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Home My WebLink About83-0478 IN RE: : IN THE COURT OF COMMON PLEAS Ms.Alice D. Ansel : CUMBERLAND COUNTY, PA an Alleged Incapacitated : Person : : ORPHANS' COURT DIVISION : NO. 478 Orphans' Court 1983 : GUARDIANSHIP PETITION FOR APPOINTMENT OF A SUCCESSOR GUARDIAN PURSUANT TO 20 PA. C.S.A. § 5514 1) Petitioner: Petitioner: Robert L. O'Brien, Esquire Address: 19 West South Street, Carlisle, PA 17013 717-249-6873 __- .� :.� �� :.:; .�,� �.;� � �� 2 The Alle ed Inca acitated Person: � � �: = ��' ) 9 p � -. � �___ ,. �,.� �-r'; ... � .__ �.� ;'� _ " C....J , • Name: Alice D. Ansel � �� Q :�� - . � Age: 48 DOB 11/13/64 �.-. �� _ �' � �� V� Address: 1920 Elm Street `Y �; . � �` �-J .. ,.,�, . New Cumberland, PA �� .: k�._. .� .�� .. <,�.. �_ � •`�S 3) The Alleged Incapacitated Person's Heirs: --�; �`� ;�� ° V��' � �a �`Y` Spouse: none Children: none Parents: Walda D. Ansel Address: Other: Sisters, Ronica Ansel, 6 North Second Street, Wormleysburg, PA 1043 Tammy Williams, 110 Willowbrook Dr., Boalsburg, PA 16827 4) Residential Services Provider: Ms.Ansel lives in a CPARC Group Home with assistance services provided by MHMR. 5) Other Providers of Services: Cumberland/Perry MHMR 6) Guardians, Robert M. Ansel, Sr. (deceased) and Walda D. Ansel, residing in a nursing home, were appointed Guardians in 1984. A copy of that Order of Court is attached. 7) Proposed Guardian: The petitioner, Robert L. O'Brien, Esquire, of MHMR, requests the appointment of a Successor Guardian due to the incapacity of Walda D. Ansel. Additionally, the statute governing Guardians has changed since 1984. One issue to be considered by the Court, is to consider surgery that Ms.Ansel's family supports but that Ms.Ansel has expressed ambivalence about. For that reason, CPARC, an advocacy group, is proposing the appointment of Dawn, Swartz, 150 East Chapel Ave., Carlisle, PA 17013 as Guardian. 7) Averment of Disinterest: The Petitioner has no interest adverse to that of Ms. Ansel. Petitioner has spoken with all the proposed Guardians and believes all are qualified and interested in the welfare of Ms. Ansel. Petitioner requests the Court appoint an attorney as Guardian ad litem for Alice, and assist with the conflict befinreen the sisters and CPARC and thereafter appoint a Successor Guardian. The Petitioner wishes the Court to consider the efficacy of the proposed breast reduction surgery and wishes the Court to examine Alice and see if this is an issue she is competent to address. 8) Reasons Why Court Review is Requested: To assist in medical decisions, and insure availability of all possible resources for Ms. Ansel's care and treatment. Medical Authorizations have to be signed prior to scheduled surgery. She will be discharged from the hospital and papers have to be signed in connection with discharge and transfer. Ms. Ansel was last adjudicated incapacitated in 1984 and major policy changes in reference to incapacity have been made in the Pennsylvania Law 9) Functional Limitations and Physical and Mental Condition: see attached report, basically, moderate mental retardation 10) Value of Estate: Gross value: 0 Income: SSI. $1,249.90/month . Financial Obligations: Cost of care. � WHEREFORE, Petitioner respectfully requests that an attorney be appointed guardian ad litem of Alice to assist her in a review of her Guardianship. Respectfully submitted, Robert L. O'Brien BY �!�� Robert L. O'Brien, Esquire Attorney for Petitioner I.D. # 28351 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 : I verify that the statements made in the foregoing Petition for Appointment of a Successor Guardian Pursuant to 20 PA. C.S.A. § 5514 are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. � Robert L. O'Brien, Esquire Dated: � �� t3 � �� _ - a l �-Q .3 9 �3 . ,�.,� . _ . . ��. - ` '�'^' �� T . ` •r �� • . ., • � T�is in1�r.�±�tisn ha;o�n • � • � �� . . • � c�.`S:t a fo ;•c,� !�il;n r�: � sad• . !lw�i! .cr�.: wn:se c�n}tide�,.- _ . y ss �;r�Puciv� r � b� ..j�ts ia �f�ta � ;-----� r�g„iat:c;:s !im s y,�ur r' ' '�'. . ,;�:: {ur!l�ar dis:tosure of��3qn'r�r"�an a'��• .. �.;..,• . w:t�oert the pricr Mrr' � ., . i!!ea conssr,t o1 tb• ''`-' Peaon �o wborn it Puto��,'• • ;:,."'`'� ..-..:.i^`� IN RE: . , :��'_:;�:�� IN THE COURT OF COMMON PLEAS OF . - "� s CUMSERLAND COVNTY, PENNSYLVANIA ALICE DIANE ANSEL • . : O��IiANS' COVRT DIVISION AN ALLEGED INCOMPETEI�T : NO. 478 ORPHANS�' C4VRT 1983 � � ORDER OF COVRT ANp NOW, this 23rd day of March, 1984, upon the Petition af Robert M. Ansel, Sr. , and walda D. Ansel, the parents of Alice Diane Ansel, after full hearing and careful study of the testimony given by Charles Cladel, Jr. , M.D. , and Elliot Sauertieg, ,M.D. , and the Court being in receipt of and having carefully studied an independent report., following examination, from Stephen � � � 8. Coslett, Ph.D. , and the Court having applied the standards as set out in In Re: Mildred J. ':erwilliger, 450 A.2d 1375, the - ; Court finds that the following facts have been established by clear and convincing evidence: • (1) That the Court has appointed Charles Daugherty, � � Esquire, as guardian ad Iitem for Alice D. Ansel, and the guardian , , has had a full opportunity to meet Alice Ansel, present evidence, and Cross-examine witnesses at the h�earing; � ' � (2) that a comprehensive medical , psychological , and social evalvation has been made of the incompetent, � includirig the Court's owrs inde�endent examir�ation requested from Dr. Stephen 8. � . Coslett, Ph.D. ; . � � ' . � • , . . � ••T�ri: Tn��tion hc . . �a :'tics . .r; z�"n disclasad . 'r� � .�, , , . f:_�tity :s .-1.:.,�,� ::.� �.;: :.? c. -r!j-�p�,. r--� rF�,�i:;t: � .... :. a� .�� '��;�.�. '" •. . ;J: . ": :Z • �'. }' r� , a '�r.Q ju�t�:�t u,s.:ro;�re c� .. �:.0 i+�-•�:e a�y . NQ. 4 7 8 ORPHANS' COURT 19 S 3 Per o��',��,�m'• .' ,'� •'��"''�':=t:on : a i a. �.r�.re•:; :;�s,_ � ,. �+ oF t�� if per►ains; _ �3) that the tr"ial judqe has personally observed : Alice Ansel and notes that she has a lfmited and chfld-like abilit . Y to communf cate; ' ,; i4) that Alice Ansel lacks �apacity to make a decision � about sterilization and her ineapacity is not likely to change in , the fareseeable future; • t5� that Alice Ansel is fully capable of reproductian and we accept the testimony of Dr. Elliot ,A. �avertieq;� additionally, sterilization is the only practicable means of contraception; ' t6� that there is a great possibility that Mfss Ansel will experience trauma or gsycholoqical damaqe if she becomes pregnant � or gives birth, and this possibility is qreater than the possibility of traur.la or psychological damages from the sterilization operation; (7) that there is a strong likelihood that Miss Ansel will be exposedfby reason of ber age and the fact that she cannot be supervised at every moment, to situations wheze sexual intercourse � may be impc�sed upon her; � � (8) that Miss Ansel cannot understand reproduction or contraception, and this condition is extremely likely to be of • a permanent condition; � � � (9� that Miss Ar►sel has no ability �o care for a child, : ; and tbis condition would not change would she be married; � . (10) that no evidence exfsts at present that foreseeable . � advances in the future will improve Miss Ansel's condition, or , �--., � . ,, offer .alternative sterilization procedures; . . (11} that. the parties movinq for sterilization are seeking � � . , ' ,. .,+�, �, ' : !� {rCrr..:r.;i.►r �--. 4 r . t ',^r:� �;!`�,rJq�!d. tQ/�'L•:.` . . �' �!'.' r. .•::. r: r' ^ ;� . �::k.�j' . . - . .. , '^l. fE" �� . • � , . "��! +l't'' . �_ ',.. , .. '!1 " . . , . - . - rlliil:��:« Lii ` . '''�� p�rS�rs :c v.: ,-.�.- ., .•. ., _ ' NQ. �4?S ORPKANS' CCtURT 19$3 � it in q�ood faith, and that ttieir pr�mary can�ern is far the best interests of Alice Ansel, and n�t fc�r their cwr� or the gubi ic's conve�ier�ce. , � Therefore, the Court orders and directs as� follows: . , 1. Alice biane Ansel is adjudqed an incom►petent, � � as de�'iA�d by Chapter 55 of the Fro�ate, Estrltt+�5 r and �`iduciary Code of the Canunonwealth of Pennsylvania. • 2. The Pe�itianers, Rabert M. An�el, Sr. . and Walda ' E�. Ajnsel, his wife, the parents of the said .Alice t3fane Ansel, � are hereby appoint�d guard�an af the gersan af Alice Diane Ansel. . 3. fihe Petitionersr Rob�rt M. Ansel, Sr. , and Wal�a �. ,,.� Ansel, �►re hereby appainted guardians af the p�erson af the said� � Alice t3ian� Ansel and are hereby expressly authorized to authariZe, permit, and direet her' surgical sterili�ation, �y the Caurt, � c�e E. H fer J. � 5amuel L. Andea, Esquire . Fo= the glaintiffs A 7�:1�E CG��'Y r?t�t:� �:C+�°"c;� � «a�i . � :«.. . � �: ,.•. .. .,� �ts�!'.•. ttf�ii.1"i.; ..:'.fi,�s!�t'^... '�•t::.•;• .•�•. .,.s� Charle� Daugherty, Esq�ire �y/�� • � i• .,x �.• • } .-• • �.•, iii i i.i {�,�iw v r}.�7 ii1 r• •► ��+.'.+t�«1 .��s�.'::w� a • � Far the Incontpetent -� � , , /,. , ' ± '�his..�:..�„� " ,� • `�',�`f ' � � ye� .si•M•. s s.�+. ��r +�•� � i :S S+g . . �� r�+� . ..�.r.......�... . �IFI.\�5/�J..�'w�=�I�'�♦ �. �w �.� � � •s � � wt'iJ L•'v.:�1i�; �/�/ ! � /",�, ; . M • ' Print Individual Support Plan(Confidential) Page 1 of 5 Plan Admin > Print Plan INDIVIDUAL SUPPt)RT PLAN Commonwealth of Pennsylvania Department of Public Welfare Plan Summary Consumer Name: ANSEL, ALICE SSN: 176500772 MCI: 480001411 BSU: 2120003983 MA: 4800014112 Date of Birth: 11/13/1964 Address: 1920 ELM ST : NEW CUMBERLAND, PA - 170701225 Fiscal Year Begin Date: 7/1/2012 Fiscal Year End Date: 6/30/2013 Plan Status: Approved Annual Review Update Date: 4/1/2013 Plan Category: Critical Revision Annual Review Meeting Date: Plan Last Updated Date: 05/03/2013 SC Entity: CUMBERLAND PERRY MH MR OFFICE AND BSU Supports Coordinator: CLIFTON, RACHAEL SC Supervisor: RICHARDS, JAMES Waiver/Program Type: Consolidated Waiver Waiver/Program Status: Enrolled Waiver/Program Begin Date: 4/1/2004 Waiver/Program End Date: G Consent to share plan: Yes �O � Reason for Abbreviated Plan: � r �� o��' � Were lifesharing options considered for N/A �� Residential Services. (� � � a ! 2. Has the ISP signature sheet been completed: Yes p�� Has the ISP Provider Choice information been Yes C� � shared with the individual: �� Consumer Demographics https://www.hcsis.state.pa.us/HCSIS/pgm/asp/ISPPT.ASP 5/7/2013 Print Individual Support Plan(Confidential) Page 2 of 5 � � Primary Demographics First Name: ALICE Last Name: ANSEL Middle Initial: D Suffix: Last Name at Birth(If different and known): Preferred Name or Nickname: Registration County/Joinder: Cumberland/Perry Socia) Security Number: 176-50-0772 If Social Security Number not provided, specify why: Date Of Birth: 11/13/1964 Race: W h ite If Race Other, Specify: Ethnicity: Non-Hispanic Gender: Female School District: Graduation Date: Original Registration Date: 02/07/1980 Current Living situation: Community Home (MR) Living situation Qualifier: 2 to 4 persons Primary Language: English Primary Language in the Home: English Ambulation: AMBULATORY CAN WALK INDEP WITHOUT ASSISTANCE Diagnosis: Moderate 318.0 County Of Residence: Cumberland Are you a US Citizen?: Yes Special Indicator: Home Phone: 7177744720 Work Phone: 7177668512 Mobile Phone: Other Phone: Pager: Confidential: Confidential Details: Status: Active Reason Status: New Referra) Address Address Type: Residential Address Linei: 19Z0 ELM ST Address Line2: https://www.hcsis.state.pa.us/HCSIS/pgm/asp/ISPPT.ASP 5/7/2013 ' Print Individual Support Plan(Confidential) Page 3 of 5 Address Line3: City: NEW CUMBERLAND State: Pennsylvania ' Zip: 17070-1225 Email: Additional Notes: Effective Beg i n Date: 09/08/2011 Effective End Date: Alternate ID Identifier Type: BSU Identifier: 2120003983 ! Effective Begin Date: 02/07/1980 Effective End Date: ; Identifier Type: MA Identifier: 4800014112 ': Effective Begin Date: 02/07/1980 Effective End Date: . Identifier Type: MCI Identifier: 480001411 Effective Begin Date: O1/31/2004 Effective End Date: Identifier Type: MEDICARE Identifier: 162227304C2 Effective Begin Date: OZ/07/1980 Effective End Date: Identifier Type: SSN Identifier: 176-50-0772 Effective Beg i n Date: 02/07/1980 Effective End Date: Medicaid Medicaid(MA) Number: 4800014112 Provider: MEDICARE ASSURED Provider Type: Provider Policy Number: 22557201 Assistance was provided in applying for MA?: N Medicaid Eligibility Effective Begin Date: 02/07/1980 Medicaid Eligibility Effective End Date: Contacts First Name: MILLIE Last Name: SCHIEL https://www.hcsis.state.pa.us/HCSIS/pgm/asp/ISPPT.ASP 5/7/2013 Print Individual Support Plan(Confidential) Page 4 of 5 " � Middle Initial: Suffix: Relationship to Individual: Other Role: Support Team Member If Power of Attorney, is document on file at agency?: If Legal Guardian, is document on file at agency?: If Living Will, is document on file at agency?: If Caregiver indicate Date of Birth: Address Linel: Address Line2: Address Line3: City: State: Zip: Home Phone: Work Phone: Other Phone: 7172492611 Email: Preferred Contact Method: Other Best Time to Contact: Contact Notes: Effective Begin Date: 01/15/2003 Effective End Date: First Name: Nikki Last Name: Ansel Middle Initial: Suffix: Relationship to Individual: Sister Role: If Power of Attorney, is document on file at No agency?: If Legal Guardian, is document on file at No agency?: If Living Will, is document on file at agency?: No If Caregiver indicate Date of Birth: Address Linel: 6 north 2nd street Address Line2: Address Line3: City: wormleysburg State: Pennsylvania Zip: 17043 Home Phone: 7177630541 Work Phone: https://www.hcsis.state.pa.us/HCSIS/pgm/asp/ISPPT.ASP 5/7/2013 ' ' Frint Individual Support Plan(Confidential) Page 5 of 5 OtherPhone: Email: Preferred Contact Method: Home Phone Best Time to Contact: Evening (6:00 - 9:00) Contact Notes: Effective Begin Date: 02/07/1980 Effective End Date: First Name: � ��`' Last Name: '��`�� Middle Initial: Suffix: Relationship to Individual: Mother Role: ��ii�i r : If Power of Attorney, is document on file at agency?: If Legal Guardian, is document on file at Yes agency?: If Living Will, is document on file at agency?: ' If Caregiver indicate Date of Birth: , Address Linel: ��3E�1T CREEK BLVD'°°� Address Line2: ' Address Line3: City: �4��G5Bl1RG ::� State: �'��n�`��°' Z i p: !�`��.18�fi Home Phone: Work Phone: OtherPhone: Email: Preferred Contact Method: US Mail Best Time to Contact: Contact Notes: Effective Begin Date: 05/07/2013 Effective End Date: https://www.hcsis.state.pa.us/HCSIS/pgm/asp/ISPPT.ASP 5/7/2013 � ' �� r�-�- :,� � Y ., ti��3 i .� � _ __.. t � � �,�. , ...�-�� GUIDANCE ASSOCIATES � � OF ____-- 412 Erford Road PENNSYLVANIA Cam Hi • v�z32.�.9� Camp Hill, PA 17011 ar isle: 717/245-2289 Stanley f.Schneider,Ed.D. Chambersburg: 7V/263-9392 Ditector � . PSYCHOLOGICAL EVALUATION NAME: Alice Ansel AGE: 25 BIRTHDATE: 11-13-65 EDUCATION: Cedar Run � OCCUPATION: CIT EVALURTION DATE: July 27 , 1990 REFERRED BY: Cumberland-Perry MH/MR - Trish Horst, Case Manager REFERRAL YNFORMATION: Alice has been referred to obtain a current I.Q, and estimate of level of functioning. TESTS ADMINISTERED: Wechsler Adult Intelligence Scale-Revised Bender Motor Gestalt Test Bender Recall Human Figure Drawings Clinical Interview INTERVIEW DATA AND OBSERVATIONS: Alice was accompanied to the evaluation by Sara Stackhouse, Program Advisor. Alice is a blonde young woman who dressed informally in a shirt and slacks for the evaluation. Her weight appeared to be appropriate to her height and build. Alice smiled frequently, was friendly, and exhibited good social skills. I observed moderate articulation difficulties, but communication was not generally problematic. Alice worked diligently and made an attempt at all tasks presented and did not appear to be ill at ease with herself or have an e�cessive lack of self-confidence. Alice lives in a group home located at 501 Market Street in New Cumberland. She has had a room mate for approximately two months, socializes well , and has exhfbited no behavior problems. At times she may engage in excessive attention seeking. Daily skills include all personal care activities except that she may need prompts for baths and help with combinq her hair. She cleans her own room, makes her own bed, washes dishes, is almost totally independent with laundry, and helps with cooking. She enjoys exercising, bowling, swimming, and all types of group outings. She provided the first names of a number of friends ' among the staff and at CIT. Her main hobby is listening to music. Alice is an adopted child and her parerits recently Counseling: Individual, Marital, Family • Psychological Testing • Civil/Criminal Litigation • Custody • f.A.P. � , � �� ~ . r��rish Horst r Case �ianager RE: Alice Ansel July 27, 199Ct Page 2 . separated, and their visit� have �hu� been more limited than usual. She experiences some anxiety about her mother not visitinc� mare. Alice is partially aware af haZards . 5he is able to �esponc� to a fire alarm and knows to stay away from the st4ve. Hawever, she may occasionally eat inedibles such as soap or powder and she cannat be trus�ed to walk acrc�ss the street by herself; �he is alsa easily persu�ded by others . Basically, however, she i.s able t� take care of her own needs and is able to initiate inquiries which will be helpful tc� her such as expressing the need for medicatian when sl�e has a cold. TEST RESULTS AND CLINICAL IMPRESSZONS: ��ECHSLER ADULT INTEI��.IGENCE SCAI,E-REVISED VERBAL TESTS SCALED SCORE PERFORMEANCE 'I'ESTS SCALED SCCtRE Information 1 Pictur� Complet�,on 2 Diqi� Span 1 Picture Arrangement 2 Vocabulary 1 Block Design 1 Arithmetic 1 Object Assembly 1 Camprehension 3 Digit Symbol 1 Simi�.arit�es 1 VER$AL I,Q, 50 � PE�.FORMANCE I.Q. 52 FULL SCALE I.Q. 46 Alice showed an awareness t�f her environmen� and ntinimum ' ability ta interpret the purpase behind actions b� giving correct answers to why� clothes need to be cleaned and what to do with an envelope that is sealed, addressed and has a stamp, o�her verbal skills were severely limited. She could not name the col+�rs in the f lag, coulcl not repea� three nu�tbers in forward series from memc►ry, gave only partially correct definitions for the words shigjpenny/breakfast, was unable to count seven blocks, and h�d no abstra�:tian ability in the form of noticing similari��s be�ween word pairs such as orange�banana or dag/lion, Alice exhibited some v�sual alertness to her environment by �noticing missing details in twro simgle pic�ures and by� arranging three pictures in praper socia3 sequence after an explanation and demonstration f rom the exarniner. She was unable ta complete simple black designs, made only one proper connection on a simple six part puzzle of a persan, �nd was unable to praperly copy simple symbc�ls with a pencil, These te�ts af cognitive skills sugge�t that Alice functions in the moderate range of inental retardation. This level c�f functianing is alsc� consistent with the interview data. s" � �, _b � ' , � �, � �.�rish HOY'Str Cas� �Ianager ,t�j RE: Alice Ansel July 2?, 199Q Page 3 BENDER MQTOR GESTAI,T TEST AND BENDER RECALL �lice's drawings suggest that she is able to distinguish between circles and angles, but she was unable to maintain �he gest�alt £or any of the drawings . She was, however, able ta express the general principle; for example, on one drawing which requires a diamond within a triangle she drew a smaller circle within a larger circle. She was able ta draw straight lines and some angular shapes as well as circles. Her visual recall p+erformance was simply a series of circles. These effor�s are consistent with levels of functioning prevfously observed. HU►MAN E'IGURE DRAWINGS Alice's figures were simt�l� ch�.ldlike drdw�,ng� with �he female figure drawn first and the male figure second. statistically, this is the usual c�rder of the drawings. She identified the male �igure as "Rick, my boyfriend, " There was some difference in the drawings but indicators of sexuality were nvt apparent. Generally the drawings �nd3.cate social skills already abserved and do not reveal any characteristics of , pathology. The maturity a�' the drawings is �onsistent with the ' level af functioning already abserved. CQNCLUSIONS AND RECOMMENDATIQNS: Alice Ansel is a 25 year old single female who is currentl.y functianing in the Moderate Range of Mental Retardation {DSM III-R 318.Ot�) . Na behavior problems are reported, and work, s+�cial, and personal functioning in same respects may be simi2ar ta the mild range of inental retardation. Overall, however, the modera�e range is a more appropriate diagnosis. No recommendations for life management are made at� this time other than the practices already in place. Eugene H. Stec er, M,A. Licensed Psychologist �xs/sb L � �� SOCIAL SDI�IIKARY ALICl3 ANSEL D.O.B. : 11/13/64 ADDRSSS: 501 �!fARRET STRB$T; NSW CII1�$RLAND, PA. 17070 TSLSPHONE: 774-7254 DAT$ OF REPORT: 12/17/91 REFERR�iL Alice Ansel is a 27 year old moderately retarded female who is being referred for individual counseling due to some significant life chanqes that are causing her emotional distress. Specifically, Alice was adopted by her foster parents in 1979 and just recently became ; aware that she has natural siblings in the area. Alice met two of her three siblings, and one sister refuses to meet her because she blames - Alice for her mother's death. After meeting her siblings and expressing interest in having a relationship with them, Alice's adoptive mother decided that it was not in Alice's best interest to ' see her siblings, and has discouraged contact with them. This confuses and upsets Alice to the point where she cannot focus on her work at her job, and she is very arqumentative with everyone. The apparent reasoning behind this is that Alice will frequently "play" one person against the other to get her own way. After two meetings with one of her natural sisters, the sister contacted Alice�s residential proqram to give them advice on how to "handle" her. �ilice is also upset by the fact that she wants more frequent face-to-face contact with her adoptive family. Although she speaks to her mother regularly by telephone, the conversations often center around Alice pressuring her mother for a visit. Mother will make plans with Alice, then frequently calls to cancel them at the last minute, or does not show at all. Alice no longer goes home for overnight visits, as she accused her adoptive father of molesting her in 1987. After extensive investigation, it was discovered that Alice made these allegations as her roommate at the group home had made similar ones and Alice was jealous of all the attention this person received. However, this so terrified her adoptive parents that they are unwilling to have Alice home for overnight visits to their home. "baby factory" . This was appareY.�ly a concern due to the fact that . Alice had been sexually molested as a child, was obsessed with boys and having boyfriends, was easily manipulated and exploited, and had the tendency to strip and wal]c around naked both inside and outside the home. Legal guardianship was given to the Ansels by Judqe Georqe Hoffer, and a tubal ligation wa� performed based on the recommendation of the court and two psychiatrists who met with Alice several times to determine her level of competency and her understanding of sexuality and reproduction. In 1986, Alice entered a connaunity living arrangement in a group home operated by The Cumberland/Perry Association for Retarded Citizens in New Cumberland,PA. She remains in this group home at the present time. After Alice's graduation from the Capital Area Intermediate. Unit in 1986, she became a full time employee at the Center for Industrial Training, a sheltered workshop, in Mechanicsburg, PA. She is still employed there, and has been having difficulty attending to her work. Alice's supervisors report that she is upset that she has not seen much of her natural siblings and wants to discuss the situation with them constantly to the exclusion of all other activities. Alice also has a boyfriend named Rick who she says she will marry. Alice and Rick regularly meet with Maria Maurer, an advocate from : CPARC, who attempts to instruct them on sexuality and appropriate behavior in public. Maria is not a therapist and has been unable to work effectively with the couple due to Alice's fixation on her personal problems. Due to the difficulty Ms. Maurer is facing working � with Alice at the present time, she also felt that a referral for mental health services would be appropriate for Alice. SUI�IIKARY It is the general consensus by Alice's treatment team that she is currently experiencing some emotional stress at this time. It is felt that siqnificant chanqes in Alice's life in the past few months may be contributing factors. Alice currently has an "I don't care attitude" and nothing really seems to motivate her, either negatively or positively. It is felt that the situation could worsen without professional evaluation and intervention. 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Vc�� .—►`}�� } � �� j � i , , '�"`� ��-a,.Q, �� i`��. r�e.t ti�a,r c�,�.�,� .�r�, � r�,a °� ��- +��,, � w�.�,�,�, �►-�al�l�,�-., � � � �`�� c��t�, ��i k� -�0,,� �'�''�� ti� � k.� �"`�`� '�� a�� G� � � � � � J �ys , S-�, ,,.��,,,�s `� � � ) . M'{ti+s c��.'�-o �� .t i t,�u,,.,y;,,c, r,,,�„ � �a.. S� 1 � � .. _�e� ��-�-�.. � �,.� --,---- — . ` i��,� ��,�, ��G�.�.ti.,, �`- • 1�`�S R S �tiw�`o'�, ��. /� � ex�.,, • . , . . - ' L t , K1y�. 2 v � �� t.�� z�,�„�.S �, r k "�`"`.�, � �'nh,�.� i y�� .� . �� y� � l��y"�l� ` � U � ��'r �es'��SU.wc�-�-�, �t� . �'y��.� ' � °�) �,, � . . � ��-� s.�.�._ ��►,.�; � ��: PSYCHIATAIST SIGNATURE � t PRIMARY TWERAPIST SIGNATURE t-- ' `'" ' PATIENT OR GWARDIAN SIGNATURE �� • . �. , ASSETS: 1. � € - � ' ' 2. 3. REVIEW DATE: � �i �.� � ,� � IN RE: ALICE D. ANSELL, � An Alleged Incapacitated Person ' .� �� IN THE COURT OF COMMON PLEAS OF THE NINTH JUDICIAL DISTRICT ORPHANS' COURT DIVISION 21-1983-0478 IN RE: PETITION FOR APPOINTMENT OF A SUCCESSOR GUARDIAN PURSUANT TO 20 PA.C.S. § 5514 ORDER OF COURT AND NOW, this 13t" day of August 2013, upon review of the Petition for Appointment of a Successor Guardian Pursuant to 20 Pa.C.S. § 5514, the court appoints Robert P. Kline, Esq., as Guardian Ad Litem, for Alice D. Ansell to assist her in a review of her Guardianship, the proposed appointment of a successor guardian, and with future filings or hearings on the petition. , � Tho as . Placey C.P.J. � �,_.=,'A i"�_I Distribution +�» � m �� ,;. _� �� ,c� Robert O'Brien, Esq. w �' �- ��,, _ Robert P. Kline, Esq. � �,`� i�� E--� ` " ,� �..'" � ��°a � • i ; � �� Dawn Swartz � c.� �'.� �. , �, Alice D. Ansell � � � ��°° y�`y �� c,:� ..; ,.::� .......e �� : ,, „ �.j c.«.a . k�'� �� :.,. �'� r....� +::�� "r : ORPHANS' COURT DIVISION : COURT OF COMMON PLEAS OF In Re: ALICE D ANSELL : CUMBERLAND COUNTY : PENNSYLVANIA : N0.21-83-478 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 8/13/13 JUDGE'S INITIALS: TAP TIME STAMP DATE: 8/13/13 IN RE: ORDER OF COURT ............................................................................................................................ SERVICE TO: ROBERT L OBRIEN 19 WEST SOUTH ST CARLISLE PA 17013 ROBERT P KLINE 714 BRIDGE ST PO BOX 461 NEW CUMBERLAND PA 17070 ALICE D ANSEL 1920 ELM ST NEWCUMBERLAND PA 17070 METHOD OF MAILING: ENVELOPES PROVIDED BY: �USPS ❑PETITIONER �RRR ❑JUDGE ❑HAND DELIVERED �CLERK OF ORPHANS COURT ❑ OTHER MAILED: 8/13/13 ............................................................................................................................ SERVICE TO: DAWN SWARTZ 150 EAST CHAPEL AVENUE CARLISLE PA 17013 METHOD OF MAILING: ENVELOPES PROVIDED BY: �USPS ❑PETITIONER ��R �JUDGE ❑HAND DELIVERED ❑ CLERK OF ORPHANS COURT ❑OTHER MAILED: 8/13/13 _`��/� L e ty erk of Orphans' Court IN RE: : IN THE COURT OF COMMON PLEAS Ms.Alice D. Ansel : CUMBERLAND COUNTY, PA an Alleged Incapacitated Person ORPHANS' COURT DIVISION NO. 478 Orphans' Court 1983 GUARDIANSHIP PETITION FOR TERMINATION OR LIMITATION OF A GUARDIAN PURSUANT 20 P.A. C.S.A. Sec. 5512.2 1) Petitioner: Petitioner: Robert L. O'Brien, Esquire Address: 19 West South Street, Carlisle, PA 17013 717-249-6873 2) The Alleged Incapacitated Person: Name: Alice D. Ansel Age: 48 DOB 11/13/64 Address: 1920 Elm Street c_ New Cumberland, PA r., 3) The Alleged Incapacitated Person's Heirs: a Spouse: none Children: none G t Parents: Walda D. Ansel co Address: Other: Sisters, Ronica Ansel, 6 North Second Street, Wormleysburg, PA 1043 Tammy Williams, 110 Willowbrook Dr., Boalsburg, PA 16827 4) Residential Services Provider: Ms.Ansel lives in a CPARC Group Home with assistance services provided by MHMR. 5) Other Providers of Services: Cumberland/Perry MHMR 6) Guardians, Robert M. Ansel, Sr. (deceased) and Walda D. Ansel, residing in a nursing home, were appointed Guardians in 1984. A copy of that Order of Court is attached. 7) Proposed Guardian: In meetings with the office of MH/IDD as well as Robert P. Kline, Esquire, questions have been raised about the need for a Plenary Guardian. The MH/IDD office is going to have an updated Psychological Evaluation done to assist with the determination. Based upon that evaluation, Petitioner will notify the Court to set a hearing so the Court may consider the determination of termination or modification of the Guardianship. 7) Averment of Disinterest: The Petitioner has no interest adverse to that of Ms. Ansel. 8) Reasons Why Court Review is Requested: To evaluate need for Guardianship services. Ms. Ansel was last adjudicated incapacitated in 1984 and major policy changes in reference to incapacity have been made in the Pennsylvania Law 9) Functional Limitations and Physical and Mental Condition: see attached report, basically, moderate mental retardation 10) Value of Estate: Gross value: 0 Income: SSI. $1,249.90/month Financial Obligations: Cost of care. WHEREFORE, Petitioner respectfully requests that an attorney be appointed guardian ad litem of Alice to assist her in a review of her Guardianship. Respectfully submitted, Robert L. O'Brien By Robert L. O'Brien, Esquire Attorney for Petitioner I.D. # 28351 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 IN RE: Alice D. Ansel : IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA an Alleged Incapacitated Person ORPHANS' COURT DIVISION NO. 478-1983 GUARDIANSHIP ORDER OF COURT AND NOW, this day of , 2013, upon review of the attached Petition, a hearing is scheduled in this matter for , the day of 2013, at a.m./p.m., in Courtroom # , Cumberland County Courthouse, Carlisle, Pennsylvania. Personal service of this Order and accompanying Notice and Petition shall be caused to be made upon the alleged incapacitated person by Petitioner or his representative, in accordance with the Probate, Estates and Fiduciaries Code. Notice shall also be given to all other persons and entities required to be notified under the Code. Proof of service shall be furnished at the above- scheduled hearing. The Court appoints Robert P. Kline, Esquire, as Guardian ad litem for Ms. Ansel, with compensation to be provide pursuant to 20 Pa.C.S.A. Section 5511. BY THE COURT, J. IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ALICE D. ANSELL, ORPHANS' COURT DIVISION An Alleged Incompetent NO. 478-1983 INCAPACITATED PERSON NOTICE A petition to have you adjudged an incapacitated person has been filed with this Court by Robert L. O'Brien, Esquire. A hearing is scheduled in this matter for , the day of 2013, at a.m./p.m., in Courtroom # Cumberland County Courthouse, Carlisle, Pennsylvania. You are strongly encouraged to be present at the hearing, and you are warned that important rights may be lost as a result of the proceeding. You have the right to be represented by counsel and the right to request the appointment of counsel and to have counsel so appointed paid by the Court where you are unable to afford to pay an attorney. YOU SHOULD TAKE THIS NOTICE TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 717-249-3166 800-990-9108 BY THE COURT, J. I verify that the statements made in the foregoing Petition for Appointment of a Successor Guardian Pursuant to 20 PA. C.S.A. § 5514 are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. Robert L. O'Brien, Esquire Dated: 2`l IN RE: ALICE D. ANSELL, � An Alleged Incapacitated Person �I� IN THE COURT OF COMMON PLEAS OF THE NINTH JUDICIAL DISTRICT ORPHANS' COURT DIVISION 21-1983-0478 IN RE: PETITION FOR TERMINATION OR LIMITATION OF A GUARDIAN PUR�UAI�1T T0 2� Pa.C.S. § 5512.2 � y� ORDER OF COURT �a�- - AND NOW, this� day of October 2013, upon review of the Petition for T�rmination or Limitation of a Guardian Pursra�ntta 20 Pa.C.S. § 5512.2, a HEA►RING is scheduled in this matter for 19 Qecember 2013 at 3:30 p.m. in Courtroom Number Si� o#the Cur�berlantf Ca�r��y CaW�thouse, Carlisle, Pennsylvania. Personal service of this Order and accompanying Notice and Petition shall be caused to be made upon Ms. Ansel by Petitioner, En accordance with the Proba#e, Estates and Fiduciaries Code. Notice shall atso be given to all other persons and entities required under the Code. Proof of service shall be furnished at the hearing. BY T E COURT, Thomas A. P�cey �=_;C.P�1� � Distribution List: � � ,._�, " � Robert O'Brien, Esq. � '';' `� � � Robert P. Kline, Esq. � ;�:. � F--� � r� Alice D. Ansell � �'� �� ll�.A �[� � � `�= :�'� a .�. TZ T.�� J 1�� "�t r.,,� •-� �.,� �::`� � "�'y C"� C-^.� ...! � �.. � � � � . � �, r- rn ` � o � � � � �- w : ORPHANS' COURT DIVISION . COURT OF COMMON PLEAS OF In Re: ALICE D ANSELL . CUMBERLAND COUNTY . PENNSYLVANIA . N0.21-83-0478 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 10/17/13 NDGE'S INITIALS: TAP TIME STAMP DATE: 10/17/13 IN RE: ORDER OF COURT ............................................................................................................................ SERVICE TO: ROBERT P KLINE (Alice D Ansells co�v is in his envelop�/as per Jud�es instructions-Marie)PO BOX 461 NEW CUMBERLAND PA 17070 ROBERT L.O'BRIEN 19 W SOUTH ST CARLISLE PA 17013 HEA'THER ORISKO 2132 MARKET ST CAMP HILL PA 17011 METHOD OF MAILING: ENVELOPES PROVIDED BY: �USPS �PETITIONER ��ND DELIVERBD ❑C ERK OF ORPHANS COURT a� ❑OTHER MAILED: 10/17/13 ............................................................................................................................ SERVICE TO: METHOD OF MAILING: ENVELOPES PROVIDED BY: ❑USPS ❑PETITIONER �� ❑JUDGE ❑HAND DELIVERED ❑CLERK OF ORPHANS COURT ❑OTHER MAILED: � , uty erk of Orphans' Court IN RE: ALICE D. ANSELL, �. An Alleged Incapacitated Person ��. IN THE CQURT OF COMMON PLEAS OF THE NINTH JUDICIAL DISTRICT ORPHANS' COURT DIVISIQN 21-1983-0478 IN RE: GUARDIAN AD LITEM AUTHORIZATION ORDER OF COURT AND NOW, this 23�d day of October 2013, upon inquiry to the court, the Guardian Ad Litem is empowered to authorize permission for Alice D. Ansell to participate in a scheduled CPARC trip(s) upon consultation with Cumberland/Perry Mental Health Intellectual & Developmental Disabilities (MH.IDD) and petitioner's counsel. This authority shall continue until the conclusion of the petition giving rise to the appointment of a guardian ad litem. , Thomas . Placey C.P.J. Distribution: .��,.; Robert L. O'Brien, Esq. � � � � - .� ° ,�- �,t � _.� c.�° �_� �._� � c�, Robert P. Kline, Esq. r� �y� �, --+ v� :� � - . �- N --S C� (` ' : g rw i�•( �°'r`►` �'° t..'� ;; W :.:J � Heather Orisko, Esq. � � � o � ;..� -... . .., -,� -� �.., �: s�, � � `*� �., .-.. c, . .;...� tU �..-.. '4�� F-�► V) G� � C,,��3 'Y"[ : ORPHANS'COURT DIVISION . COURT OF COMMON PLEAS OF In Re: ALICE D ANSELL : CUMBERLAND COUNTY . . PENNSYLVANIA . N0.21-83-0478 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 10/23/13 JUDGE'S INITIALS: TAP � TIME STAMP DATE: 10/23/13 IN RE: ORDER OF COURT ............................................................................................................................ SERVICE TO: ROBERT L OBRIEN 19 W SOUTH ST CARLISLE PA 17013 ROBERT P KLINE 714 BRIDGE ST NEW CUMBERLAND PA 17070 HEATHER ORISKO 2132 MARKET ST CAMP HILL PA 17011 METHOD OF MAILING: ENVELOPES PROVIDED BY: �USPS ❑PETITIONER � �� JUDGE ❑HAND DELIVERED ❑CLERK OF ORPHANS COURT ❑OTHER MAILED: 10/23/13 ............................................................................................................................ SERVICE TO: METHOD OF MAILING: ENVELOPES PROVIDED BY: aU� ❑PETITIONER ❑HAND DELIVERED ❑�GE ❑OTHER ❑CLERK OF ORPHANS COURT MAILED: , �� uty erk of Orphans'Court IN RE: ALICE D. ANSELL, �� `�� IN THE COURT OF COMMON P�EAS OF THE NINTH JUDICIAL DISTRICT ORPHANS' COURT DIVISION 21-1983-0478 . _. IN RE: PETITION FOR TERMINATION OR LIMITATION O� A GUA��JIA�i ,� PURSUANT TO 20 PA.C.S. § 5512.2 �: ° � �> � w -,; � ,;.� ��, ni � c� . .ac;� OPINION r`-' �' �, �" �,; �'' �.n..� ...,,.. ....3 � L� ;„� ,c'�,' y PLACEY, C.P.J., 23 DECEMBER 2013 `�y � -�:� °�' F`�°' �`�� ,..y ,�� --�� -�� , c._. ...:. r�;� At issue in the present case is whether Alice D. Ansell sho��d�e adju`�ica�ec�"�n _ �, -*, a permanent basis as a person with a limited incapacity and whether Dawn Swartz should be appointed as limited guardian of her person for the purposes of assisting Ms. Ansell in making complex medical decisions and in those cases when Ms. Ansell is unable, unwilling or incapable of making a life sustaining medical decision, that Ms. Swartz may do so. A hearing was held in this matter on 19 December 2013 in the Cumberland County Courthouse. Alice D. Ansell was present in the courtroom together with her court appointed counsel, Robert P. Kline, Esquire, who participated in the hearing. Also present was counsel for the Ansell family, Heather Orisko, Esquire, and many family and friends in support of Alice Ansell. Based on the evidence presented at this hearing, the following findings of fact are made: 1. Alice D. Ansell is an adult individual and domiciliary of Cumberland County, Pennsylvania, who resides in a New Cumberland group home. 1 2. Petitioner is solicitor for the Cumberland County MH/IDD. 3. The prior appointed guardians, Ms. Ansell's parents, are incapable of acting as her guardian in any meaningful capacity due to death, infirmity and or incapacity. 4. Alice D. Ansell suffers from mild mental retardation. 5. The medical evaluation, testified to at the hearing, is marked as exhibit 1 and made part of the record. 6. As a consequence of her condition, Ms. Ansell's ability to receive and evaluate information effectively and communicate decisions is notably impaired. 7. At a minimum Ms. Ansell requires skilled and educated assistance in communicating and discussing issues involving complex medical decisions. 8. The long term prognosis for improvement, at the present time, is negligible. 9. Ms. Ansell is a delightful person and is adamant about what she wants and does not want. 10. Alice D. Ansell is in need of a limited guardian of her person to assist her in making complex medical decisions and when she is unable or unwilling to make such a decision in situations involving life threatening conditions the guardian needs to be authorized to do so. 11. The duration of this necessary limited guardianship must be considered at best indefinite and practical purposes permanent. 2 . 12. The proposed guardian, Dawn Swartz who resides in Carlisle Boro, Cumberland County, and has previously worked with Ms. Ansell and continues to volunteer with Ms. Ansell. 13. Ms. Swartz has the education, training and most importantly the experience in working with Ms. Ansell to fulfill the role of guardian. 14. Ms. Swartz is an appropriate person to serve as this limited guardian of Alice D. Ansell's person and is qualified to do so under the statute. 15. The foregoing findings of fact are made on the basis of clear and convincing evidence. DISCUSSION The provisions respecting an adjudication of incapacity are contained in Title 20 Pa. C.S. § 5501 et seq. Petitioner has substantially complied with these provisions and based on the foregoing findings of fact an appropriate order appointing a limited guardian of Ms. Ansell shall be entered. Thomas A. Placey C.P.J. Distribution: Robert O'Brien, Esq. Robert P. Kline, Esq. Heather Orisko, Esq. 3 : ORPHANS' COURT DIVISION . COURT OF COMMON PLEAS OF In Re: ALICE D ANSELL . CUMBERLAND COLJNTY . PENNSYLVANIA . N0.21-83-0478 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 12/23/13 JUDGE'S INITIALS: TAP TIME STAMP DATE: 12/23/13 IN RE: OPINION ............................................................................................................................ SERVICE TO: HEATHER ORISKO 2132 MARKET STREET CAMP HILL PA 17011 ROBERT L OBRIEN 19 W SOUTH STREET CARLISLE PA 17013 ROBERT P KLINE 714 BRIDGE ST PO BOX 461 NEW CUMBERLAND PA 17070 METHOD OF MAILING: ENVELOPES PROVIDED BY: �USPS ❑PETITIONER ❑RRR ❑ JUDGE ❑HAND DELIVERED � CLERK OF ORPHANS COURT ❑ OTHER MAILED: 12/23/13 ............................................................................................................................ SERVICE TO: METHOD OF MAILING: ENVELOPES PROVIDED BY: ❑USPS ❑PETITIONER ❑RRR ❑ JUDGE ❑HAND DELIVERED ❑ CLERK OF ORPHANS COURT ❑ OTHER MAILED: _ � J Deputy Clerk of Orphans' Court "�`� IN RE: . IN THE COURT OF COMMON PLEAS OF ' . CUMBERLAND COUNTY, PENNSYLVANI�1 THE MATTER OF . THE NINTH JUDICIAL DISTRICT . ORPHANS ' COURT DIVISION ALICE D. ANSELL . 21-1983-4778 IN RE: APP4INTMENT OF LIMITED GUARDIAN ORDER OF C4URT AND NOW, this 19th day of December, 2013, upon consideration of the Petition for Termination or Limitation of a Guardian for Alice D. Ansell, following a hearing at which it is found that the prior guardians are no longer able ta serve in that capacity, and it appearing through medical testimony that Alice is in need of a limited guardian to assist her decision making for complex medical procedures, a limited guardian shall be appointed. That limited guardian ahall be Dawn Swartz, who shall assist Alice Ansell with her decision making responsibilities in instances involving complex medical procedures and in instances involving medical procedures � necessary to preserve her life where Alice is unable, unwilling, or incapacitated to make such a decision, Dawn Swartz is authorized to elevate her assistance to decision making. The Court finds that Alice suffers from mild mental retardation as a result of which the order is required. By the Court, � � � � Thomas . Placey C.P.J. � � �-- � N t� ' �. � � � � c�.-`�� Q � s �as � ��`� � � � � +.�s.+�F �Y'1 � � /��,� � � v J � '� w�4w . � `� �1 � � � �"� �.n.� L�.J � C'� � � � � � � ``�� Robert L. �O'Brien, Esquire ' 19 West South Street Carlisle, PA 17013 Robert P. Kline, Esquire 714 Bridge Street P.O. Box 461 New Cumberland, PA 17070-0461 Heather N. Orisko, Esquire 910 South George Street York, PA 17043 :mae : ORPHANS' COURT DIVISION . COURT OF COMMON PLEAS OF In Re: ALICE D ANSELL . CUMBERLAND COUNTY . PENNSYLVANIA . N0.21-83-478 CERTIFICATE OF SERVICE OF ORDER ORDER DATE: 12/19/2013 NDGE'S INITIALS: TAP TIME STAMP DATE: 12/30/13 IN RE: ORDER ............................................................................................................................ SERVICE TO: ROBERT L OBRIEN 19 WEST SOUTH ST CARLISLE PA 17013 ROBERT P KLIAIE 714 BRIDGE ST PQ BOX 461 NEW CUMBERLAND PA I7070 HEATHER N ORISKO 910 SOUTH GEORGE ST YORI�PA 17043 METHOD OF MAILING: ENVELOPES PROVIDED BY: �USPS ❑PETITIONER ❑RRR �JUDGE ❑HAND DELIVERED ❑CLERK OF ORPHANS COURT ❑OTHER MAILED:O1/02/14 ............................................................................................................................ SERVICE TO: METHOD OF MAILING: ENVELOPES PROVIDED BY: ❑USPS ❑PETITIONER ❑RRR ❑JUDGE ❑HAND DELIVERED ❑CLERK OF ORPHANS COURT ❑OTHER MAILED: � � /�� J l, e uty erk of Orphans' Court r AUTHORITY TO PAY COURT APPOINTED COUNSEL �P DEC 3 12013 1.COURT 2.VOUCHER 14661 O District Justice Common Pleas ❑ Appellate ❑ Other N--,4 3.FOR(D.J.,C.P.,APPELLATE) 4.AT(CITY/STATE) :Ell GET CODE L,19 PA _ o-Gcu 6.IN THE CASE OF 7.CHARGEIOFFENSE(PURDON CITATION) 8. D PETTY OFFENSE /A {-il a NW ❑ FELONY D MISDEMEANOR 9.PROCEEDINGS(Describe briefly) 11.PERSON REPRESENTED 12.CIVIL DOCKET NO. �^ �� `� t ❑ Defendant-Adult 02—)(Q13 �- 2 ❑ Defendant Juvenile 2) - )Cjb3 —C24'-7- P_ _ 1K 3C_- _ 3 O Appenant 13.CRIMINAL DOCKET NO. GU's'-s � �'afC 4 ❑ Apoellee 5 ❑ Habeas Petitioner 6 ❑ Material witness 7 ❑ Parolee Charged With violation 14 APPEALS DOCKET NO. 10. PERSON REPRESENTED(Full Name) a �a Probationer Charged with violation 9 Yr�Iher/��II7a-" \.__ 16.NAME OF ATTORNEY/PAYEE AND Appl Dale � t»7j MAILING ADDRESS KLINE LAW OFFICE Bridge Street Post Office Box 461 NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE New Cumberland, PA 17070 17.TELEPHONE No. 18. SOCIAL SECURITY no OREIN NO �- Z514a I 2a-,1-4 Ci 3(4 Z-11.0 CLAIM FOR SERVICES OR EXPENSES C_> = m 1g. SERVICE HOURS DATES O -AMO LAIMED a. Arraignment and/or Plea tSl -p Multlpl rater pyr times total hour I WAIT "Court' com b. Preliminary Hearing penstaUyn.Egtgr fulfil below. C Motions and Requests f" Z I--A c:T Q d Bail Hearings _� C3 O 0 e. Sentence Hearings = I. Trial r-- rV r- g. Revocation Hearings - -i N O h. Juvenile Hearings (� _1`1 i. Appeals Court 19A TOTAL IN COURT COMP. I. Other(Specify on additional sheets) (k1. b Y If OL 0 TOTAL HOURS X$66PERHOUR -$ (.p, * v50 20. a. Interviews and conferences L`V Multiply rate Per hour times total hours. Enter total"Out of Court W b. Obtaining and reviewing records 1 s Q✓ compensation below. H O 2 c Legal research and brief writing b 3 O d.Investigative and other work(Specify on additional sheets) 20A. TOTAL OUT OF COURT O O COMP.J`p TOTAL HOURS= a2.Z X$45 PER HOUR 21. ITEMIZATION OF REIMBURSABLE EXPENSES AMT. PER ITEM Mileage$a Qpermile x W3 •%moo m Please contact Court Administrator for current mileage rate = 21A TOTAL ITEMIZED EXP. 0 O `$ (tile- 0,c7 22.CERTIFICATION OF ATTORNEY/PAYEE — f 23. GRAND TOTAL CLAIMED qI Has compensation and/or reimbursement for work In this case previously been applied for? ❑ YES AT15 =$ to%z r$p It yes,were you paid? ❑ YES ❑ NO Ifyes,bywhomwere you paid? How much? Has the person represented paid any money to your knowledge anyone else,In connection with the matter for 24.DEDUCT.PRIOR PYMTS. which you were appointed to provide represents Ion? D Y if yes,give details on additio al She Is `s 1 swear or affirm the truth or correctness � f — 2 I 25:NET AMO Nl CLAIMED m of the above statements Signature of Attcey/Payee Dale :s 26.nrmovt 27.AMT.APpROLVED rnun u Signature of PAYMENT Judge Date: _$ Copy 1 -Mail to CoLvdWrininistrator at completion of service n`LA ' u. ` ROBERT P. KLINE, ESQ. k. " S t 9 December 26, 2013 Melissa Calvanelli, Court Administrator Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Alice D. Ansell Orphans Court No. 21-1983-0478 Dear Melissa: Enclosed with this letter is the Authority to Pay Court Appointed Counsel in the above-captioned matter. If you have any questions, please do not hesitate to contact me at my office. Very it rs, Robert P. Kline, Esquire RPK/srf Enclosure Y 714 Bridge Street P.O.Box 461 ... New Cumberland,PA 17070 '' (717)770-2540. (717)243-5940 Fax(717)770-2553