marjorie A. Wevodau First Deputy One Courthouse Square Carlisle, Pao 17013 Glenda i=arner Strasbaugh Register of Wills & Clerk of the Orphans' Court Kirk So Sohonage, Esquire Solicitor (717) 240-6345 FAX (717) 240-7797 OFFICES OF l\egister of Wills anb (!Clerk of tbe ~rpbans' (!Court <!Countp of ([umherlanb December 1, 2005 James J. Mulholland 72 Covered Bridge Road Newburg PA 17240 IN RE: Estate of Scott F. Mulholland, an incapacitated person File No. 21-03-0969 Dear Sir/Madam: It has come to my attention that you have not filed the guardian reports required by 20 Pa.C.S.A. S5521(c) in the above captioned guardianship. Enclosed you will find the suggested formes). Please mail those reports, along with a check for the filing fee which is $15 for each report filed, payable to the Clerk of Orphans' Court, to the following address within (30) days: Clerk of Orphans' Court One Courthouse Square Carlisle, P A 17013 If you have any questions, please contact your attorney. Respectfully, to. . V cA:::~Luu.jJ .~~J~.-::J' Glenda Farner Strasbaugh j Clerk of the Orphans' Court Clerk of Orphans' Court of Cumberland County INRE: ~ t.-tI t/ F ('1/;{[ /ftJ ll'l ~ Docket No. ~/- ? p cJ.3 ... q t '7 An Incapacitated Person ANNUAL REPORT OF GUARDIAN OF THE ESTATE I, ...flJl'J'1te 5 ,] ~ Mvf L L/tJ tllt) A.~ ' was /were appointed plenary guardian(s) of the est~~e of. S C- 0 it r..- f11 "l 11-0 l (/1-/I;{ by Decree of the Honorable Judgel(fiV/~ 4./lcffJled 1- r - CJf.. This is my annual report for the period from 1- I - 0 s to I J- - 3/ - 0 ~- , ("The Report Period"). L SUl\1MARY A. Value of principal assets at the beginning of the Report Period? $ ;1/~ , B. Total amount of income earned during the report period? $ /).j 7t 9. 5-, Total amount of all expenditures made for care and maintenance of the C. incapacitated person during the Report Period? 1. From principal $ $ / 'J.. 1'179,. Y.1 2. From income D. Total amount spent for all other purposes during the Report Period? $ E. Total amounts remaining at the end of the Report Period? 1. Principal $ $ if rt?- o? 2.Lllcome Total Income and Principal $ l'...., (~ '\ I '0") -; ,.......,.",. C'.~. II. ADDITIONAL INFORMATION A. Principal: 1. Total amount remaining at the end of the Report Period? $ 2. How is principal currently invested? 3. Have there been any expenditures from principal during the RepOlt Period? 0 Yes 0 No If you answered YES, was there Court approval for all expenditures from principal? 0 Yes 0 No 4. Did you receive any principal assets during the report period whIch were not included on the inventory or a prior report filed for the estate? 0 Yes 0 No If you answered YES, did you receive Court approval prior to receiving additional principal? 0 Yes 0 No 5. State the sources and amounts of the additional principal you received: $ $ R Income: 1. State sources and amounts of income received during the Report Period (i.e., social security, pension, rents, etc.): eil/I~ SEt< 1/ le-c- (j~",-~;:'/T I' Cf3 '9.. 5bY~ '3 C 'I-I); /"1tP#4-'7/1' .5 S-J: If ~!foCJ.ocY1 70tJr CJO/f11t? .."fij { $ Total Income received during Report Period $ I J-, 7 (9. S-C )Y< . , 2. How is income currently invested? (Please specify, restricted bank accounts, client care account, etc.) (J~~ .$vIi -!~V:?-~fJI~~ (C6f?.-f~ ;JCL/-. ~ '# g 'Bo 110 s7~C.- 50 t 5~7f'ig(//I() 5-7vC- S'OI 3. Specify what payments were made for the care and maintenance of the incapacitated person (i.e., clothing, nursing home, medicine, support, etc.). Mt7.'\-rf 1/ IIrg 7 rid =: / ~ fj'l'f~O() ~ To ~/L{Jo/(,A/~j'(:- C2/}(( 6 I ~ 511///<==-5/1 cf/!-t f14 /"c; 75" 4-9 FoR.. Me4(~ I fEflSIJ"''' L -.r:te~f. QI1 i> C L(/t/II~q" / / / /)55/ >r}zY frI- 4. Specify what other payments were made during the Report Period. I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this verification is subject to the penalties of 18 Pa. C.S.A. ~4904 relative to unsworn falsification to authorities. /-J--Ot' Date f/j; 9Cltj-687 --0 7~/ * FILING FEE $15 MUST ACCOMPANY THIS FILING. Clerk of Orphans' Court of Cumberland County INRE: 5ctJ!j r. l'1rA llf{lL(I1~ Docket No. 7/- r/J 0 3 - 9? 7- An Incapacitated Person ANNUAL REPORT OF GUARDIAN OF THE PERSON I, fit /Js1t..:~ 5 j~ 111..;/ l 1-/0 ( L"1 J'1-1 ' was /were appointed plenary guardian(s) oft?e person of 5 co 1/ r. 1'1 r.1 L Not {'I ~y Decree of the Honorable Judge l(c:vl"'- /J.I!E5"), !dated / -)" - 0 Y'__. This is my annual report for . J the pi::liod from I - I ~ (;) S- to 1:2 -"3/- 0 ~- , ("The Report Period"). L. Current address of the incapacitated person ~ Yrs. f)()f3; Jf/"'C:- IJ.J /'1 ry 1. Present age of the incapacitated person: Outlook Pointe Scott F. Mulholland rm/116 129 Walnut Bottom Rd Shippensburg, PA. 17257 3. The incapacitated person's residence is: o own home/apartment ; ) o nursing home ~otlrdmg- horne/personal care home _..,.' I o guardian's home/apartment o hospital or medical facility o relative's home (Name and relationship) o other: (describe) 4. The incapacitated person has been in the present residence since 1')-/ /7" / t? '/- . If the incapacitated person has moved within the past year, state change and reason(s) for change: 5. Name and address ofthe incapacitated person's primary care giver: fJlZ- CA/ If ll/J'1'1 # /V If: 7/7 - 7- "37--3)../1 J ')- c____LA/ /fL~i../IBoffr~ ((1, 5-1/1 PI' C; -1-- Sff C1~ ~ ) j? /9, I 7 ') S-7 6. The major medical or mental problems of the incapacitated person are as follows: , < ) e-/f J 2-0 111;( r3"v; /I () 'I /~~ J- OfJ 5c;E > I YC /Cor1f1fJtlLjloVE .' I )') I Orfof(c!61L 7. Specify what, if any, social, medical, psychological and support services the incapacitated person IS reCeIVIng: 5' VI (}f, : -r 15 G- II;:) (/ 10(,(;2- /I c:- /) L t If . I 7 t S- De> Lei 8;(Ook -1 e/b CIfAP't)JF/25 /J'I/-1/ ;4 ~ ( 7 ;)-01 7/7-)/7- 7s:J-3 8. It is our opinion as guardian of the person that the guardianship should: (check one) ~tinue, D be modified, D be terminated. (Briefly explain your response) Sc~T/ /3 /?1, V !3V?p//fcA- . !jc IS I .J IN G L--c.J V~:: 1// O""f During the past year, I have visited the incapacitated person r-'9~/L V c::j-- / ..,..,.70..........,...,..0 T7~ro~+ 1....("1+;""""'" a v \"'-J.. at,..... v l':>.Ll. .La.::> UJ.J.b 9-i? times with the 9. If t75 5/;9 C- t: "v/jd ~ {A/e- /)/2 c..:: roW"/V The repOli of a social service organization employed by the guardian to oversee and coordinate the care of the incapacitated person for the period covered by this report may be attached to supplement this report. /VOle:: W/lL FCl~U~,a~P/ TI/15 ;fc./c>/t7 (,V /fc.:~ /lV/l1 {I/-(J t t-- I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this verification is subject to the penalties of 18 Pa. C.S.A. 94904 relative to unsworn falsification to authorities. I - J -t? {; Date ~~tj7~~~ 19natur~f Guardi . CjcJr;-?i7- 07y/ * FILING FEE $15 MUST ACCOMPANY THIS FILING.