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HomeMy WebLinkAbout06-05-12IN RE: IN THE COURT OF COMMON PLEAS OF DANIEL A. SHAFFER :CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ~ c , PETITION FOR APPOINTMENT OF GUARDIAN ''_"~ ~ ~-~ ' c f _ ~~ i TO THE HONORABLE, THE JUDGES OF SAID COURT: ~~jjC ~ ~' Petitioners, through their undersigned attorney, petition Your Honorabl~ourt for t~ieir N appointment as CO-GUARDIANS of the person of DANIEL A. SHAFFER, and in support the eof respectfully request: Petitioner, Susan M. Shaffer of 74 Horn Road, Shippensburg, Cumberland County, Pennsylvania, 17257, a sui juris adult. is the natural mother of DANIEL A. SHAFFER. 2. Petitioner, Steven E. Shaffer of 74 Horn Road, Shippensburg, Cumberland County, Pennsylvania, 17257, a sui juris adult. is the natural father of DANIEL A. SHAFFER. 3. DANIEL A. SHAFFER, is a 17 year old single adult male whose birthday is July 21, 1994. 4. DANIEL A. SHAFFER, resides with the Petitioners at 74 Horn Road, Shippensburg, Cumberland County, Pennsylvania 17257 and does not receive residential services. DANIEL A. SHAFFER attends a state approved private school known as Western PA School for Blind Children located in Pittsburgh, Pennsylvania. 6. DANIEL A. SHAFFER, is an alleged mental incompetent as is evidenced by a letter from Dr. Jody Ross, who indicates that DANIEL A. SHAFFER has severe mental and physical disabilities, including CHARGE syndrome, autism, deafness, blindness and milk protein allergy. Said letter is incorporated by reference and attached at Exhibit "A". 7. The proposed Guardians have no interest that is adverse to those of DANIEL A. .~~ t~ SHAFFER. 8. The Petitioners are willing to serve as Co-Guardians of DANIEL A. SHAFFER, an alleged mental incompetent, and they have signed consent letters which are attached as Exhibit "B"and "C". 9. It is the position of the Petitioners that Guardianship is necessary in order to secure medical and social services on behalf of DANIEL A. SHAFFER. 10. DANIEL A. SHAFFER, is unable to manage his property, or is liable to dissipate it or become the victim of designing persons and lacks sufficient capacity to make or communicate responsible decisions concerning his person. 11. The Petitioners are the parents of DANIEL A. SHAFFER. 12. The Petitioners believe that there exists no less restrictive alternative in view of the physical and mental disabilities of DANIEL A. SHAFFER. 13. No other petition has been filed for the appointment of a Guardian for the alleged incompetent. WHEREFORE, Petitioners respectfully request that they be appointed Plenary Co-Guardians of their son, DANIEL A. SHAFFER, both of his person and of his property. Duncan & Hartman, P.C. By: ®-~- S an J. Hartman, Attorney for Petiti S, a-o is VERIFICATION I verify that the statements made in the foregoing Petition for Appointment of Guardian Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Date: / ~- ~. i~ ~ !~ _~ } ~ 1: ~l/ ~~~ ~°tiC ~~ ~ ti Susan M. Shaffer / c~ 1 ~_ `. >~ Steven E.. Shaffer IN RE: : IN THE COURT OF COMMON PLEAS OF DANIEL A. SHAFFER :CUMBERLAND COUNTY, PENNSYLVANIA AN INCOMPETENT :ORPHAN'S COURT DIVISION . NO: CONSENT TO BE APPOINTED GUARDIAN Susan M. Shaffer, being duly sworn according to law, deposes and say that she agrees to serve as the guardian for her daughter, DANIEL A. SHAFFER. My residence is 74 Horn Road, Shippensburg, Cumberland County, Pennsylvania. My occupation is Associate Director of Northeast Conference of the Teaching of Foreign Languages. I speak, read and write in the English language. I do not have any interest adverse to DANIEL A. SHAFFER. I am not a fiduciary or an officer or employee of a corporate fiduciary of an Estate in which the alleged incompetent has an interest; not the surety, or an officer or employee of a corporate surety of such a fiduciary, r~ j p Susan M. Shaffe r ~; Sworn to and subscribed before me this oL°j ~ day of -~J~y , 2012. ~' Not COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL JOAN D. ADAMS, Notary Public Carlisle Boro., Cumberland County My Commission Expires March 15, 2015 IN RE: : IN THE COURT OF COMMON PLEAS OF DANIEL A. SHAFFER :CUMBERLAND COUNTY, PENNSYLVANIA AN INCOMPETENT :ORPHAN'S COURT DIVISION . NO: CONSENT TO BE APPOINTED GUARDIAN Steven E. Shaffer, being duly sworn according to law, deposes and say that he agrees to serve as the guardian for his son, DANIEL A. SHAFFER. My residence is 74 Horn Road, Shippensburg, Cumberland County, Pennsylvania. My occupation is Self Employed, Owner and Operator of Shaffer Wood Flooring.. I speak, read and write in the English language. I do not have any interest adverse to DANIEL A. SHAFFER. I am not a fiduciary or an officer or employee of a corporate fiduciary of an Estate in which the alleged incompetent has an interest; not the surety, or an officer or employee of a corporate surety of such a fiduciary, ~~v l~, ~~ ,±~--- Steven E. Shaffer Sworn to and subscribed before me this ~ ~ day of ~~-`"`-~-~ , 2012. ~~ Not COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL JOAN D. ADAMS, Notary Public Carlisle Boro., Cumberland County My Commission Expires March 15, 2015 PENNSTATE HERSHEY Milton S. Hershey 1Vled.ical Center Mark D. Widome, M.D., MPH Professor of Pediatrics Divisiun chief sash Iriana, M.n. Associate Professor of Pediatrics Medical Director Cheston M. Berlin, Jr., M.D. University Professor of Pediatrics Professor of Pharmacology February 29, 2012 RE: Daniel Shaffer DOB: 07/21/94 )/delveis Clapp, D.O. Assistant Professor of Pediatrics To Whom It May Concern: Kathryn R. Crowell, M.D. Assistant Professor of Pediatrics ~ Daniel Shaffer is a nearly 18 year old patient of mine with CHARGE Lama M. Duda, M.D. syndrome, blindness, deafness (with a cochlear implant), milk protein Assistan[PmfessorofPediatrles allergy with history of anaphylaxis, encephalopathy eosinophilic Nicole Hackman, M.D. , esophagitis, seizure disorder, autism and self destructive behavior. Assistant Professor of Pediatrics Kelly H. Kline, D.O. Daniel is totally dependent on others for his care and wellbeing and AssistantProfessorofPediatrics unable to make decisions for himself. It is medically necessary for his Benjamin Levi, M.D., PhD mother to obtain guardianship of Daniel at the age of 18 to insure his Professor of Pediatrics and Humaniti« continued wellbeing both medically and otherwise. Jenmter R. Miller' M.D. Assistant Professor of Pediatrics If you have any questions, please call me at 717-531-7300. Thank you for your prompt attention to this request. Laura Murphy, M.D. Associate Professor of Pedlatrics Ian M. Paul, M.D., M.Se. Sincerely, Professor of Pediatrics ,.` and Public }fealth Sciences 1 Jody M. Roes, M.D. `~ _ s y`'L I '^~`"'~ Assistant Professor of Pediatrics Jody Ross, M.D. Deeps sekhar, M.D. Assistant Professor of Pediatrics Assistant Professor of Pediatrics Alawia K. Suliman, M.D. Professor of Pediatrics Christine D. Artwld, RN, CRNP Clinirallnsvuctor EXHIBIT ~} Penn State Mllton 5. Hershey Medical Center • Penn State College of IDiedicine • Penn State Hershey Children's Hospital Penn State Hershey Pediatrics, Mai] Code HSOS, 35 Hope Drive, Suite 102,103, P.O. Box 850, Hershey, PA 17033-0850 M TeL- 717-531-7300 • Faz: 717-531-8992 An Equal Opportc~ity Univcrsi[}'