HomeMy WebLinkAbout04-29-13 IN RE: CONSTANCE M. MEREDITH. : IN THE COURT OF COMMON PLEAS
An incapacitated person : OF CUMBERLAND COUNTY,
: PENNSYLVANIA
ORPHANS' COURT DIVISION
WILLIAM R. MEREDITH, : NO. 06-0294
Petitioner
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PETITION FOR APPOINTMENT -
OF SUCCESSOR GUARDIAN
AND NOW comes Petitioner, William R. Meredith, by and through his Rtfiorney, lyinda
J. Olsen., Esquire, and submits this Petition for Appointment of Successor Guardian e.%d in
support hereof avers as follows:
1. By order of Court dated June 6, 2006, Leslie Tomeo, Esquire was appointed to
represent the incapacitated person, Constance M. Meredith.
21. On June 12, 2006, Constance M. Meredith was adjudicated a totally
incapacitated person, and William J. Meredith was appointed as plenary guardian of the person
and estate of Constance M. Meredith. A copy of this Honorable Court's Final Order dated
June 12, 2006 is attached hereto as Exhibit "A."
3. The Guardian, William J. Meredith, died on April 13, 2013. A copy of the
death certificate of William J. Meredith is attached hereto as Exhibit `B."
4. All of the Annual Reports of the Plenary Guardian of Constance M. Meredith
have been timely filed.
5. The assets of Constance M. Meredith have not changed since the Guardian's
Annual Report filed in December, 2012. A copy of the time-stamped Annual Reports of the
Guardian dated February 7, 2013 is attached hereto as Exhibit "C."
1
;-y-
6. Constance M. Meredith is still a resident of South Mountain Restoration Center,
10058 South Mountain Road, South Mountain, PA 17261.
7. A successor Guardian needs to be appointed because of the death of Guardian,
William J. Meredith.
8. William R. Meredith is the son of Constance M. Meredith and William J.
Meredith.
Q.
I William R. Meredith wishes to be appointed successor guardian for his mother.
10. Since the time the Guardian, William J. Meredith, was hospitalized, William R.
Meredith has been handling all financial and healthcare decisions on behalf William J.
Meredith and Constance M. Meredith.
11. The health of Constance M. Meredith is declining, and in order to effectively
and properly make financial and medical decisions on behalf of his mother, William R.
Meredith is seeking to be appointed as successor guardian in his deceased father's place.
WHEREFORE, Petitioner requests that this Honorable Court appoint William R.
Meredith as Permanent Plenary Guardian of the person and estate of Constance M. Meredith.
Respectfully submitted,
HAZEN ELDER LAW
Date Linda J. Olsen, Es$uire.
PA I.D. No. 92858
2000 Linglestown Road
Suite 202
Harrisburg, PA 17110
(717) 540-4332
Jolsen(&h zenelderlaw.com
2
VERIFICATION
I verify that the statements made in this Petition are true and correct. 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 William R. Meredith
3
COPY
IN RE: CONSTANCE M. MEREDITH : IN THE COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY,
: PENNSYLVANIA
: ORPHANS' COURT DIVISION
An alleged incapacitated person : NO. 06-0294
On the Petition of WILLIAM J. MEREDITH
FINAL ORDER OF COURT APPOINTING PLENARY GUARDIAN
AND NOW,this 1 'day of Jam- , 2006, a hearing in this case having been
held on June 12, 2006 at 2:30 p.m., and it appearing to the Court that CONSTANCE M.
MEREDITH was served with a Citation and Notice of this hearing on May 17, 2006,.and the Court
finds that the physical or mental condition of CONSTANCE M. MEREDITH would be harmed by
her presence at hearing, and further finds from the testimony:
1. That CONSTANCE M. MEREDITH suffers from Paranoid Schizophrenia and
Organic Brain Syndrome,conditions which impair 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:CONSTANCE M.MEREDITH
in such decisions and that there exists no other less restrictive alternative mechanism for decision-
making.
3. That based on the incapacity of CONSTANCE M. MEREDITH to receive and
evaluate information and to make or communicate decisions, a plenary Guardian of the Person and
plenary Guardian of the Estate are required on a permanent basis_
F1xhibit "A"
NOW,THEREFORE,based on the clear and convincing evidence supporting the foregoing
findings it is ORDERED, ADJUDGED and DECREED that CONSTANCE M. MEREDITH be
and is hereby adjudged an incapacitated person,and WILLIAM J.MEREDITH is appointed Plenary
Permanent Guardian of the Person and Estate of CONSTANCE M. MEREDITH. As Plenary
Permanent Guardian of the person, WILLIAM J. MEREDITH has the authority to access all
CONSTANCE M. MEREDITH's medical records,including but not limited to psychiatric records.
Further,as Guardian of the person, WILLIAM J. MEREDITH shall have the power and authority to
serve as personal representative for all purposes of the Health Insurance Portability and
Accountability Act of 1996, (Pub.L.104-191),45 CFR Sections 160 through 164 ("HIPAA"). The
Guardian shall be considered the personal representative for CONSTANCE M. MEREDITH's heath
care disclosures under the federal HIPAA regulations and shall have full authority to review
CONSTANCE M. MEREDITH's medical records and to execute releases of confidential
information from medical providers and insurers or other third party payors.
As Guardian of the Estate, WILLIAM J. MEREDITH shall have the authority to make
distributions from principal for the payment of care expenses, and all medical needs. In addition,
WILLIAM J. MEREDITH shall have the authority to make distributions from principal for legal fees
and the taxes„ utilities, and insurance for any real property owned by CONSTANCE M.
MEREDITH.
An Inventory must be filed within ninety(90) days. A report by the Guardian shall be filed
within 12 months and annually thereafter.
�� L(��t►Ve'e�
Bondi �__ �e-pasteci$q a uardian.
CONSTANCE M.MEREDITH,an incapacitated person„has the right 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.
If CONSTANCE M. MEREDITH was not present at this hearing on appointment of
Guardian,then Petitioner shall serve upon and read to CONSTANCE M.MEREDITH 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 days.
BY THE COURT:
0 .
J.
P,l
rQ
A TRUE COPY FROM-RECORD
in Testimony wherof, I hereunto
set my hand and the seal
of said Court at Carlisle, PA
This day
t�u
Clerk of the orphans Court
Cumberland County �
IN RE: CONSTANCE M. MEREDITH : IN THE COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY,
: PENNSYLVANIA
: ORPHANS' COURT DIVISION
An alleged incapacitated person NO. 06-0294
On the Petition of WILLIAM J. MEREDITH
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, T?IE 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/HER DUTIES IN
ACCORDANCE WITH THE COURTS 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"
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING. It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00 „l This is to certify that the information here give
correctly copied from an original Certificate of D(
Local Registrar. The orig
Aye--- duly filed with me as t
certificate will be forwarded to the State
cm i�
Record,; Office for permanent filing.
P 19435430 APO 15/20
viii f Certification Number
Local Registrar Date Issued
Type/Print In COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH-VITAL RECORDS
It ll Permanent
Black Ink CERTIFICATE OF DEATH St..File Number:
176�m� Invx Legal No--(First,Middle,Last.S.M.) 2.Sex 3.-saIGIS.C."ry Number 14.Date of Death(--/--v/Y,)(Spell M.)
William Jr. Metr,�d-±tll 1198 22 7�;; Arpr*11- 13, 2013
92.A&.-Last Birthday '.) Sb.Under I Y- Sc.Under 2 0- 17. IRIe rt,an Stator or Foreign C-L,Y)
84 Hours -iui� 29 cmx-sut, ChMADEn7lcamcl
- Month, I Day, I Hour' 8, 19 17b-Sifthpi-I(Ca-nty)
ti-AX-C.(ll.t.or Foreign Country) d8b.Residence(Sir at and Number-Include Apt No, Sc. IdD...d-1 UY.In.T.-hip?
Sd-Rc.ld.- 165 Tj-rm Drlipe E3 Yes,decedent ll�d I, a.
C%MTdZ)a37-L.jnCt I Be.Residence(Zip Code) 1 7 01 d,decedent II-d within limits of CcLrl1S1E3_city/born.
9-Ev.r(n-1 Or-E- -Marital Stalls.1 1-1 Death M M.-I.cl 1.Str-Nine Spouse's Name(if wife,give name prior to first marriage)
:0 a. E3 No [I)U.k-n 1110 E3 Divorced E3 No-Married C3 UkEZdawed 11 ( 3:X::111rC-_
Father's-.-e(First,Middle,Last,S.M.) 3.Mother's Name Prior to First Marriage(First,Middle,Last)
Paul Hoever MrEClith 8lanclzo d1iVe warp
14a.Informant24b. hlp-01,-d,-t 1144 Infor-Iint'.M.111n.Address{Street and Number,City,State,Zip Code)
William R. 04 Pine Gm-c>N7ta Rtc-l- I, (3Ex:r7c3nE.afs, PA 17324
gh-ln;�Orle;i- - - - - ----f Death Occurred Scree-here OtheY-`2-1- 7Pc�;FTW- -0 iT.;`pi�.FOjni� - - -
r Than- TJ Decedent's Home
o 0 Emergency Ft.. /O.tp.,li-, E3 Dead on Arrival 0 C3 Nursing Home/Long-Ter'm Care Facility F3 Other(Specify)
ail !Sb.Facility Name(Ifm
not Institution,SIVe street and number) J15Wlt,-T-,State,and Zip Code each
CD:f Me�lcjj--Ln PT§, 7�10aLnc
16a.Method of Olsp sftjao M 8.0.1 Ea C--otla- 16b.Do-of Disposition 16c.Place If Disposition(Name of cemetery,I-matory,or other plot.)
EJ Romovat from state E3 0-ti- C�L�3�1.-m-ici Valley Merrkc>3�iaal Gztrdetrls
C3 Other(Specify) 4/17/2013
16d.Location If Disposition(City or T-,State,and Zip) 174.Slize.t... :;;=11 117b,U 111,Number
Carlisle PA 17013 je±:f� P�D 012633 T,
S,-",U-=m
E 17c.Name
and CF
of Funeral Facility
Funeral HCXTW--r 1 0- 630 S- Hanover S t- P21 17013
do-c'.-.1out--Check the box that be.,describe.the 19.Decedent If Hispanic Origin Chock the 20,D.I.d..t*.Rare-Check ONE OR MORE race.to Indicate-hat
highest d.-I.or I.-I of school Completed at the time of death. box that best describe.-h.l..r he decedent the decedent considered himself-herself to be.
8th Sr.dless Check the-N.- ma-WhIce E3 Korean
No diploma,9th-12th grade b.,�lf decedent is not Spanish/Hispanic/Latino. E3 Black or African America. C3 Vietnamese
.Ar High school graduate or GED completed Or No,not Spanish/Hispanic/Latino F-3 American Indian or Alaska Native C3 Other Asia,
M Sam...Il.g.-dp.but..cl.a- E-3 Yes,Mexican,Mexican American,Csaicand Ej Asia.Indian ED Native H-11iin
173 Associate degree(e.g.AA,AS) F-3 Yes,P..rt.Rican E3 Chinese C] Gutirrninl--Ch.-.r,.
EJ Bachelor's degree(e.g,BA,A.,85) Q Yes,Cuba. r3 Fill".. C3 Samoan
C3 Ma%tWr*S degree(-9-MA.MS,MEnS,MEd,MSW,MBA) E3 Yes,other Spanish/Hispanic/Latino Cl Japanese ED Other Pacific Islander
EdD)or professional degree (specify) C3 Other(Specify)
" D""""(e.g. D�'., JO)
I--.-MD. 'Oph-
21-O-ced-V.Shgl...I. Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22..Decedent's Usual Occupation-indicate type of work
D;e,-hjt. Q Japanese E3 Samoan d ..during most of-Irking life. 00 NOT USE RETIRED-
E3 Sock or African American M K.- 0 Other Pacific island,,
E)America,India.0,Alaska N-- F-3 Vietnamese 1--3 Dan,,K-/N.,Sure
1-3 Asian Indian [3 Other Asia., 1-3 Refused 22b.Kind of business/Industry
E3 Chinese M Note-Hawaiian EJ Other(Specify)
E:3 Filipino Q Guamanian Ch--o Macatlax�icsbur Naval Su Z
ITEMS 230-Z31d MUST Be COMPLETED Pronounced Dead(M0/DIV/Yr) of Person P-U..I.x Death(Only when applicable) License Number
BY PERSON WHO PRONOUNCES R
CERTIFIES DEATH I I ( _�I ;
34 r Z;t 7;�k 1��
Death .1-1 :-t-tocil (43 0<7 t-
'ej
CIiuSE OF OEA s App-4-1.
26.Port 1. Enter the chain 0f_jtyitnrA--diseases,In jul,s,or complicatio--th-directly *used the death. DO NOT enter t-lo.4-en-such as cardiac.-L,
respiratory arr-,.1-na-lcul-fibrillation without showing In.analogy. CIO NOT ABBREVIATE. Enter only one......n a fine. Add ddfli-1 I-as If n.-sary. i Onset Death
IMMCOIATE::��c�En---------- "192 IS-d
(Final
resulting in death) dfli- 1.(or as I cans.q..n..of):u.
ya- re-le, -ici::h I slza� --- - ,
San---tI-I-Y list-ndItI. Do.to(or -q-te,of):
If any,leading 1.the-U_ j
listed an line a- Enter the c- ADfV---tj"" 411;1"L 9.5k
UNDERLYING CAUSE Due to(.,as.consequence f):
M (disease or Injury that
FE Initiated the events resulting I
in death)LAST. Due to(or-a consequence of):i
s7 26.Part B. .---other sI nlfjr,pt.9-QAftJ9-rR�ntrjbutjXAC,&jb but not resulting In the und piIY p d?
CtYq -----_ 5,�
`51yfng cause al-1.P. 127.W.W out
W a r a a uYtE -.liable
p.y findin,
tee plot the IOU-of death?
4-
1:3 Yes .9".
29.if Female:- C3 Not 30.Did Tobacco Us.C I of Death
E:3 pregnant-.thin Pa..,Va., Yes r3 Contribute to Death? 31.M...
Pregnant at tiree of death 0 - Probably C3 Homicide
C3 No 9"-itinkn- E3 Accident C3 pending I.Yastla-l..
C3 Not pregnant,but Pnean-1 within 42 days If death 0 Suicide 0 could not be clotarrelned
.2 13 Net Pregnant,but pregnant 43 days to i year before death 32.Date of InJ-(Mo/Dan,/-)(Spell-Inch)
Unknown if pregnant-h-n the past year 33.Tim.of Injury
34.Plot.of Injury(..a-
n.;far-;school) 35.Location of Injury(Street and Number,City,County,State,Zip Code)
36.Injury at Walk 37.if Transportation Injury,SpacIr- 38-Describe-Injury D.C.-..:
Drover/Operator 17 Pedestrian
C3 No P.,-.., C3 Other(Specify)
3VC*.:tif1ev-physician --.d nurse Practitioner,medical oxaminor/co,oner(Check only-)z
Zlng onlyc To he best of my knewfedill.,death occurred do,To the cause(s)and manne,stated.
Pronouncing&Certifying-To the best of my kn-A.dit.,death occurred at the time,date,and place,and due to the cause(s)and-nn.,stated.
E3 Medical Examin.r/C.,.n.,-On the basis of.-Iruitl-and/or investigation,In my opinion,death occurred at the nmdate,and place,and due to th use(,)and mar-er -d.
Slanist-of co,rtifl., e�� r1lo ?I 101"We!> _7
396.No-.,A ZIP Code of Person Completing Cause If Death 26, Ticleof-Ifierz Lic.... .-bar:-
ZVI
d
chary
lee.
4 R UAW
sac.I
ZT.-.nd-?ts
Exhibit "B"
Disposition Per-,,No.
COPY
ANNUAL REPORT OF'
GUARDIAN OF THE ESTATE
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
M
C>
rn
Estate of Constance M. Meredith, an Incapacitated Person :"
Ca -0 ")
C C:)
No. 06-0294 :* v r" i rn
r— M co ;0 C;l
7!� cf�
I. 1WRODUCTION
William J. Meredith was appointed
[@Plenary Chimited Guardian of the Person by Decree of Edward E. Guido
dated June 12, 2006 and Amended Final Order dated Ju1y.24 2006. ................
A. This is the Annual Report for the period from January 1,2012 to
j3eccmber 31,2012 (the"Report Period'); or
B. This is the Final Report for the period from
to (the"Report Period"), and is filed
for the following reason:
L The death of the Incapacitated Person. Date of death:
2. The Guardianship was terminated by the Court by Decree of
J., dated
Farm c02 rev.1013.06 3.06 Pagel of
Exhibit "C"
Estate of Constance M. Meredith,an Incapacitated Person
11. SUMMARY
A. State the value of the estate reported on the Inventory $235.577.53.
B. State the value(s)of principal assets at the begirtning of
the Report Period, (Same as Inventory if first Report,
otherwise,ending balance from last Report.) 51,792.09
C. What is the total amount of income earned during the
Report Period?111 .00 gross/month SS x 12 $3.960.00
D. What is the total arnount of income andprincipal
spent for all purposes during the Report Period? $3,960.0
E. What are the balances remaining at the end of the Report
Period?
1. Principal $1,792.09
2. Income $ -0-
3. Total of Principal and Income $1.792.09
Ward is on Medical Assistance and her monthly income goes to the
nursing home.
ADDITIONAL INFORI%IATION
((f more space is needed,please attach additional pages.)
A. Prineipal
1. How is the principal balance listed above currently
invested? (Please specify,e.g., real estate,
certificates of deposit, restricted bank accounts,etc.):
Guardianship account at South Mountain Restoration Center. She is currently
receiving Medical Assistance to pay for her care at South Mountain.
2. Have there been any expenditures from the principal
during the Report Period? ........................................... 0 Yes N No
If Yes:
a. Have all expenditures from the principal been for
the sole benefit of the Incapacitated Person? ......N/A..... 0 Yes 0 No
Form G-o2 rer.10.13.06 Page 2 of 5
Estate of t onstance M. Meredith, an Incapacitated Person
b. List purpose and amount of expenditures: N/A
$
_ S
c. Was Court approval received prior to
expending,the principal? ...N/A......................... 0 Yes 13 No
Were additional principal assets received during the
Report Period which were not'included in the
Inventory or a prior Report filed for the Estate? .....................o Yes & No
If yes:
a. Was Court approval requested prior to
receiving the additional principal? ............................❑ Yes o No
b. State the sources and amounts of the
additional principal received:
$
B. Income
I. State sources and amounts of income received
during the Report Period {e.I,r, Social Security,
pension,rents,etc.):
Social Secant, $330.00 uross/month
_ $
Total income.received during Report Period: $3,960.00
rorm G42 rei%!p.13.96 Page 3 of 5
Estate of Constance M. Meredith, an Incapacitated Person
2. How is income currently invested? (Please
specify, e.g.,restricted bank accounts, client
care account, etc.):
Guardianship account at South Mountain Restoration Center. All income,
minus$45.00 personal needs allowance is paid to South Mountain for her
care.
C. Expenses for Care and Nfaintenance
Specify what expenditures were made from the principal and
income for the care and maintenance of the Incapacitated
Person(e.g., clothing, nursing home, medicine,support, etc.):
Nursing home and clothing
D. Other Expenditures
Specify what other expenditures were made during the Report
Period. (Do not include any items stated in response to
question C above.) NONE
E. Guardian's Commissions
List amounts of CRTpp;is4t4p paid as Guardian's commission
And state how amount was detem-tined: NONE
Court
Amount Method of Determination Approval Obtained
D Yes c3 No
13 Yes o No
Fom C-02 rev.]a 13.06 Page 4 of 5
Estate of Constance M. Meredith, an Incapacitated Person
1+. Counsel lFee
List amounts paid as counsel fee, and indicate whether Court approval was obtained.
Coill-I
Amount Approval Obtaieted
None o Yes o No
o Yes 0 No
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.
3
Dale Signature of Guardian of the Estate
William J. Meredith
Name of Guardian of the Estate(", e or print)
165 Linn Drive
Address
Carlisle.PA 17013
City.State,Zip
(717)243-540
Form G-02 rev. 10.1306 Page of
ANNUAL REPORT OF Copy
GUARDIAN OF THE PERSON
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
C> M
rn C-1)
G")� C)
Estate of Constance M. Meredith,an Incapacitated Person M C-1
5-i
No. 06-0294 Z3
C-0
I. INTRODUCTION
William J. Meredith was appointed
Wenary [Limited Guardian of the Person by Decree of Edward E. Guido J.,
dated June 12. 2006 and Amended Final Order dated July 20, 2006.
A. This is the Annual Report for the period from January 1,2012 to
December 31,2012 (the"Report Period"); oi-
B. This is the Final Report for the period from
to (the"Report Period"), and is filed
for the following reason:
I. The deatli of the Incapacitated Person. Date of death:
2. The Guardianship was terminated by the Court by Decree of
J., dated
For a Final Report, oluitSections 11tIlrolig1l IV
Farm G-03 M%101.!3.06 Page I of 4
Estate of Constance M. Meredith, an Incapacitated Person
11. PERSONAL DATA
Age of the Incapacitated Person: 80 Date of Birth: May 23, 1932
Ill, LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
South Mountain Restoration Center
10058 South Mountain Road,
South Mountain,PA 17261
B. The Incapacitated Person's residence is:
0 own home I apartment
21 nursing home
0 boarding home/personal care home
Guardian's home/apartment
hospital or medical facility
relative's home(name,relationship and address)
1:1 other:
C. The Incapacitated,Person-has been in the present residence since March 22, 2007. If
the Incapacitated Person has moved within die past year, state prior residence and reason(s) for
move:
FOrMO-03 WV. Page 2 of 4
Estate of C onstance M...McEedith, all Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
South Mountain Restoration Center
10058 South Mountain Road
South Mountain, PA 17261
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
Constance M. Meredith suffers from Paranoid Schizoplircnia, Organic Brain
Syndrome and dementia.
B. Specify what,if any, social,medical,psychological and support services the
Incapacitated Person is receiving:
All social,medical,psychological and support services are provided by or
coordinated through South Mountain Restoration Center.
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
9 continue
0 be modified
C3 be terminated
Form G-03 rev.1!7,13.06 Page 3 of 4
Estate of Constance M. Meredith. an Incapacitated Person
The reasons for the foregoing opinion are:
The major medical and mental problems have remained the same.
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
approximately 4 times with the average visit lasting___hours. 15 minutes.
The report of a social service organization employed by the Guardian to oversee and
coordinate the care of the Incapacitated Person far the period covered b),this Report may be
attached to supplement this-Report.
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 unswom falsification to authorities.
(9- r7- 13
Date Signature qfGraYdian of the Person
Wi111M J,MeLe-ftith
Name oy'Guardian of the Person(I)re or print)
165 Litin Drive
,Mdreys
Cadigle.PA 17013
City,state,ZIP
(717)243-5464
lWephone
Form G-03 rev.10,13.06 Pape 4 of
IN RE: CONSTANCE M. MEREDITH. : IN THE COURT OF COMMON PLEAS
An incapacitated person : OF CUMBERLAND COUNTY,
: PENNSYLVANIA
: ORPHANS' COURT DIVISION
WILLIAM R. MEREDITH, : NO. 06-0294
Petitioner
CERTIFICATE OF SERVICE
I, Linda J. Olsen, Esquire, certify that on C1,4,,,j .24 , 2013, 1 served a true
and correct copy of the within Petition to Appoint Successor Guardian on the parties named
below, by depositing same in the United States mail, postage prepaid as follows:
Leslie Tomeo, Esquire William R. Meredith
505 Colfax Avenue 404 Pine Grove Road
Scranton, PA 18505 Gardeners, PA 17324
South Mountain Restoration Center
10058 South Mountain Road
South Mountain, PA 17261
Respectfully Submitted,
HAZEN ELDER LAW
Date 4�lndZaJ.%lsen, Esquire
PA I.D. No. 92858
2000 Linglestown Road
Suite 202
Harrisburg, PA 17110
(717) 540-4332