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Home My WebLink About02-0482 IN THE MATTER OF THE PERSON AND ESTATE OF: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA LOUIS MILLER, AN ALLEGED INCAP ACIT A TED PERSON ORPHANS' COURT DNISION NO.2I-02- 4 ~ ~l../ PETITION FOR APPOINTMENT OF PERMANENT PLENARY GUARDIANS OF THE PERSON AND ESTATE AND NOW COMES THE PETITIONER, the Area Agency on Aging, in and for Cumberland County, Peunsylvania, by its solicitor, Anthony L. DeLuca, Esquire, who represents and avers as follows: 1. The Petitioner is the Area Agency on Aging, in and for Cumberland County, Pennsylvania, with its office located at 16 West High Street, Carlisle, Cumberland County, Pennsylvania. 2. The alleged incapacitated person is Louis Miller, age 70, who currently resides at ManorCare Health Services, 940 Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania, since April 10, 2002. 3. The following are the known relatives of the alleged incapacitated person: Jeff Miller - Son 1303 N. Galloway Ave. Mesquite, Texas 75149 Marlin Miller - Brother 368 South Street Wellsville, PA 17365 George Miller - Brother 4319 Long Drive Harrisburg, P A 17112 Angie Miller - Niece 128 N. Beavercreek Road Dillsburg, P A 17019 4. On April 8, 2002, the Petitioner, through it's authorized representatives, visited Louis Miller at the Salvation Army in Carlisle, Pennsylvania and made the following observations: a. He was disheveled and unkempt in appearance; b. He had poor personal hygiene; c. He was eating in a ravenous manner; d. He appeared malnourished; e. His gait was unsteady; and f. He needed help with bathing, dressing, and grooming. 5. On or about April 1 0,2002, the Petitioner, through it's authorized representatives, again visited Mr. Miller at the Salvation Army in Carlisle, Pennsylvania and observed that: a. There was a large infected area on his right hand; and b. There was mental impairment in that he had little recollection of the time period from March 28, 2002 when he walked away from the Lakeview Estates Personal Care Home until April 7, 2002 when he arrived at the home of a friend in Carlisle, Pennsylvania. 6. Louis Miller has, for at least three (3) months, been incapable of managing and caring for himself and his financial affairs. 7. Louis Miller exhibits symptoms of mental incapacity, including but not limited to dementia of mixed etiology, both vascular and alcohol. 8. Louis Miller's mental incapacity prevents him from managing and caring for the affairs of his person and estate. 9. On April 12, 2002, a psychiatric evaluation was conducted ofMr. Miller by David Rosenthal, M.D. who concluded that he believed Mr. Miller was not competent to participate in care/placement decisions due to diminished judgment capacity. 10. The Office of Aging, in and for Dauphin County, Pennsylvania, completed an Options assessment of Louis Miller on September 12, 2001 to determine the level of care required for him. II. The Options assessment reflected the following: a. That he has word finding difficulty; b. Short and long term memory problems; and c. Impaired judgment in decision making skills. 12. The Options assessment further reflected that Mr. Miller suffers from various physical problems including: a. A-fibrillation; b. Hypertension; c. Hypothyroidism; d. Cancer of the tongue which renders his speech unintelligible; e. History of alcohol abuse; and f. History of CV A with right sided weakness. 13. On April 18, 2002, Mr. Miller allegedly choked on oatmeal and turned blue before he was revived by the Heimlich method. 14. On May 9,2002, a nursing facility options assessment was completed by Petitioner and nursing home care was recommended because: a. He has a diagnosis of dementia; b. He has moderate cognitive impairment; c. He has a history of alcohol abuse; d. He has a history of elopement from facility where he has been staying; e. He has a history of tongue cancer with garbled speech; and f. He is on a pureed diet due to potential for choking and aspiration. 15. Less restrictive alternatives are not available because there is no one able to care for him. 16 Petitioner believes and, therefore, avers that Louis Miller has no estate except for his monthly social security of $845.00. 17. Petitioner is willing to accept the appointment of Permanent Plenary Guardians of the Person and Estate of Louis Miller. 18. The nature of Petitioner's interest is that ofa welfare agency. 19. Petitioner has no interest that is adverse to the alleged incapacitated person. 20. To Petitioner's knowledge, no previous application has been made for the Order herein requested or for a similar Order. 21. No other Court has ever assumed jurisdiction in any proceeding to determine the incapacity of Louis Miller. 22. The failure to appoint Petitioner as Permanent Plenary Guardians of the Person and Estate of Louis Miller will result in irreparable harm to the person and estate of Louis Miller. WHEREFORE, Petitioner prays that this Honorable Court appoint Petitioner as Permanent Plenary Guardians of the Person and Estate of Louis Miller. Respectfully Submitted, . Q ~r~~!!Le~ Anthony L. Detica, Esquire 113 Front Street P.O. Box 358 Boiling Springs, P A 17007 (717) 258-6844 VERIFICATION I hereby verify that the facts and information set forth in the foregoing Petition for Appointment of Permanent Plenary Guardians of the Person and Estate of Louis Miller are true and correct to the best of my knowledge, information, and belief. I understand that any false statements contained herein are subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. 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" MAY 1 6 IOO? b ent By: CUMB CO OFFICE OF AGING o~ TOrry DELUCA At: 92583902 . 7172406118 i Jun-4-0211:26AMi Page 1 .I~'::!JJI!?: _ Iq.__~s...t.,.o."'~ ~..".,... -(h".,.,.. SUMMIT HEALTH 8EHAVlORALHEALTHSERV~ES OEROPSYCHIA TRY CONSULTATION SERVICE 6l3"l~ ~ 2-30'- 3'.J:c. PI "I Date &. Time:" Case: Resident: lOUlb 1L.':'E~ ,Alteqding-Physician:____ Clinician:..,J)'f, ..s~t v..=aP~"ncrI:rR'~iC'N 0 Facility: MANOR. ARE. !Mh..ill< Platl ~Iew 0 Di"lP'O$i.: ' Initial g./"" R.oom1/- ~l.~. cld ~ ~ ~ <Z"uo..., t ~ y Q..; !.J I <:T'fV> ~ ""'" "f~ Q; f'f' ' t ~ l qd;- 0... Q...~.k!L..d -V M'\'> \: ov ':t . t"0Y>-- )1,~~ ~ """~W<.""'o...- ~~ ..0" ~~ . ^-i. ~ ~ pa-t'i ~ _ JCi; 'f ...tU.....-oJl9.-, c\ . -43 \-b",\:: 'r'./.2.~~ ~~Gv':j ~ :fCl..,);.r\.r;:n.J..- d.~.....~ ~ ~i (]V ~ _ oS- u... V ~.opi to...Q..i - ~I en-.- . \ ~ .' d ~ G..d f...'NV' ~ cry......... ./"'('t-..l.. '.~ .<'-'-~ A u-\.-, o-.'C ....., I. 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U:J-" (J ,A\\,a..C"tI ~\ '>>-<;\\cU'~; .~d ok, CJf-.--' .-.:1 V~Q'Ycr\ c:L\..:n-- 0) ~"f'.-/ ~ Cl'vN ~ F \ .R.I.....k oJ:.: ~:t-e<> ~ ro..v.... ~ . clJ2J~\~ , -1)IO"dl-....>;:;v.:)v\ Ax... A)<.y, M" ,.A.I-A I;~ ?CVv ~ ~C"l'--Qn..~, '- ~ "- . .~ A-a.-... ~,~l::w",,- ~ Gi..u- ---- ---- ---- .-- --' f~~'- '14- (Clinic SlgDature) WfI~ C"'-':'!:"! - F.cl!!!y R~~~ ~!!n~ Copy - !h~~~!!' n!~o~,;a;rt ~n~~~ :!.e!:!"~ _ (O,)J9'.Il;4199) on/en '.1 '00 iil/.:l ~ ~t;60 3fll zoOZ-to-Nnr . IN RE: LOUIS MILLER AN ALLEGED INCAPACITATED PERSON IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-2002-0482 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 rights will be affected, including our right to manage money and property and to make decisions. A copy of the petition which has been filed by AREA AGENCY OF AGING is attached. You are hereby ordered to appear at a hearing to be held in Court Room NO.2, Cumberland County Courthouse, Carlisle, Pennsylvania, on JUNE 6 ,2002, at 11 :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 hearing, you have the right to appear, to be represented by an attorney, and to request ajury trial. If you do not have an attorney, you have the right 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 right 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. B~: ~ Qh Cle 0 Cumbe nd County, Carlisle, PAl My Commission Expires 151 Monday, January, 2006 IN THE MATTER OF THE PERSON AND ESTATE OF: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA LOUIS MILLER, AN ALLEGED INCAPACITATED PERSON ORPHANS' COURT DIVISION NO.21-02- 'tia cn AnON TO THE ALLEGED !NCAP Acn A TED PERSON To: LOUIS MILLER: We command you to appear at a hearing in the Orphans' Court of Cumberland County, to be held in Courtroom No. s of the Cumberland County Courthouse, on :r~" , 2002, at ,,:~ 0 o'c1ockL.M.,to show cause why you should not be adjudged an incapacitated person and a Guardian appointed for your person and estate. Edward E. Guido, J. :",.) ~, s=> .,.-' -'~ IN THE MATTER OF THE PERSON AND ESTATE OF: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA LOUIS MILLER, AN ALLEGED INCAPACITATED PERSON ORPHANS' COURT DIVISION NO.21-02- 4 ~ 1,\ PRELIMINARY DECREE AND NOW, this/&-thdaYOf !J7/iY ,2002, upon consideration of the annexed Petition, it is hereby ORDERED AND DECREED that a Hearing on this matter is set for the to -M day of ULlIU l.. ,2002, at II: ..30 ----4.... M. O'clock in Courtroom No. 5' at the Cumberland County Courthouse, 1 Courthouse Square, Carlisle, Pennsylvania. Lindsay D. Baird, Esquire is appointed to represent the allegedly incapacitated person. Edward E. Guido J. (,! P .... ....-.~ c IN THE MATTER OF THE PERSON AND ESTATE OF: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA LOUIS MILLER, AN ALLEGED INCAPACITATED PERSON ORPHANS' COURT DIVISION NO. 21-02-482 ORDER OF COURT AND NOW, this 6th day of June, 2002, after hearing, we find Louis Miller to be an incapacitated person. The Area Office of Aging, in and for the Cumberland County, Pennsylvania, is hereby appointed as permanent plenary guardian of the person and estate of Louis Miller, the incapacitated person. By the Court, Edward E. Guido, J. Anthony L. DeLuca, Esquire For the petitioner 1t " ~l AUTHORITY TO PAY COURT APPOINTED COUNSEL ~b FES 0 4 200SY' ,. COURT 2. VOU1'!2R - o District Justice o Common Pleas o Appellate o Other ! 7914 ~ 3. FOR (OJ. C.P.. APPELLATE) 4. AT (CITY/STATE) 5. BUDGET CODE /'\ /"0 / 1t1J- /.~7;)f /).'/4().:J-1./ Pi) a.IN THE ~FAId&.f HJ"5a1"CS~~ 7. CHARGE/OFFENSE (PURDON CITATION) 8. 0 PETTY OFFENSE , J /-'u I ~ /Yh. //t y- O FELONY 0 MISDEMEANOR 9. PROCEEDINGS (Describe briefly) 1 1. PE~ON REPRESENTED 12. CIVIL DOCKET G' ~ /~~a.t:'.~ atb?-d/ 111 ?11.LY' IY/ IJ PJ I Oelendant - Adult {Jr;OA4r"~; tj"'l 2 0 Defendant. Juvenile all.- ()~ - </?2 3 0 Appellalll 13. CRIMINAL DOCKET NO. 1-1?W1. a C(CJvL~'T 4 0 Appellee 5 0 Habeas Pelitioner 6 0 Material W.tness 7 0 Parolee Charged With Violation 10. PERSON REPRESENTED (Full Name) 8 0 Probationer Charged With Violation 14. APPEALS DOCKET NO. J (/'U /5 /YJ III~ ;/ 9 0 Other: ~- j {J '-(J"j., 1 6. NAME OF ATTORNEY/PAYEE AND Appt Dale MAIL/NG ADDRESS ,J ~l<lcJ Lindsay Dare Baird 37 South Hanover Street NAME OF COMMON PLEAS JUI:1GE ASSIGNED TO CASE Carlisle, PA 17013-3307 ~/OJl.,_~ 17. TELEPHONE No. 11 a. SOCIAL SEClJl:lttlY NO OR E IN NO 01-"/:1 - 57 3.:>. : c/'9? ";jJW . <fjq..<J CLAIM FOR SERVICES OR EXPENSES 'J :.-", ....... ;' 19. SERVICE HOURS DATES . 'cAMOUfilllS CLclilPw-fEO:) a. Arraignment and/or Plea Mt!/tlp~ rate l?!!' hour timest~lal b. Preliminary Hearing hoot. ,to obtain "In Court" cern- Pifnlfafion. Enter tota/bEt.'ow,' c. Motions and Requests . . .- d. Bail Hearings . _.--~j ce ..."...- " :;) e. Sentence Hearings o. "u._j"") 0 f\,) U I. Trial CO ~ g. Revocation Hearings h. Juvenile Hearings i. Appeals Court 19A TOTAL IN COURT COMPo ~ Other (Specify on additional sheets) TOTAL HOURS '" X $50 PER HOUR =$ 20. a Interviews and conferences iVA J. n..iI/" 1" 7 u U., " ?5" \./ttrl /7-.2/ '(lS- Multiply rate per hour times total b. Obtaining and reviewing recor6s r .5l> Ah I ,,~ hours. Enter total "Out of Court" ...... , compensation below. Oce c. Legal research and brief writing /Yl.fmtJ Ie l / A.dtJL >> ~/) Fl"6 <./ tJ,j- .-:::l :::l0 d. Investigative and other work (Specify on additional sheelS) V 20A TOTAL OUT OF COURT OU COMPo I '7S- .~~RHOUR '"'$ '/ F. -7 ~ - TOTAL HOURS- 21. ITEMIZATION OF REIMBURSABLE EXPENSES AMT. PER ITEM MileaQe $.25 per mile x ce w J: 21A TOTAL ITEMIZED EXP. ... 0 -$ 22. CERTIFICATION OF ATTORNEY/PAYEE ~( 23. GRAND TOTAL CLAIMED Has compensation and/or reimbu~ent for work In thla case prevloualy been applied for? 0 YES NO -$ ?t. 7~- If yes. were you paid? 0 YES NO If yes. by whom _re you paid? How much? Has the person repre~ented paid money to you, or to your know~e anyone els.e. In co~nection ~i~h the matter for 24. DEDUCT. PRtOR PYMTS. which you w~re appointed to provide representation? 0 YES 0 If ye~ ~SraddltlOnal ~he~ts .... "'$ I swear or affirm the truth or correctness .' lJ -L.;. d V 0 ) 25. NET AM~JPLAIMEJ?- of the above statements Signature ot Attomfly/Pay"U' Date =$ . 7~ 26 A"""OVl~1 . ~~ ~ . Date: J/t~ 'j/ 27. ':M;. AP?Ai. 7)' . FOil S.gnalure of PAYMEN' Judge Co 1 - Mail rc; Co~mjnlstrator at completion of service v py \\t '<I"- . ! /J ') /-I{/! ,;-.Md-'!.~'~ QTumbtrlanll QTnuntu OOffitt nf Aging & QTnmmunitu ~truittli " "- HUMAN SERVICES BUILDING 16 West High Street, Carlisle, PA 17013 [717] 240-6110 or 697-0371, Ext. 6110 532-7286, Ext. 6110 Fax: 240-6118 website: www.ccoa.net/al!im! e-mail: 8!!inl!IlVCcoa.net July 11,2003 NancYc1a~~;~ Earl R. Keller Vice Chairman Richard L. Rovegno Secretary John F. Connolly ChIef Clerk Dennis R. Marion County AdminiSlrafOr Tenv L. Barley . Director ANNUAL GUARDIANSHIP REPORT FOR LOUIS MILLER Report from Guardia~ of Person: Cumberland County Ofl'i6e:4-Aging Janet E. Paull, Aging Care Manager II On June 2, 2003, Guardianship of Person for Louis Miller was granted by Judge Edward E. Guido to the Cumberland County Office of Aging. At the time of the appointment, client resided at the Manor Care Health Services, Carlisle, Pennsylvania. He had been placed there under a Temporary Protective Order signed on April! 0, 2002 by Judge Guido. Following the Guardianship hearing, Mr. Miller returned to the Manor Care Facility. Upon admission to ManorCare, client was diagnosed with dementia with moderate cognitive impairment, history of alcohol abuse, history of tongue cancer, malignancy of head and neck with a resection done in !993, hypothyroidism. He was also a high risk for elopement since he had eloped from several facilities in the past. During the next few months, there were several times when the client wandered from the facility. Client did not get far from the facility during any of these times. The facility tried several different approaches including increased supervision, Wanderguard bracelet, and increased supervised trips outside the facility. During this period oftime, Mr. Miller expressed his desire to be placed in a veterans' home. Mr. Miller was a veteran of the Korean War and it was believed that he would be happier and less likely to wander ifhe were in such a facility where there are more men with whom he could socialize. The Office of Aging completed the application process and Mr. Miller was placed on the waiting list at the five state veterans' homes. On January 14,2003 Mr. Miller was admitted to the Hollidaysburg Veterans Home in Blair County, Pennsylvania. Mr. Miller was taken there by two Aging Care Managers from the Cumberland County Office of Aging. Prior to his admission to Hollidaysburg Veterans Home, he was visited regularly by a representative of the Office of Aging. Since his move, we have been in telephone contact Celebrating 30 Years of Service to Cumberland County's Seniors 1973 - 2003 ;.. - with Hollidaysburg Home personnel. In February, Mr. Miller was moved from the Nursing section to the Personal Care section of the Home. In speaking with his social worker last month, I was advised that Mr. Miller has adjusted very well. There have been no episodes of elopement or even any attempts. Nor have there been any episodes of alcohol consumption. In May client was admitted to the hospital for bronchitis and to rule out pneumonia. He was only in overnight. On July II, 2003 a representative of the Area Agency on Aging for Blair County, Blair Senior Services, visited the client on our behalf. She reviewed his medical chart and reported the following information. He was seen by a psychiatrist on February after client reported feelings of depression. The physician provided a diagnosis of depression and prescribed a medication. Staff has reported that the medication seems beneficial to him. He has also received a new upper denture. Client expressed an interest in stopping his smoking and has received an order to attend smoking cessation meetings. The chart reflects no behavioral problems at present. He is described as responding appropriately, quiet, keeps to self, does not socialize much with others but is friendly but occasionally agitated and irritable. The Hollidaysburg Veterans Home had demonstrated an adequate quality of care for Mr. Miller by managing his daily needs and continuously monitoring his medical problems. Therefore, we believe that Mr. Miller should continue to reside in the Hollidaysburg Veterans Home. As a result of the success of this relocation, the Cumberland County Office of Aging is in the process of requesting the Guardianship of Person be transferred to the Blair County Senior Services. Ji!tl;?- /Ir/S arumbtrlanb arnuntl1 (@ffitt nf i\ging &: arnmmunitl1 ~truitts <!.. ~ HUMAN SERVICES BUILDING 16 West High Street, Carlisle, PA 17013 [717] 240-6110 or 697-0371, Ext. 6110 532-7286, Ex!. 6110 Fax: 240-6118 website: www.ccoa.net/al!inl! e-mail: 8Qinrr({Uccoa.net ANNUAL GUARDIANSHIP REPORT FOR LOUIS MILLER Nancy A. Besch ChOlrman July 11, 2003 EarlR. Keller Vice Chairman Richard L. Rovelmo SecreTary John F. Connolly ChlefCldk OennisR.Marion County Administrator TerryL. Barley DIrector Report from Guardian 9fEstate: \ Cumberland County Offi~e'OfAging Janet E. Paull, Aging Care Manager II On June 2, 2003, Guardianship of Person for Louis Miller was granted by Judge Edward E. Guido to the Cumberland County Office of Aging. At the time of the appointment, client resided at the Manor Care Health Services, Carlisle, Pennsylvania. He had been placed there under a Temporary Protective Order signed on April 10, 2002 by Judge Guido. Following the Guardianship hearing, Mr. Miller returned to the Manor Care Health Services. A checking account was opened at the Orrstown Bank, where client had a previous account. Mr. Miller currently receives Social Security of $791.00. An accounting of this checking account is attached to this report. Prior to Mr. Miller's admission to the Hollidaysburg Veterans Home, the Cumberland County Office of Aging began the application process for veteran's benefits. These benefits began in May and he receives $1156 on a monthly basis. Ofthis amount, $616 goes to the Veterans Home. Since receiving the veterans payment, the amount due out of the social security to the home was reduced to $435.20 per month. Mr. Miller also received a check from the Veterans Administration making retroactive payment of $17,880.40. These funds are being held in his Members Fund at the Hollidaysburg Veterans Home and are used for his use and to meet his needs. A report ofthis account is also enclosed. i".....J Celebrating 30 Years of SeNice to Cumberland County's Seniors 1973 - 2003 ,.. 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'" "" " W H OJ "'0 <<: '" ~ ~ '" ~ ~ "' {j -lJ c< C W M :fi :fi ..0 "M "..-t O~ '" :;, :< H "jE-1 Z <"l 0 '" '" '" ~ '" '" 0 '" " '" '" '" ~ W C '" '" ..... .g ..... ..... c< "" u'l '" c< ... 'M '" '" ..... " '" ..... '- '" W '" '" '" ~ '" IN THE MATTER OF THE PERSON AND ESTATE OF: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA LOUIS MILLER, AN ALLEGED INCAP ACIT ATED PERSON ORPHANS' COURT DIVISION NO. 21-02-482 PETITION FOR TRANSFER OF GUARDIANSHIP AND NOW COMES THE PETITIONER, the Area Agency on Aging, in and for Cumberland County, Pennsylvania, by its solicitor, Anthony L. DeLuca, Esquire, who represents and avers as follows: 1. The Petitioner is the Area Agency on Aging, in and for CumbtRl;lIld County, - d Pennsylvania, with its office located at 16 West High Street, Carlisle, 'Cumberl~d County, Pennsylvania. , DJ 2. ;"J The incapacitated person is Louis Miller, age 71, who currently resides ib)the personal care section of The Hollidaysburg Veterans Home in Hollidaysburg, Blair County, Pennsylvania and has resided there since January 14, 2003. 3. On June 6, 2002, after a hearing, Louis Miller was determined to be an incapacitated person and the Petitioner, The Area Agency on Aging, in and for Cumberland County, Pennsylvania was appointed Permanent Plenary Guardian of the Person and Estate of Louis Miller. A copy of the Order of Court is attached hereto, marked as "Exhibit "A", and incorporated herein by reference. 4. After the Petitioner was appointed Permanent Plenary Guardian of the Person and Estate of Louis Miller, he was placed in the ManorCare Health Services Facility at 940 Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania. 5. Mr. Miller, a Veteran of the Korean War, often expressed an interest in being placed in a Veterans Home. The Petitioner subsequently filed an application for placement in one ofthe state's Veterans Homes. 6. On January 14, 2003, Mr. Miller was transported to The Hollidaysburg Veterans Home in Hollidaysburg, Blair County, Pennsylvania. 7. Prior to the transfer, the Petitioner contacted David M. Slat, the Executive Director of Blair Senior Services, Inc., in Blair County, Pennsylvania, a Guardian support agency as defined at 20 Pa. C.S. 95551, et. seq., and he advised that Blair Senior Services, Inc. would accept the appoint as Permanent Plenary Guardian of the Person and Estate of Louis Miller succeeding the Cumberland County Office of Aging in this capacity. A copy of the Acceptance by Proposed Successor Guardian is attached hereto, marked as Exhibit "B", and incorporated herein by reference. 8. Lindsay Dare Baird, Esquire, who was appointed to represent Louis Miller at the Guardianship Hearing, has been contacted regarding this Petition and voices no objection I to the Guardianship being transferred to Blair Senior Services, Inc., 1320 12th Avenue, Altoona, Blair County, Pennsylvania 1660 l. WHEREFORE, Petitioner respectfully requests that this Honorable Court enter an Order terminating the appointment of The Area Agency of Aging, in and for Cumberland County, Pennsylvania as Permanent Plenary Guardians of the Person and Estate of Louis MiIIer and appoint a Successor Guardian, Blair Senior Services, Inc., as Permanent Plenary Guardian of the Person and Estate of Louis MiIIer, the incapacitated person. All Guardian fees shall be paid by the Guardian of the Estate of Louis MiIIer, an incapacitated person. Guardian fees shall be based on the then current fee schedule of Blair Senior Services, Inc., for the type of services involved. Respectfully submitted, 17007 VERIFICATION I hereby verify that the facts and information set forth in the foregoing Petition for Transfer of Guardianship are true and correct to the best of my knowledge, information, and belief. I understand that any false statements contained herein are subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. Dated: ~u'iilld '-I &bO 5:. , ~) ((,\i\.Ll- -=2o-.u..Q.Q Janet Paull -, .~.. ',- ,~......,,- IN THE MATTER OF THE PERSON AND ESTATE OF: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA LOUIS MILLER, AN ALLEGED INCAPACITATED PERSON ORPHANS' COURT DIVISION NO. 21-02-482 ORDER OF COURT AND NOW, this 6th day of June, 2002, after hearing, we find Louis Miller to be an incapacitated person. The Area Office of Aging, in and for the Cumberland County, Pennsylvania, is hereby appointed as permanent plenary guardian of the person and estate of Louis Miller, the incapacitated person. By the Court, Edward E. Guido, J. ".>> /0' ... Anthony L. DeLuca, Esquire For the Petitioner 1t EXHIBIT "A" ------ IN RE: lOUIS B. MillER, an incapacitated person :IN THE COURT OF COMMON PLEAS OF :CUMBERlAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Case No.: ACCEPTANCE BY PROPOSED SUCCESSOR GUARDIAN I, David M. Slat, Executive Director of Blair Senior Services, Inc., certify that I am over 21 years of age and a natural born citizen of the United States. Furthermore, I am able to speak, read and writ6 the English language. Blair Senior Services, Inc., is a guardianship support agency as defined at 20 Pa. C.S. S 5551, et. seq., with offices at 1320 12th Avenue, Altoona, Blair County, Pennsylvania 16601. Neither I nor Blair Senior Services, I nc. has any interest adverse to the incapacitated person, louis Miller. I hereby accept on behalf of Blair Senior Services, Inc. the appointment as plenary guardian of the person and estate of louis B. Miller, succeeding Cumberland County Office of Aging in this capacity. BLAIR SENIOR SERVICES, INC. By: ~O~~~ David M. Slat, Executive Director Sworn to and subscribed before me this ,2003. Notartal Seal Brenda J. Carothers, Notary Public City of A1toona, Blair COUflly My COmmission expires Aug. 12, 2006 M8lTlIler, PennsylvamaAssocialionofNotartas EXHIBIT "B" AUG 1 1 Z003 'i 0/ H Z U) ",; Z ",; :> 0 r.. [il ..:I U) 0 0 ~ <( ..:I >< ~ [il [il I)., U) [il 8 ~ 0 U Z Z I)., ",; [il ~ :> "- Z Z 0 8 r.. 0 0 0 [il H [il H U) ...I 0 :;: I)., U) :I: U Z 0 llJ ;1:t- '" :;: H 8 ",; ",; Z 0 :3lli",< 0 -:> I)., ~ ",; I-IILOa.. U ><H r.. ",; 8 <2: t;j ('I"J (I)' 80 0 U I)., ...I >-I-x,-, r.. Z .. Z ~ H LJJzijl;!; 0 ::> 8 ~ r.. _H 0 :I: >- Z 0 . a: o ~ N [il 0 ~ r.. U) a: a: o a.. 8 U ::> <Xl 8 [il 0 Z Z Ou.a.:<n p:: 0 .... 8[il ..:I [il Z ",; 0 ~'" CJ ~ z ::> o u I "';8 ..:I t!) 0 H I <(...... :J 0 Z N :;:",; H 0 H 0 is u ",; - 0 8 :;: [il 8 ~ f- eo ..:I U) I [ilU) ..:IZ H ",; Z ~ ~ Z ~ :I:[il U) ..:10 8 ::> <( :I: [il ",; N 8 H r<U) [il t!) 8 i1l :I: 0 ::> ~ I)., ;:;: I)., ZZ 0 2;[il Z ::>~ 0 H"'; ,..:I "';1)., AUTHORITY TO PAY COURT APPOINTED COUNSEL 1. COURT 2. VO~UTCHER _ N~ ! 5 5 6 6 ^ District Justice ^ Common Pleas ^ Appellate ^ Other 3. FOR (D.J., C.P., APPELLATE) 4. AT (CITY/STATE) OGET CODE 5. B ~ / C~- --- lr+~~~ t _ 6. IN THE tC"Pl~! /frso» ' S 7. CHARGE/OFFENSE (PURDON CITATION) 8. ^ PETTY OFFENSE % I ~ ~ ^ FELONY ^ MISDEMEANOR 9. PROCEEDINGS (Describe briefly) 11. PERSON REPRESENTED 12. CIVIL DOCK11ET NO. ®r~9/~ - ~ 1 ~/ ~ ' ~ 1 ^ Defendant-Adult 2 ^ Defendant • Juvenile p~~~ ©c~ ' ~a .~...~ ~,~ ~ C y / f7 ~a~~~} [~l L /~ 0 t 3 O Appellant 4 ^ ADPellee 13. CRIMINAL DOCKET NO. ' C S ^ Habeas Petitioner ~ / J! ~ ~,( GL 7 ~~ Q ~j lQ ~/ ~ 6 ^ Material Witness ~ 10. PERSON REPRESENTED (Full Name) 7 O Parolee Charged With Violation e ^ Probationer Charged with violation 14. APPEALS DOCKET NO. 9 ^ ONec ~/ ~~ ~` i 6. NAME OF ATTORNEY/PAYEE AND MAILING ADDRESS Appt Date ~ /~ '~ ~`~` ~ Lindsay Dare Baird 37 South Hanover Street NAME OF COMMON LE. JUDGE ASSIGNED TO CASE Carlisle, PA 17013-3307 17. TELEPHONE No. 18. soc~a~secuartvr,o oREuvrvo CLAIM FOR SERVICES OR EXPENSES t9 SERVICE HOUP.S GATES AMOUNTS CLAIMED . a. Arraignment and/or Plea Multiply rate per hour times total hours to obtain "in Court" com- b. Preliminary Hearing pensation. Enter total below. G Motions and Requests d. Bail Hearings ~ O a. Sentence Hearings V f. Trial 2 g. Revocation Hearings h. Juvenile Hearings i. Appeals Court 190. TOTAL IN COURT COMP. 6 Other (Specify on additional aheets- ,/ ~6`Z{ ~ ~ j ' G ~--- TOTAL HOURS = ~ ~ ,KS+B ~ER HOUR - $ ~ ~• , S 20. a. Interviews and conferences ~ / rj ~ -2.~ Multiply rate per hour times total t of Co h r Ent r tot l "O rt" b. Obtaining and reviewing records ,~ ,mil 5 (J " ~~' G'Z-- u u ou s. e a compensation below. LL O ¢ c Legal research and brief writing ~ O d. Investigative and other work (Specify on additional sheets) 200. TOTAL OUT OF COURT O U COMP. TOTAL HOURS = '` /:oCJ it'SaQ ER HOUR $ ~~ , ~ S 21. ITEMIZATION OF REIMBURSABLE EXPENSES AMT. PER ITEM Miles a $.25 r mile x w 2 21 A. TOTAL ITEMIZED EXP. O a$ 22. CERTIFICATION OF ATTORNEY/PAYEE , Has compensation and/or reimbu ment for work in this case previously been applied fort ^ YES ~NO iii1//~~ 23. GRAND TOTAL CLAIMED = $ ~ ~ G~ Ifyes.wereyoupaid? ^ YES ~NO Ityes.bywhomvvereyoupaid? How much? 24. DEDUCT. PRIOR PYMTS. Has the person represented psi any money to you, or to your know a anyone else, in connection with the matter for $ = a de ails on additional sheets resentation? OYES NO If es id r i d t t , n o prov e ep e which you were appo ~- k •!J L- ~ ~ T CLAIMED NET MO = ~ I swear or affirm the truth or correctness ~ 25. A U /Peyee Oate of the above statements Signature : $ . r ~~ 26.nPPFIOVEl7 Signature Of F (1N ,Date: 27. A=MT. APPRO~ $ aAVMENt Judge ~ Copy 1 -Mail to Court Administrator at completion of service '. IN THE MATTER OF THE PERSON AND ESTATE OF: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA LOUIS MILLER, AN ALLEGED INCAP ACIT A TED PERSON ORPHANS' COURT DIVISION NO. 21-02-482 ORDFR if\. AND NOW, to wit, this,l day of August, 2003, after reviewing the Petition for Transfer of Guardianship, it is Ordered and Decreed that the Appointment of the Area Agency on Aging, in and for Cumberland County, Pennsylvania as Permanent Plenary Guardian of the Person and Estate of Louis Miller, an incapacitated person, is terminated and Blair Senior Services, Inc., a guardian support agency as defined at 20 Pa. C.S. 95551, et seq., with offices at 1320 12th Avenue, Altoona, Blair County, Pennsylvania 16601, is appointed as Permanent Plenary Guardian of the Person and Estate of Louis Miller, an incapacitated person. All guardian fees shall be paid by the guardian of the Estate of Louis Miller, an incapacitated person. Guardian fees shall be based on the then current fee schedule of Blair Senior Services, Inc., for the type of services involved. (',I ~~ ~---' BY THE COURT: ) C~ Edward E. Guido, J. f.....-i ~ Anthony L. DeLuca, Esquire For the Petitioner Lindsay Dare Baird, Esquire For Louis Miller IN RE: Louis W. Miller an alleged incapacitated person : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, : PENNSYLVANIA : Case No. 21-02-482 INITIAL INVENTORY I, the undersigned, guardian of the estate of Louis W. Miller, an incompetent, on oath state that to the best of my knowledge and belief, the following is a complete and accurate inventory of all property owned by the ward at the time of my appointment as such fiduciary, and that the amount set opposite each item of property is the fair market value thereof at the time it came under my control as such fiduciary. Legal Description and Extent of the Ward's Interest Real Estate Encumbrances, Liens, Etc., and Respective Amounts Thereof Net Value None known None Known $0.00 Total Net Value of Real Estate None Description Real Property Encumbrances, Liens, Etc., and Respective Amounts Thereof Net Value Clothing (See Attachment) None Known $100.00 Total Real Property $100.00 Intancible Personal Property [List .separately in detail: cash on hand; money on deposit, stating names and addresses of depositories; bonds, stating names of issuers, interest rates, classes, maturity dates, serial numbers, face amounts, and dates to which interest is paid; corporate stocks, stating certificate numbers, names of issuers, classes, and number of shares; notes receivable, stating the names and addresses of makers, dates, amounts, interest rates, and dates to which interest paid, balances due, maturities, and security, if any; accounts receivable, stating names of debtors, dates of last items and balances due; and other intangibles, describing in detail. ] Cash on Hand: None Known Money on deposit, stating names and addresses of depositories: Checking Account: On 08/13/2003, Louis W. Miller held a checking account with Orrstown Bank, 77 East King Street, Shippensburg, Pa. 17257. The account was titled Louis W. Miller C/O Cumberland County Office of Aging, account number 108006186. The account was maintained by the Cumberland County Office of Aging as a depository for Mr. Miller's Social Security benefits. Cumberland County Office of Aging closed this account on 09/23/2003 and returned the balance of conserve funds totaling $1,903.80, to the Social Security Administration as per their directive. On 10/0812003, Blair Senior Services, Inc. established a checking account for Louis W. Miller with Citizens Bank, 2035 Broad Avenue, AItoona, Pa 16601. The account is titled Blair Senior Services, Inc. Consumer Escrow Account. Mr. Miller's Social Security benefit is being direct deposited into this account. The account balance as of 11/25/2003 is $3,170.05 Savings Account: On 08/13/2003, Louis W. Miller held a savings account through the Hollidaysburg Veteran's Home Member's Fund at Omega Bank, 224 Allegheny Street, Hollidaysburg, Pa 16648. Mr. Miller's V A benefit is being direct deposited into this account. Mr. Miller's account balance as of 08/13/2003 was $13,649.09. The account balance as of 11/25/03 is $12,479.49. Certificate of Deposit: None Known Bonds, stating names of issuers, interest rates, classes, maturity dates, serial numbers, face amounts, and dates to which interest is paid; None Known Corporate stocks, stating certificate numbers, names of issuers, classes, and number of shares; None Known Notes receivable, stating the names and addresses of makers, dates, amounts, interests rates, and dates to which interest paid, balances due, maturities, and security, if any; accounts receivable, stating names of debtors, dates of last items and balances due; None Known Other intangibles, describing in detail. None Known Total Intangible Personal Property as of 08/13/2003 $15,552.89 Summary Total Real Estate Total Real Property Total Intangible Personal Property None $ 100.00 $ 15,552.89 Total Estate $ 15,652.89 The undersigned is not indebted or obligated to the ward except as stated herein. Dated: 11/;;')/ d.oo3 , . ~1~~ Ignature] - Blair Senior Services, Inc. Louis W. Miller 1320 12th Avenue Hollidaysburg Veterans Home Altoona, PA 16601 POBox319 Hollidaysburg, Pa. 16648 Inventorv List RoomILocation Descrintion Value 3 Coats $15.00 1 Gloves (pair) $0.50 6 Hats $6.00 2 Paiamas $2.00 31 Shirts $31.00 3 Shoes (pair) $3.00 1 Shnners (pair) $0.50 2 Belts $.50 I Sweater $1.00 5 Trousers $10.00 12 Undershirts $6.00 9 Underwear $4.50 I Box ofM;iscellaneous Personal Items $20.00 Total $100.00 ~) 1-.' 1-' 1-' 1-' 1--.' 1-\ 1-' N N N N N ,~ --------- --------- "----- --------- --------- .......... .......... --------- .......... .......... .......... 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U/- {J;J-I/f/.} <!tumbtrlanb <!tountll (@ffitt of .Aging &= <!tommunitll ~truitts Q, HUMAN SERVICES BUILDING 16 West High Street, Carlisle, PA 17013 1717[240-6110 or 697-0371, Ex!. 6110 532-7286, Ext. 6110 Fax: 240-6118 website: www.ccoa.net/al!in2 e-mail: 3Q:inQ(a)cco3.net Nancy A. Besch Chmrman FINAL GUARDIANSHIP REPORT FOR LOUIS MILLER October 8, 2003 EarlR. Keller Vice Chairman Richard L. Rovegno Secrefary John F. Connolly Chu:fClerk Dennis R. Marion County Adminislrafor Terry L. Barley Dlrec/or Report from Former Guardian of Person: Cumberland County Office of Aging Janet E. Paull, Aging Care Manager II On June 2, 2003, Guardianship of Person for Louis Miller was granted by Judge Edward E. Guido to the Cumberland County Office of Aging. At the time ofthe appointment, the client resided at the Manor Care Health Services, Carlisle, Pennsylvania. He had been placed there under a Temporary Protective Order signed on April 10, 2002 by Judge Guido. Following the Guardianship hearing, Mr. Miller returned to the Manor Care Facility. Upon admission to ManorCare, client was diagnosed with dementia with moderate cognitive impairment, history of alcohol abuse, history of tongue cancer, malignancy of head and neck with a resection done in 1993, and hypothyroidism. He was also a high risk for elopement since he had eloped from several facilities in the past. Mr. Miller expressed his desire to be placed in a veterans' home. Mr. Miller was a veteran ofthe Korean War and it was believed that he would be happier and less likely to elope if he were in such a facility where there are more men with whom he could socialize. The Office of Aging completed the application process and Mr. Miller was placed on the waiting list at the five state veterans' homes. On January 14, 2003 Mr. Miller was admitted to the Hollidaysburg Veterans Home in Blair County, Pennsylvania. Mr. Miller was taken there by two Aging Care Managers from the Cumberland County Office of Aging. Prior to his admission to Hollidaysburg Veterans Home, he was visited regularly by a representative of the Office of Aging. After his move, we maintained telephone contact with Hollidaysburg Home personnel. In February, Mr. Miller was moved from the Nursing section to the Personal Care section of the Home. Celebrating 30 Years of Service to Cumberland County's Seniors 1973 - 2003 ~ , /~ . , fk '04 AUG 16 PiZ :45 ( .;'-, ('l'l~'" l.f; 111.;,.; IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: LOUIS W. MILLER, an incapacitated person ORPHAN'S COURT DIVISION No. 21-02-482 Description of Pleading: Report Submitted Pursuant to Section 5521 (c) of the Probate, Estates and Fiduciaries Code Filed By: Blair Senior Services, Inc. 1320 12th Avenue Altoona, PA 16601 (814) 946-1235 ."" . , IN RE: LOUIS W. MILLER, an incapacitated person. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT DIVISION Case No.: 21-02-482 REPORT SUBMITTED PURSUANT TO SECTION 5521(c) OF THE PROBATE, ESTATES AND FIDUCIARIES CODE AND NOW, comes the Guardian, Blair Senior Services, Inc., and reports as follows to the Court on the Guardianship of Louis W. Miller pursuant to the requirements of 20 Pa.C.S. S 5521 (c): I. Guardian of the Estate A. Current principal and how it is invested: A checking account with Citizens Bank had a balance of $17,233.85 as of July 31,2004. B. Current Income: Mr. Miller received Social Security benefits in the amount of $798.00 per month for October 2003 through December 2003 and $808.00 per month for 2004; Social Security Conserved Funds in the amount of $1,903.80; Veterans Pension in the amount of $1,200.00 per month for January 2004 through April 2004 and $1,375.00 per month for May 2004 through July 2004; Veterans Pension Retroactive Pay in the amount of $2,408.00; Funds transferred from resident account at Hollidaysburg Veterans Home in the amount of $11,785.42; and checking account interest in the amount of $81.15 for the period of October 2003 through July 2004. C. Expenditures of Principal and Income: The following expenditures were made on behalf of Mr. Miller during the period from October 1, 2003 through July 31, 2004: room & board - $13,781.20; consumer spending money - $640.00; Blair Senior Services' Fees - $1,070.00; legal fees - $37.00; medical - $32.00; and clothing - $359.32. \ . II. Guardian of the Person A. Current Address: Hollidaysburg Veterans Home, Personal Care Unit, PO Box 319, Hollidaysburg, Blair County, Pennsylvania 16648. B. Major Medical and Mental Problems: Depression, sIp Carcinoma (head and neck) with radical surgery, Old Acute Cerebrovascular Disease, Vascular Dementia, Chronic Atrial Fibrillation, Chronic Ethanol Abuse, Neurogenic Bladder, Hypothyroidism. C. Living Arrangements and Support Services: Mr. Miller continues to receive care by registered nurses, LPN's and certified nurses aides. He is also seen monthly and as needed by Dr. Wiegering. Mr. Miller participates in activities at the Hollidaysburg Veterans Home as much as he is capable. D. It is the opinion of the guardian that the guardianship must continue due to Louis W. Miller's incapacity. E. Number and Lengths of time the guardian has visited Mr. Miller in the past year: 1. Direct Contacts - 22 visits lasting in duration from 15 minutes to 3 hours, for a total of 17 hours and 15 minutes during the reporting period between August 13, 2003 and July 31, 2004. 2. Collateral Contacts - a total of 26 hours and 15 minutes during the reporting period between August 13, 2003 and July 31, 2004. 3. Total hours of Contacts Direct and Collateral- 43 hours and 30 minutes during the reporting period between August 13, 2003 and July 31, 2004. BLAIR SENIOR SERVICES, INC. r;;;/q /0<./ Date BY~lll~ ~ DIM. Slat, Executive Director .~ - . On July 11, 2003 a representative of the Area Agency on Aging for Blair County, Blair Senior Services, visited the client on our behalf. She reviewed his medical chart and reported the following information. He was seen by a psychiatrist on February after client reported feelings of depression. The psychiatrist provided a diagnosis of depression and prescribed a medication. Staff has reported that the medication seems beneficial to him. He has also received a new upper denture. Client expressed an interest in stopping his smoking and has received an order to attend smoking cessation meetings. The chart reflects no behavioral problems at present. He is described as responding appropriately, quiet, keeps to self, does not socialize much with others. He is friendly but occasionally agitated and irritable. The Hollidaysburg Veterans Home has demonstrated an adequate quality of care for Mr. Miller by managing his daily needs and continuously monitoring his medical problems. Therefore, we believe that Mr. Miller should continue to reside in the Hollidaysburg Veterans Home. As a result of the success of this relocation, the Cumberland County Office of Aging contacted Blair Senior Services to see ifthey would be willing to be named as Guardian of Person, which they agreed to do. The Cumberland County Office of Aging petitioned the Court for this transfer, and on August 13,2003, Judge Edward Guido signed a court order naming Blair Senior Services, Inc. as the new Permanent Plenary Guardian of Person of Louis Miller. .Pl- (:2- 1/ f)') QTumberlanh QTountt! OOffice of ,Aging & QTommunitt! ~eruiceli 16 West High Street, Carlisle, P A 17013 [717] 240-6110 or 697-0371, Ex!. 6110 532-7286, Ext. 6110 Fax: 240-6118 website: www.ccoa.net/af!im! e-mail: 3!!in!!rmccna.net HUMAN SERVICES BUILDING FINAL GUARDIANSHIP REPORT FOR LOUIS MILLER NancyA. Besch Chairman October 7,2003 Earl R. Keller Vice Chairman Richard L. Rovegno Secrerary John F. Connolly Chle/ClerK. Dennis R. Marion County Administrator TerryL Barley Director Report from Former Guardian of Estate: Cumberland County Office of Aging Janet E. Paull, Aging Care Manager II On June 2, 2003, Guardianship of Estate for Louis Miller was granted by Judge Edward E. Guido to the Cumberland County Office of Aging. At the time of the appointment, client resided at the Manor Care Health Services, Carlisle, Pennsylvania. He had been placed there under a Temporary Protective Order signed on April 10, 2002 by Judge Guido. Following the Guardianship hearing, Mr. Miller returned to the Manor Care Health Services. A checking account was opened at the Orrstown Bank, where client had a previous account. Mr. Miller currently receives Social Security of $798.00. On January 14, 2003 Mr. Miller was admitted to the Hollidaysburg Veterans Home in Blair County. In May Mr. Miller began receiving Veterans benefits. He receives $1156 on a monthly basis. This check goes directly into Mr. Miller's Members Fund at the Hollidaysburg Veterans Home. Of this amount, $616 goes to the Veterans Home for his care. Since receiving the Veterans payment, the amount due out ofthe social security to the home was reduced to $435.20 per month. Mr. Miller also received a check from the Veterans Administration making a retroactive payment of $17,880.40. These funds were deposited in his Members Fund at the Hollidaysburg Veterans Home and can be used to meet his needs. As a result of the success ofMr. Miller's relocation to the Hollidaysburg Veterans Home, the Cumberland County Office of Aging contacted Blair County Senior Services to see if they would be willing to be named as Guardian of Estate, which they agreed to do. The Cumberland County Office of Aging petitioned the Court for this transfer, and on August 13, 2003, Judge Edward Guido signed a court order naming Blair Senior Services, Inc. as the new Permanent Plenary Guardian of Estate of Louis Miller. Once the transfer of the Representative Payee for Social Security was accomplished, our Office received instructions to return any remaining monies that were in Mr. Miller's checking account to the Social Security Administration. This was done on September 17, 2003, thus closing out his account. A final accounting ofMr. Miller's finances for which the Cumberland County Office of Aging was responsible is attached. Celebrating 30 Years of Service to Cumberland County's Seniors 1973 - 2003 , - c: :J o 01") 00 <(0 c.N :.c~ If) :J c: ...., .~ :::J "E~ "'- :JN "8 ~~ :2 3 .~ ...., :J o ...J ~I l/I ~I ~ ~ ~ ~ ~ ~ ~, ~ ~ ~ ~ m m m m rn rn m m C. S () ,t)UU()OOUU, >< S SSlJf:)(j ." " oc.... 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",I "~,"re , lte I Debit Credit -_.- __ 1""::'()6/19/020penaccount__=- _ _~_$220.00 $220.00 _ __..l.. 07/05/02 Social Security__ _ $2,427.00, $2,647.00 07/05/02 Social Security -_1.:1 $791 00 $3,43800 93, __ ~;;~;~~~ ~~~~~~aIJLlr1d HCR ~an~.r..C~re _ ---fu-i~~~~ ____ ~;:j~~:~~ 94 _Q.7/10/02'HCR M~r1or Care.~..r.~_May ______$1,52200 ___ ~!1,810.00 95 07/25/02 Lakeview Estate $785.00 $1,025.00 96~~;~;;~~ ~Z~~~~t~~YHc~-:anor_C2~re _----- $-1...,$5..~21-25..0000. ___...$_79~1(50... ~. ;$:~2071. 691.-_:.~0...~0- 97 08/07/021 HCHManor Care Jun&July 98 08/27/0..3 pe.r..sonal fund H...CR M_anor_Care_ $15001 $26400 1 09/10/03 Social Security -..' .. $791.00"$1,055:00 . 99 '-0-9116/02 HCR Manor Care - Aug- - - $761.00----- - $294.00 -- ;~~ -- 09/25/02~~;~o:o~~~n~e~~~anor Care - ===r-~-$15.00 -==-- I ~m~~ 102 10109/02 personal fund HCR Manor Care ---I $15.0~-- l-1264.00 10/11/02 SociaISecurity-- ----- -, $791.00 $1,055.06 -~0/21/02 Insurance CheckSocialSecurity . $108,00 $1,163.00 103 1Q1?1762}i..CR Manor gare - Sept------- $771.00 - --i- $392.60 104 10/23/02 personal fund HCRManor Care $15.00 $377.00 11/07/02iSocial Security --- $845.00 $1,222.00 ::: : :;::: ::;,~~';:~;~~~,"" c,re': :~I~ :::: 107+;~;~~;~~ ~~~~~~~~Sr%~HtRrv1anCJr C~~__~_~WOo J8~500J1~;~~:~~ ;~~'-- ;~. ;.~.~;~~~~~o~~~~n~a.H..r~~~"anor Care-. $~;~:~~. --.-..... j~,;:..~ --61/07/03-Social Security.. ______n -----;--$856,00 $1-;248.00 110 01/07/03 'personal fund HCR Manor Care $1500' .-- 1 $1,233~00 111 01/10/03HCR ManorCare-Dec .... $874.00 ------$359.00 - ---------- 112 01/14/03 Hollidaysburg VetHome $409.86 -$50-,86 113: .01/14/03 Personal Fund HolliciaysburL__ $10.00 -$60.86 02/03/03 deposit __ $856.60 $795.14 114! 02/07/03, Persona.~fu.nd Hollidaysburg $40.00 ___ $755.14 01/23/03' overdraft charge $25.00 $730.14 115 02/20/03 check voiderror $730.14 116 02/20763!HollidaysblJrg Vet HOrne Feb- $604.80 $125.34 03/04/03 d_eposit check _ __ _ ______ _ __ $739.30 $864.64 117 03/10/03 Hollidaysburg Vet Home Mar__- $511.44' -$353.26 118 03/10/03 Personal Fund Hollidaysburg Vet Home . . $"OcOQ $313.20 119 __ _03/_1()/03 HCR Manor Care Jan .!2QO.00 $113.20 04/07/03 Social Se<:.urity $798.00 $911.20 120 04/15/()3 HollidaysburgYetf-jCJ.me Apr $558.40 $352.80 121 04/15/03 Persona.I_F'ulldHollidaysburg Vet Home $50.00 $302.80 122 04/15/03 HCR Manor Care Jan $213.00 $89.80 - ________..___n________ No descripticln____ $798.00 $887.80 __l?L____ voided__ _._._____ $887.80 124 05l07.1():3 HClilidaysburg Vet Home $,,35~()1____ $452.60 06/06/03 ,Social Security --------=-=~-= $798.00 $1,250.60 125 6/12/2003iHollidaysburg Vet Home__________ -_}4-3.51-6----------$815.40 'n()7.L03./03.,Social Security $798.00 $1,613.40 126'1 07/08/03'Hollidaysburg Vet Ho_ln_enn____n___$_,,3_5.20 _n $1,178.20 08/04/03 Social Security_ n______ i $798.00 $1,97620 127 08/04/03 Hollida sbur Vet Home $435.20 $1,541:60 ~ , .. __ 09/0!)/03 Social Security _____ $798,00 128 09j05/03, Hollidaysburg Vet H()me _~435,20, '~~~:' rOd,' s~"". Mm,";'~o~ ~ ,:ro:!_ Balance $2,33~,00 $1,903,80 $0,00 $1,250.60 Page 1 of 1 Connellan, Carl From: Connellan, Carl Sent: Thursday, January 27,20057:24 AM To: 'Lindsay Baird' Subject: RE: Louis Miller Good. Let me know as soon as you hear something. Carl C. -----Original Message----- From: Lindsay Baird [mailto:bairdlaw@pa.net] Sent: Wednesday, January 26, 2005 12:30 PM To: Connellan, Carl Subject: Louis Miller Hi Carl, I have contacted the appropriate person to follow up on the letter Mr. Miller wrote Ed about his (Mr. Miller's) money concerns. I will be filing a memo to the Court once I have money trails established. Thank you, Lindsay 1/27/2005 LOUIS W. MILLER POST OFFICE BOX HOLlDA YSBURG, PENNSYL VAIA 16648 THE HONORABLE EDWARD E. GUIDO CUMBERBAND COUNTY, COURT HOUSE CUMBERLAND COUNTY, PENSYLVAIA YOUR HONOR I AM WRITING TO YOU WITH A PROBLEM, PERTAINING TOO MY GUARDIAN, MR. TIM TYLER. I REQUEST A COURT ORDER AUDIT OF MY FUNDS. I FEEL SOME FUNDS ARE MISSING. RESPECTFULL Y l..) , ,~ ~!;J }lI] (, ! f ~ fY l.A-- A_{J/ LOUIS W. MILLER 4 LINDSAY DARE BAIRD AT'I'ORNF.Y AT LAW 87 SOL'T'II H ANOYER CARI,ISLE. T"ENNSYLVANIA 17013.3807 TEL. (717) 243-5732 PAX (717) 243-8110 February 4, 2005 The Honorable Edward E. Guido One Courthouse Square Carlisle, PA 17013 RE: Louis Miller No. 21-02-482 Orphans' Court Dear Judge Guido: In response to Mr. Miller's undated letter to you expressing concern about allegedly missing funds, you requested I look into the matter. I called Ms. Janet Paull of our county's Office of Aging to procure the number of Mr. Tim Tyler referenced in Mr. Miller's letter. I learned that Mr. Tyler is Mr. Miller's Guardian Support Worker and is employed by Blair Senior Services, Inc. Blair Senior Services, Inc. was appointed guardian of the person and estate of Mr. Miller by your court order of August 13, 2003. Mr. Tyler was kind enough to gather the enclosed documents. Although I am not a financial professional, review of the documents reveals that no money spent is unaccounted for nor do any of the expenditures seem to be frivolous. The documents enclosed are: 1. Court Order to terminate Office of Aging's guardianship. 2. REPORT SUBMITTED PURSUANT TO SECTION 5521 (C) OF THE PROBATE, ESTATES AND FIDUCIARIES CODE: Filed 8/16/04 3. Account information for the reporting period 8/1/04-1/28/05. 4. Copy of Master Client Account detail for the above period (2 pages). 5. Copy of Master Client Account detail for the above period (2 pages) _ expenses. 6. Copy of "Shopping activities for consumers" with detail. 7. Copy of: Walmart receipt for Christmas purchases, receipt for $250.00 payment from Blair Senior Svcs, and receipt indicating change was put back into L. Miller's spending account. 8 Master Client Account balance sheets for months of August, 2004 through January, 2005 (6 pages). 9. Copy of Smith Funeral Home, Inc. expenses - signed 11/3/04. 10 Copy of Homesteaders Life Company group enrollment form for Louis Miller - 11/3/04. 11. Pre-need Funeral Agreement and Assignment form: statement of funeral merchandise and funeral services - signed 11/3/04. As Blair Senior Services, Inc. has guardianship of Mr. Miller and his estate, it would seem appropriate to vacate my appointment. Thank you for your time. Respectfully submitted, /7 "-'/l Ut{'Mi', / ,ct:li{),)t.. t ~t--~ /Lindsay Date/Baird, Esquire ,// LDB/nfa Enclosure cc: Anthony L. DeLuca, Esquire IN THE MATTER OF THE PERSON AND ESTATE OF: . IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYL VANIA LOUIS MILLER, AN ALLEGED INCAPACITATED PERSON ORPHANS' COURT DIVISION NO. 21-02-482 ORDFR ~ . AND NOW, to wit, this'} day of August, 2003, after reviewing the Petition for Transfer of Guardianship, it is Ordered and Decreed that the Appointment of the Area Agency on Aging, in and for Cumberland County, Pennsylvania as Permanent Plenary Guardian of the Person and Estate of Louis Miller, an incapacitated person, is terminated and Blair Senior Services, Inc., a guardian support agency as defined at 20 Pa. C.S. g5551, et seq., with offices at 1320 12th Avenue, Altoona, Blair County, Pennsylvania 16601, is appointed as Permanent Plenary Guardian of the Person and Estate of Louis Miller, an incapacitated person. All guardian fees shall be paid by the guardian of the Estate of Louis Miller, an incapacitated person. Guardian fees shall be based on the then current fee schedule of Blair Senior Services, Inc., for the type of services involved. N ~ r" Q BY THE CO ",,",;..::;.c.'~ /. L- II I:! (V) ~ '.'1 . I CJ L':l =: !3 ,~ ",t".. .......1..--' Edward E. Guido, J. Anthony 1. DeLuca, Esquire For the Petitioner Lindsay Dare Baird, Esquire For Louis Miller A TFlUE COPY FROM RECORD In Testimony wherof, I hereunto HI my hand'and the ... _ of~~ Court t '. PA ~day of . 20,42 "'- .Qud ciJ . . ".....Y <C. ,_~" t . Ii ReoCITf.e.d;Q~f9f, pi,; .' 'flegiSt."lJ of V,mls .04AUG 16 Pl2 :45 '~\-rl.-n<;c;<" Court \.rit;I: \. ... ~,'" ~ "... . -:> .... Gumberfand Co., PA IN THE COURT OF COMMON PLEAS OF CUMBERlAND COUNTY, PENNSYLVANIA IN RE: LOUIS W. MILLER, an incapacitated person ORPHAN'S COURT DIVISION .No.21-o2-482 Description of Pleading: Report Submitted Pursuant to Section 5521(c) of the Probate, Estates and' Fiduciaries Code Filed By: Blair Senior Services, Inc. 13201211I Avenue . A1toona, PA 16601 (814) 946-1235 IN RE: LOUIS W. MILLER, an incapacitated person. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA : : ORPHAN'S COURT DIVISION : Case No.: 21-02-482 REPORT SUBMITTED PURSUANT TO SECTION 5521 (c) OF THE PROBATE, ESTATES AND FIDUCIARIES CODE AND NOW, comes the Guardian, Blair Senior SelVices, Inc., and reports as follows to . the Court on the Guardianship of Louis W. Miller pursuant to the requirements of 20 Pa.C.S. ~ 5521 (c): I. GuardIan of the Estate A. Current principal and how it is invested: .A checkingaccourit with Citizens Bank had a balance of $17,233.85 as of July 31, 2004. B. Current Income: Mr. Miller received Social Security. benefits in the amount of $798.00 perrnonth for October 2003 through December 2003 and $808:00 per month for 2004; Social Security ConselVed Funds in the amount of $1,903.80; Veterans Pension in the amount of $1,200.00 per month for January 2004 through April 2004 and $1,375.00 per month for May 2004 through July 2004; Veterans Pension Retroactive Pay in the amount of $2,408.00; Funds transferred from resident account at Hollidaysburg Veterans Home in the C. Expenditures of Principal and Income: The following expenditures were made on behalf of Mr. Miller during the period from October 1, 2003 through .!uly 31, 2004: room & board - $13,781.20; consumer sPending money - $640.00; Blair Senior SelVices' Fees - $1,070.00; legal fees - $37.00; medical- $32.00; and clothing - $359,32. II. Guardian of the Person A. . . - .- ....'-, -, .~-"" - ,'-' '.'- Current Address: Hollidaysburg Veterans Hom~;Personal Care Uj't'lt, P,O Box 319, Hollidaysburg, Blair County, Pennsylvania 16648. B. Major Medical and Mental Problems: Depression, sIp Carcinoma (head and ~.~...:..~\'d'~:ti~_,.:,..>#~.J J neck) with radical surgery, Old Acute Cerebrovascular Disease, Vascular Dementia, Chronic Atrial Fibrillation, Chronic Ethanol Abuse, Neurogenic Bladder, Hypothyroidism. c. Living ArrangementS and Support Services: Mr. Miller continues to receive care by registered nurses, LPN's and certified nurses aides. He is also seen monthly and as needed by Dr. Wiegering. Mr. Miller participates in activities at the Hollidaysburg Veterans Home as much as he is capable. D. It is the opinion of the guardian that the guardianship must continue due to Louis W. Miller's incapacity. E. Number and Lengths of time the guardian has visited Mr. Miller . .. in the past year: ~--- :~.: ..:~ . ," 1. Direct Contacts - 22 visits lasting in duration from 15mimites to 3 hours, for a total of17 hours and 15 minutes during the reporting period between August 13, 2003 and July 31, 2004. .. . 2. Collateral Contacts - a total of 26 hours and 15 minutes dUring the reporting period between August 13, 2003 and July 3~, 2004. 3. Total hours of Contacts Direct and Collateral.,.. 43 hours and 30 minutes . during the reporting period between August 13, 2003 ant;f July 31,2004. BLAIR SENIOR SERVICES, INC. rs /9 !o c.f Date BY~lh~~ o M. Slat, Executive Director Louis Miller Account information for the reporting period of 8/1/04 - 1/28/05 Income Social Security Veterans Pension $ 808.00 (August thru December 2004) 1,375.00 (August thru December 2004) Checking Account Interest $73.08 (July thru November 2004) Social Security Veterans Pension $ 820.00 (January 2005) 1,412.00 (January 2005) Checking Account Interest $12.07 (December 2004) Account Balance as of 7/31/04 Total Income for reporting period Total Interest for reporting period Expenses for reporting period Account Balance as of 1/28/05 $17,233.85 13,147.00 85.15 ( 17,285.39) $13,180.61 ---------- ---------- Run date: 01/28/2005 @ 10:30 Bus date: 01/28/2005 Date Transaction 01~210006 LOUIS MILLER CASH BALANCE 08/05/2004 2454T~0000009 GJ 08/05/2004 2457T~0000012 GJ 08/09/2004 2461T~0000009 GJ 08/11/2004 2467T~0000014 GJ 08/19/2004 2477T~0000013 GJ 09/07/2004 2490T~0000009 GJ 09/07/2004 2492T~0000013 GJ 09/13/2004 2498T~0000012 GJ 09/17/2004 2499T~0000011 GJ 09/27/2004 2506T~0000012 GJ 10/04/2004 2516T~0000009 GJ 10/04/2004 2518T~0000012 GJ 10/12/2004 2521T~0000009 GJ 10/15/2004 2527T~0000014 GJ 10/29/2004 2535T~0000010 GJ 11/04/2004 2545T~0000009 GJ 11/04/2004 2548T~0000013 GJ 11/04/2004 2555T~0000001 GJ 11/11/2004 2559T~0000009 GJ 11/16/2004 2565T~0000013 GJ 11/30/2004 2581T~0000008 GJ 12/03/2004 2587T~0000009 GJ 12/03/2004 25B9T~0000011 GJ 12/14/2004 2607T~0000009 GJ 12/14/2004 260BT~0000013 GJ 12/30/2004 2624T~0000009 GJ 01~210006 LOUIS MILLER CASH BALANCE MASTER CLIENT ACCOUNT Account Deta i 1 Jnl Description Ref I AUG DO ~mQ:l'U'l'1 "J,'l'.:.",," '\ 8/03 CKS Ct"-t"""'~) JULY INT CCIvJ_l."'(..\nj l4e.c,l ,.~~n?)-\') 8/11 CKS 8/18 CKS SEPT 00 9/03 CKS 9/13 CKS AUG INT 9/27 CKS OCT 00 !D/OI CKS SEPT INT 10/14 CKS 10/29 CKS NOV 00 11/02 CKS 11/04 CKS OCT INT 11/15 CKS 11/30 CKS OEC 00 12/02 CKS NOV INT 12/14 CKS 12/30 CKS Ref 2 Reporting: 08/01/2004 to 12/31/2004 CSACOTL.L27 Page 1 Ref 3 Posted Amount 2 .183 ~ OOCR 100.00 15~22CR 1.800.05 125.80 2.183.00CR 120.00 1.886.72 15~25CR 110.00 2.183.00CR 148.00 14.99CR I. 788. 62 110.00 2.183.00CR 370.00 4.412.00 15.67CR 1.781. 40 110.00 2.183.00CR 120.00 11. 95CR 1.781. 40 110.00 ..~ ~t-- AC- I./^ , is{;;,' Ill/. S (X.u", do, lJlV. f (iX'1-- po I iI::d ci <(n'5 \ qil'+ ~~~ nC{~ '-I k' ~ ud~~u: I iki'i'l,,'.l, \.;<,1(" ICe Run date: 01/28/2005 @ 10:30 Bus date: 01/28/2005 Date Transaction 01-210006 LOUIS MILLER CASH BALANCE B 01/01/2005 2628T-0000067 GJ Amount. . . : 01/04/2005 2634T.000000g GJ 01/04/2005 2636T-00000II GJ 01/13/2005 2649T-00000IO GJ 01/28/2005 2665T-0000008 GJ 01-210006 LOUIS MILLER CASH BALANCE MASTER CLIENT ACCOUNT Account Detail Jnl Description Ref 1 Beginning balance -13.347.00 JAN 00 1/04 CKS OEC INT 1/28 CKS Ref 2 Reporting: 01/01/2005 to 01/28/2005 CSACOTL.L27 Page 1 Ref 3 Posted Amount 13.347.94CR 2.232.00CR 120.00 12.07CR 2.291.40 13.180.6ICR 13.180.6ICR Run date: 01/28/2005 @ 10:31 8us date: 01/28/2005 t )LJJ(;nS{S MASTE~ CLIENT ACCOUNT Account Deta i 1 ( - ~-"--..., Reporting: 08/01/2004 to 12/31/2004 CSACOTL.L27 Page I Date Transaction Jnl Description Ref I Ref 2 Ref 3 Posted Amount 01-606001 MILLER-ROOM & BOARO 08/1 1/2004 2464T-0000038 AP HOLLIDAYSBURG VETERAN'S HOME 11547 entry 1. 7BI.40 09/13/2004 2495T-0000024 AP HDLLIOAYSBURG VETERAN'S HOME 11722 entry 1. 7BI. 40 10/14/2004 2524T-0000049 AP HDLLIDAYSBURG VETERAN'S HOME 11906 entry 1. 781.40 11/15/2004 2562T-0000051 AP HOLLIOAYSBURG VETERAN'S HOME 12110 entry 1. 7BI. 40 12/14/2004 2603T-0000046 AP HDLLIDAYS8URG VETERAN'S HOME 12278 entry 1,781.40 01-606001 MILLER-ROOM & 80ARO 8.907.00 01-606002 MILLER-SPENDING MONEY 08/03/2004 2451T-0000029 AP HOLLIDAYSBURG VETERAN'S HOME 11476 entry 100.00 09/03/2004 2487T-0000031 AP HOLLIDAYSBURG VETERAN'S HOME 11688 entry 120.00 09/13/2004 2495T-0000026 AP HOLLIOAYSBURG VETERAN'S HOME 11723 entry 100.00 10/01/2004 2513T-0000023 AP HOLLIDAYSBURG VETERAN'S HOME 11837 entry 120.00 11/02/2004 2538T-0000029 AP HOLLIOAYSBURG VETERAN'S HOME 12031 entry 120.00 12/02/2004 2584T-0000021 AP HOLLIDAYSBURG VETERAN'S HOME 12215 entry 120.00 01-606002 MILLER-SPENDING MONEY 680.00 01-606004 MILLER-8SS FEE 08/18/2004 2474T-0000031 AP BLAIR SENIOR SERVICES, INC. 11590 entry 110.00 09/27/2004 2503T-0000031 AP BLAIR SENIOR SERVICES, INC. 1177B entry 110_00 10/29/2004 2532T-0000019 AP BLAIR SENIOR SERVICES. INC, 11951 entry 110.00 11/30/2004 2578T-0000019 AP BLAIR SENIOR SERVICES, INC, 12159 entry 110_00 12/30/2004 2621T-0000023 AP BLAIR SENIOR SERVICES. INC, 12328 entry 110.00 01-606004 MILLER-BSS FEE 550.00 01-606014 MILLER-LEGAL FEES 10/01/2004 2513T-0000025 AP EVEY ROUTCH BLACK OOREZAS 11838 entry 28.00 01-606014 MILLER-LEGAL FEES 28.00 01-606016 MILLER-PREPAID BURIAL 11/04/2004 2552T-000000I AP HOMESTEAOERS LIFE COMPANY 12042 entry 4,412.00 01-606016 MILLER-PREPAIO BURIAL 4,412.00 01-606022 MILLER-MEDICAL 08/1 1/2004 2464T-0000040 AP MERCY EMERGENCY SERVICS. LLC 1154B entry 18.65 08/18/2004 2474T-0000033 AP MERCY MEOICAL IMAGING 11591 entry 8.58 08/18/2004 2474T-0000035 AP BLAIR ORTHOPEDIC ASSOCIATES 11592 entry 7.22 09/13/2004 2495T-0000028 AP MERCY MEOICAL IMAGING 11724 entry 5.32 10/14/2004 2524T-0000051 AP BELlS UROLOGIC, INC. 11907 entry 7.22 01-606022 MILLER-MEOICAL 46.99 01-606023 MILLER-MISC 11/02/2004 2538T-0000031 AP ROBERT LENDER 12032 entry 250.00 01-606023 MILLER-MISC ~ 250.00 tl"l ~\n'(i.., I\;CV~'" \{;, \...C\.U.!, \\\c\ici 14,873.99 ~~:& '::,H (\.lj-$lC j",d SiI.i ri)"V) {C, di. kr ,<It mo,:d \-JJ+ Run date, 01/28/2005 @ 13,01 Bus date, 01/28/2005 r- l \' ; ,-' X:::tfl;i 0t'-J , - MA TER CLIENT ACCOUNT Account Deta 11 Date Transaction Jnl Description Ref 1 Ref 2 Ref 3 01-606001 MILLER-ROOM & BOARO 01/28/2005 2662T-0000019 AP HOLLIOAYSBURG VETERAN'S HOME 01-606001 MILLER-ROOM & BOARD 12487 entry 01-606002 M]LLER-SPENOING MONEY 01/04/2005 2631T-0000026 AP HOLLIOAYSBURG VETERAN'S HOME 01-606002 MILLER-SPENDING MONEY 123B4 entry 01-606004 MILLER-BSS FEE 01/28/2005 2662T-0000021 AP BLAIR SENIOR SERVICES, INC_ 01-606004 MILLER-BSS FEE 124B8 entry 01-606019 MILLER-PERSONAL SUPPLIES 01/2B/2005 2662T-0000017 AP 01-606019 MILLER-PERSONAL SUPPLIES BLAIR SENIOR SERVICES, INC_ 12486 entry /1' On \\\[;(lChL\ i )Oi )C5-r;rvL-T~j\( (- 1-0\\\ \:JL\L~r~ ~-(~~<,Sk$e\~J ~l;{ t" \v bcci\" ('-I,d c'-\ \\i (- l \t lh~u,'J~d \~{\\'S. , L';Lu- CC{f,(ILIj lU\\ \ Cl'""L 'b Ytc cc CO,\I.... {c -\, ,\'-. 0\1\~ lc"L.J " Reportin9' 01/0]/2005 to 01/28/2005 CSACOTL_L27 Page 1 Posted Amount 1. 781. 40 I.7B1.40 120,00 120_00 110 _ 00 110_00 400 _ 00 400 _ 00 2,411.40 SHOPPING ACTIVITIES FOR CONSUMERS , Consumer's Name~r)l Ai", f'I l \\~r Requested By: \ 1m ~AI1 r Date: II ImlW Amount withdrawn from cons~er's account: $ ';),~ DO DATE VENDOR ITEMS PURCHASED COST II II") LA).... \ m rt . '~"b~ n cJ {:I 1'4 "'L~ .\ (/ I S ~\e..."~ ... f\ '" (~. q r. III,S Mer. C:;or~ , 4. R II'IIS W ~~bS h..,o"<c 1 X'l\ II '/15 sl<.- r.1 ,~ l Rc. " I 15 WeN....... A ,~,1v-. I q (.. ") " ' I I&::' ~<; \ ~ ,( i ., ( L\~ cp, B 1 \ I 1< I "rn a (. ... 1<1 ct. .t:'J o..r'\-b. II i 1"1 ()\lp! VCR Clq I<l I " II C; <:\ .."'OO1.....-r- R B4 '\ 'J 1'\ <<'I", r J( ,,~cJ<( I, </'-1 Ir,.,( fA DO I), e. ,,,Ac A, I \ N..... ~, I In.4l () ~I'J U;}) ill! J.L , $lgi:l;jti:ii~,~f.e~~oi:i.,ReoeMng :Al>(jveltems " . 3;c.0~1 vu ------ . .~1;;1 ~~-' \ ,." ,., ""- .-,_.' .AMOUNT RETURNED TO F1S~'CE . --0-- ~ ',~ Ij~ Signature of Fiscal Employee (' j At f ./JYih l?i~~e<if;$t!\lp~r : /Y\ ~o- K GA 1\).A.l~ , .. I FOR FISCAL USE ONt Y Cash Withdrawn ~,VJ fXJ Reconciles With Above "Amount Account # $ , Receioted Amount ( ;1 'YJ. tv ) YES V-- Cash Returned $ -0-- NO Signature of Reconciler jj, ItA. J... It. M ""'n-"/''''''':,,_,,~"_ -"f..... . U : ~,;(:.- ." 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II o m C/) ~ ~ ."t'__?-_,....~...~~ __., _ :.~-~~~.~....:.:..~~ ~~ _.....t>I;,~ ~ HOLLlDAYSBURG VETERANS HOME MEMBERS FUND DEPOSIT RECEIPT For the Account of L Of It "'S !Y\ .1\ ('/ The Sum of t., <-/1 Received From i?,c:; fl./.', -fH eVta'3r Account Number SI'J(l Code 1/61:, Commonwealth of Pennsylvania Department of Military Affairs Date N? 64293 A \\ I ,:). '\ )od . J $ If' If? Dollars j (--" ;f "- l'_ Furd Custodian SVH-410' I Run date: 01/28/2005 @ 10:32 Bus date: 01/2B/2005 01 Created by postlng Description 01-210006 LOUIS MILLER CASH BALANCE Total Llabilities Excess Revenue over (under) Expendltures Total Net Assets Total Liabilitles and Net Assets MASTER CLIENT ACCOUNT Balance Sheet IJU,fiiJ/- v Period ending 08/31/2004 Balance 17 . 406.22 17,406.22 .00 .00 17,406.22 Select..: A01-210006 GLBALSH.L27 Page 1 Run date: 01/2B/2005 @ 10:32 Bus date: 01/2B/2005 01 Created by posting Descrlptlon 01-210006 LOUIS MILLER CASH BALANCE Total Liabilities Excess Revenue over (under) Expenditures Total Net Assets Total liabilities and Net Assets MASTER CLIENT ACCOUNT Sa 1 ance Sheet :.Jtl)~ )lbt. L Select..: AOI-210006 GLBALSH.L27 Page I Period ending 09/30/2004 Balance 17. 4B7.75 17 .4B7.75 .00 .00 17.4B7.75 Run date: 01/28/2005 @ 10:32 8us date: 01/28/2005 01 Created by posting Description 01-210006 LOUIS MILLER CASH BALANCE Total liabilities Excess Revenue over (under) Expenditures Total Net Assets Total liabilities and Net Assets MASTER CLIENT ACCOUNT Balance Sheet Ot ~)JJt>L Select..: AOI-210006 GLBALSH.L27 Page 1 Period ending 10/31/2004 Balance 17.639.12 17.639.12 .00 .00 17.639.12 Run date: 01/28/2005 @ 10:33 Bus date: 01/2B/2005 01 Created by posting Description 01-210006 LOUIS MILLER CASH BALANCE Total Llab;lities Excess Revenue over (under) Expenditures Total Net Assets Total liabilities and Net Assets MASTER CLIENT ACCOUNT Balance Sheet A/rbI.{' nIX-L Select..: AOI-210006 GLBALSH.L27 Page I Period ending 11/30/2004 Balance 13.164.39 13.164.39 .00 .00 13.164.39 Run date: 01/28/2005 @ 10:33 Bus date: 01/28/2005 01 Created by posting Description 01-210006 LOUIS MILLER CASH BALANCE Total Liabilities Excess Revenue over (under) Expenditures Total Net Assets Total Liabilitles and Net Assets MASTER CLIENT ACCOUNT Balance Sheet Ju rdJt/L Select..: AOI-210006 GLBALSH.L27 Page I Period ending 12/31/2004 Balance 13.347.94 13.347.94 .00 .00 13.347.94 Run date, 01/28/2005 @ 10,33 Bus date, 01/28/2005 01 Created by posting Description 01-210006 LOUIS MILLER CASH BALANCE Total Liabllitles Excess Revenue over (under) Expenditures Total Net Assets Total Liabilitles and Net Assets MASTER CLIENT ACCOUNT Balance Sheet '~ja !'.LctL u;Y . selectj., AOI-210006 GLBALSH.L27 Page I Period ending 01/31/2005 Balance 13.180.61 13.180.61 .00 .00 13.180.61 ~.M"~, GOODS AND SERVICES ~ FUNERAL HOME,INC. Charges are o~ for those items you selected or that are required. If we are r~uir by law or by a cemetery or crematory to use any 2309 Broad A_ue AJtoona, PA 16601 item, we will explain reasons in WJiting below. www.smllhfuneralcenter.com Kevin M. Smith. S~ Jeffrey W. So'"""', Funeral Director If you selected a funeral that may require an embalming, such as a , Den_ Srnllh long, AfIIen::am Coonfi1atDr funeral with viewing, you may have to ~ for embalming You do ' C814) 944-ID55 (8141943-S991 not have to pay for embalming you d' nill ;IIlProve If ~u selected No. P04-534 arrangemen1B such as direct cremation or immediate rial. If we charge for embalming, we will explain why below. SERVICES FOR Louis W. Miller DATE OF PREPLAN November 3, 2004 CASH ADVANCES Certified Copies or Death CertiIicale # 6 $ 12.00 PLACE OF DEATH Clergy $ DATE OF STATEMENT Musician $ DATE OF SERVICE Paid Notices AItoona Mirror -under 21 lines $ nlc CHARGE OF SERVICES SELECTED Cemetery $ Crematory $ 1. Professional Services Medical Elcaminer $ SeMces or Funeral D_ $ 635.00 Hairdresser $ Embalming $ 745.00 Burial Penntt Fees $ other Preparation or Body $ 215.00 $ $ $ $ $ $ 1,595.00 TOTAL CASH ADVANCES $ 12.00 2. FaclIiIles & equipment Use or Facilities & staff fer Vrewlng 1 VISitation $ w. Charge you for our .........In obIolnlng (opocIfy cash odYanco items:) Use or Facilities & staff fer Funeral Ceremony - $ Use or Facilities & staff fer Memorial Service - $ SUMMARY OF EXPENSES Use or Equipment & staff fer Graveside SeMCe $ 175.00 Use or equipment & staff fer Church _ _ $ TOTAL ALL ITEMS $ 4,412.00 Use of Preparation Room $ 1/0.UU Sales Tax (If App) @ % $ 0.00 $ 350.00 GRAND TOTAL $ 4,412.00 3. Automollve Equipment Less Payment made $ Transfer of Remains to Funeral Home $ 260.00 Hearse to Cemetery 1 Crematory $ 215.00 Other $ Use of fimousine(s) for services $ BALANCE DUE .Ian 30, 0001 $ 4,412.00 Sedan $ Service 1 Utility Vehicle $ 75.00 BILUNG TO Blair Senior Services Adcfdional Mileage to/from IGNC, Annville, PA $ 387.00 1320 Twelfth Avenue AItoona, PA 16601 $ 937.00 ACKNO~DGEMENTANDAGREEMENT TOTALSER~CECHARGES $ 2,882.00 I hereby acknowledge thai I have the right to ananga the final selVice for the person named above, and I authorize this funeral establishment to perform MERCHANDISE services, furnish goods, and incur outside ~ specified in this Casket (or alterna!Ml container) York _ Saturn $ 1518.00 Slalement. I acknowledge thai a Casket Price and a outer Burial Ilesc. Bronze tone lag RoseIan Crepe ConIa_ Price List were made available to me and thai a copy of the General Outer Burial ConIainer $ Price List was given to me prior to my making financial arrangements. AcIcnowtedgemen ciords $ TERMS OF PAYMENT Register Book $ FuH payment is due no Ialerthan January 30, 0001 P_ Cards $ If any payment is 001 paid when due, an ull8l1ticipated LATE CHARGE or MemoriaJ Folders $ 1.= month \ANNUAL PERCENTAGE RATE 18%) will be added to the Clolhlng $ un . balance. agree to pay the Balance due _ on this ohlb....ol, plus ~ Late Charge. In the event I default In == to this funeral $ ishment, I agree to pay reasonable attaney and all court costs in CremationUm $ addition to any Late Cha'?; :fplicable. I unclOrstand and agree thai I am $ assuming persooalliabllity or the charges set forth in this stat.",..lI, and $ thai Is In addition to the Iia~mr= by law upon the _ of the $ cle<: ,ed. By my signature ,hereby ~a11 of the above and acknowledge receipt of a signed copy of this Addilionallenns of TOTAL MERCHANDISE CHARGES $ 1,518.00 payment are: SPECIAL SERVICES Forwarding to: $ DISCLAIMER OF WARRANTIES Receiving from: $ Our funeral home makes no rep!"'" otaliuns or wammlIes regard:p' cas_ or Immediate Burial. $ outer burial containers. The ~ wammlIes, ""'" I or iinpI' ,granted In connection with goods sold . the funeral senrice are the express written Direct Cremation $ warranties, If any, extended :z..the rnanufaclurer _. No _ warranties $ Including the Implied warra of merchantabllily or fitness for particular TOTAL OF SPECIAL CHARGE $ 0.00 ~~SOfl4 TOTAL FUNERAL HOME CHARGES $ 4,400.00 l(plO<f (This - does 001 Include _ advances) Si..... SSN David M. Slat, Executive Director, Blair Senior Serv DISCLOSURES x as Guardian of Person & E~tatp. for LOlli,:: W. Mil]er If any law, cerneIery C1e.......y or other requirements _ requked an Signed SSN embalming or the purchase of any _, the law or requil8lnonl is eocpIained ACCEPTANCE Our funeral ~ree to ~ all the selVices, =:iming was done with pennissjon. )( '\)'\AA C, Ilh~Jl merchandise and on this By / "- /'-<: ../.D Fp-o \~ "U)Z -L.... '-....---" ENROLLMENT FOR GROUP INSURANCE TO ~ HOMESTEADERS LIFE COMPANY 2141 GRAND AVENUE/P.O. BOX 1756/OESMOINf5, IOWA 50306l515~288.7481 GIIO[ EI\'IIOLlME FOR PROPOSED INSURED (Please Print) 4/. //"" L .:>." '\ t-) . Last First Initial .-P O. ,(JO._: :;/f' A~~..,L7 /?I:"LL~. Residence - No. and Street APPLICANT/OWNER (If Oth!l(than PfO'!"sed Insured) ,-S-/ar I)L)",,.; /JJ. Last First .Initial 1Z1 State -0/../" ~~f.j'/ Sex Irlhd e (M/DIY) /../Af ~ 1 J"',1 L/L City or Town ' ' Stete //G ...;1/- .?.s-c. / SSNo. 77 . Age /~~f/'; Zip Phone No. ./. J., )11 /..7</.1' ~#2-" . Address Itf'~J;" S"-,,,.- ~"""'G Py6' - /,;1 .1.r Relationship to Insured ...:s-o h Relatlohshlp 10 Insured BENEFICIARY 4'./:/z.o"" City ,7i 1/ /l7./hr (Atter payment under any assignments, remaining proceeds arela be paid to the estate of the Insured unless a beneficiary Is specified above.) /,;;;, "tV Zip SSNo. R E Q U E S T E o l3"'SINGLE PAVMENT PLAN 0 Certificate .r'0.:7 ~-~? ,i'/? Premium $ /}f) Face Amount $ 0 Rider , o MULTIPLE PAYMENT PLAN In lieu of the deeth benefit d.scrlbed, we may Issue a c.rUficat. Years providing an Immedlat. death benefil equal to the face amount If the Premium Face AmI. $ . Insured signs the enrollment lonn and the followtng questions are Payable answered "'no." . Premium $ OPTIONAL HEALTH HISTORY (Multiple Payment Plens) 1. Is the Insured now bedddd.n, or currently admitted to or been DEATH BENEFITS ON THE MUL T/PLE PAYMENT PLAN ARE LIMITED advised 10 enter a hospltal,nurslng home, hospice program, or AS FOLLOWS: ' any extended care facility; or been diagnosed as having or been Years Premium Pavable treated fer AIDS or ARC? 0 YES 0 NO Less than 5 years 1st Year = 50% of Face Amt. 2, Within the past five y.ars has the Insured been diagnosed or 2nd Year = Face Amt. trealed for any of the following aliments? 5 years or greater 1st Year = 35% of Face Amt. Hearl Disease Liver Disease Alcohol Abuse - 2nd Year Cl 70% of Face Amt. Circulatory Disease Kidney Dlsease Drug Abuse 3rd Year = FaceAmt. Stroke Anemia Nervous Disorder It death by accident during the limited period, the face amount Is payable. Lung Disease Cancer o YES ONO Diabetes . '0 Semiannually o Quarledy o Multiple BIII- (Ust other policies for C-O-M or MB) Payment Method o Monthly o Annually o Dlrecl Bill o Check.Q-Matic (See Reverse) Dividends ~hase Additional Insurance o Accumulate at Interest o Paid In Cash o Reduce Premium Replacement-Will the proposed certificate replace any existing life insurance or 8MUity contracts? OVe. ~'(If .Yes.' complete replacement papers) B E N E F I T S DECLARATIONS-To the best of my knowledge and belief, all statements and answers on this enrollment form are complete and true. It is agreed that no insurance shall take effect unlilthe premium has been paid and a certificate has been issued while the insured is living. I certify, if I am applying for insurance on behalf of the Insured,' that I have an insurable interest in the proposed Insured's life, and have full authority to use hjslher funds as premiums on the insurance applied for. I have paid $ ~'W.? '" " with this enrollment form. S/gneda! ~AC,..< /'A Date /1/.3/0'/ ~ ...em State ,~~~ Signature of AppllcanVOwner (If other than Proposed Insured) Signature of Proposed Insured David M. Slat, Executive Director, Blair Se~ior Services, Inc. as Har ap 0 eraon ~ a e o~ u~s. . er . Agent latement: jjy my signature I certny that, to the best of my knowledge, all Information contained In this enrollment form i correct, was recor ed a urately, and confirm this enrollment form was signed In my presence. Agent ':\ '-a( No. -2...LL1~L -__~ SecurltyOpUon o Advantage Option hite - Homesteaders; White - Homesteaders: Pink - Provtder; Canary _ Owner PRENEED FUNERAL AGREEMENT AND ASSIGNMENT EXHIBIT 1 - STATEMENT OF FUNERAL MERCHANDISE AND FUNERAL SERVICES NOTE: TInS AGREEMENT IS TO BE FUNDED BY THE ASSIGNMENI' OF INSURANCE BENEFITS FORTHEBENEFITOFL"",,',,&) ~~.- /~;?o/..NI4J'" 4/",.,,,,,, /'h' /d.tf,~/ (Funeral Recipient/Insured) (Address) (phone) IN AGREEMENT WITH AND ASSIGNMENI' TO ,c; //A:n,// s;;..,>i/ h_,~_/ /~~, 7:~ (Funeral Provider Name) $ Transfer of Remains to Fnneral Home $ If beyond a mile radius, which is our service area, there will be a charge of $_ per mile one way. Family Carls) _at $ each $ Limousine Hearse $ Cremation $ Forwarding/Receiving Remains $ Other Services/Facilities/Equipment (Specify) $ 1$ I TOTAL GUARANTEED MERCHANDISE NON-GUARANTEED CASH ADVANCES $ Escort $ Grave Opening and Closing $ Memorial Cards/Book $ Clothing (Specify) $ Monument/Marker $ Engraving $ Other (Specify) $ $ We charge you for our services in obtaining: TOTAL NON-GUARANTEED CASH ADVANCES GUARANTEED PROFESSIONAL SERVICES Services of Funeral Director and Staff Embalming (See Agreement and Below') Other Preparation Visitation _ Days at $ /Day Fnneral Ceremony/Memorial Service Other Use of Facilities and Staff (Specify) $ $ $ $ $ TOTAL GUARANTEED SERVICES Death Certificates Flowers Music Honorariums Obituaries Hairdresser Shipping Container Other (Specify) at$ 1$.. TOTAL GUARANTEED AND NON-GUARANTEED FUNERAL PRICE GUARANTEED MERCHANDISE Casket Manufacturer Model Name Model Number I Exterior Description Interior Description Outer Burial Container Model Name Model Number I Manufacturer Constructed of Other Guaranteed Merchandise (Specify) $ $ $ $ 1$ $ $ $ $ $ $ $ $ $ , 1$ ~&.,/.O() SFc:' ( AJ#"c"~d "REQUIRED PURCHASES-charges are only for those items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items, we will explain the reasons in writing below. EXHIBIT 1 ABOVE AND THE PRENEED FUNERAL AGREEMENT AND ASSIGNMENT ON THE REVERSE SIDE SHALL CONSTITUTE THE TERMS AND CONDITIONS OF THIS AGREEMENI'. David M. Slat, Executive AG~. NT AND SIGN"'f,ElY.{ BY, Director, Blair Senior AGREEME T ND prANCE BY: X : .,' ~ 'fV.AJl.YI.. ~Services. Inc. 1/ ..... / (~lw1!~fPwdlaser) ~rson & es~:t~;~.n(Date~< 3/0-1 (Si ' rovider' . edRepresentative) J';ri~~:P" /~.JD /.7<.41 ~o:}:;'is w. MUle ~n-/o1.JS- oPJ.?f /f/"04.d <f1u<7n,,~ .YP"~}?s:J) (Address) , (phone) (Location) (phone) .4/ktJ.,<l ?/J /(',.1.. /)/ ,AJ/./c,o",,,, PA /~C.C) / (City, State) f (Z;p) (City, State) , (Z;p) HOME SALES ONLY: You, the Buyer, may cancel this transaction at any time prior to the third business day after the date of this transaction. See the attached Notice of Cancellation form for an explanation of this right. POOI-A ClHLC, 1995, All rights reselVed. No use or reproduction without express permission. Rev. 03/10/95 Copies: Original - Homesteaders Life CompanYi Pink - Provider; Canary - Purchaser X~G. I.\'''R''-- ,\,"" .... .'", '.' ;,"'': . '~:lI.~~ME~TE~DERs ..' " '. ;' . ". . LIFE COMPANY ASSIGNMENT OF OWNERSHIP (IRREVOCABLE) . Box 17561 Des Mol...., IA 50306-1756 I 600-477,3633 f1.'}.b~~"f -:(.":"':~:-~: .., p -, .' ~',:;; . .;.", "~ll;I~~~~~~BI.l:'ASSIGN~ENT TO ,F4NER~l HOME/MORTUARY. The undersigned hereby irrevocably assigns, ;li"!!' 'C:(Nole: lhi5Iorm'does not aSsign death beliefits to the funeral home.) . ~~&i'\.tr~~~te~~;~~dJ~liveJS to )::: /??"~.rT// .5::, tL/ ~_,,~j .~~ 7::"". the c(::.:.;_, '. " ; . "'_ (Funeral HQme/Mortuary). . . :~';"""~~n~;~hlp righ~ ,under the policYlcertifi~ate insuring the life of 4'n jaJ, . ~~ ~ '~;lk;F'i~:--:-:' '-":~'-~""', " -f ; ;.~. . " . , '. _ (ns red Name) . ..'/;I:,/'"i' Said 'assignment shall. be contingent upon the Funeral Home/Mortuary assigning ownership rights to the Trustees of the ., ,~:;C:..'Funeral AssUrance Trust in accordance with paragraph 2 below. I retain the right to change the beneficiary/assignee of . ;g,'?t~i,;:lthe Poli~ylce~jfjcate ioth,: funer~l. hOme ,?f my choice. Notwithstanding the foregoing, the undersigned shall retain : " ':I'-~'\ phySlc~ltUstOdy of the polocylcert,f,cate of Ins,urance. 'f~~~'i',"-'- :':',1' ,"~ . l'-:.' "". H; i"~:I.. <-:~;" ~ , ';;, 'UNDERSTAND THAT,BY ASSI(:ONING MY OWNERSHIP RIGHTS TO THE FUNERAL HOME/MORTUARY, I CAN NOT SURRENDER MY POLICY/CERTIFICATE FOR THE cASH VALUE OR RECEIVE ANY REFUND FOR ANY PREMIUMS PAID AFTER THE "j io bAY RIGHT"TO-CANCEl PROVISION DESCRIBED IN THE POLICY/CERTIFICATE. '(1" ..~ x ~.. . ~ fA...\ ~ Il4Dl/ Signature or PolicylCertificate Owner Date David M. Slat, Executive Director, ~lair Senior Services Inc. as Guardian of Person & Estate for Louis W. Miqler . ~~'~i~;~~6~i~i~'AS~;GNMENHOTRUsrEES OF FUNE~AL ASSURANCE TRUST. In accordan~e with paragraph 1 .")',''':.,' above 'aNd a'; atepresentalive of the Funeral Home/Mortuary listed above, the undersigned hereby irrevocably assigns, I~>. transfer.r'aM'delivers td the Trustees of the Funeral Assurance Trust, as Nominee, under the Trust Agreement dated WfAptit.'l,'.j99S.... (conformed copy of which appears on the reverse side hereoO, the ownership rights under the t,:P<>,' ','It, '91t/!hific~teinsUting thelif:, of the i~sured as specified a~6ve. This Assignment shall be irrevocable. and will not '. be' a(teredj' amended, revoked, 'or termmated, m whole or In part, by the underSIgned. The undersIgned hereby ~renouNcesid.f.hilf\self ahy ihterest, either vested or contingent, including any reversionary right or possibility of reverter (1 itrarid IinhE!'tidlky/ceriificate assigned to Trustees, and any power to determine or control, by alteration, amendment, ..?levocaliot1, 'tlt tehnihation, or otherwise; the beneficial ownership or control of the policylcerlificate. X Sign .f .-. PoliCYlCertifi~ate Num~er (l~ be filled in by Homesleaders Ufe Company) , ,~'", -,,-J A(:Cl:P"rANCE. >.the Trustees of the Funeral Assurance Trust have agreed pursuant to the terms of said Trust to accept bWNership 6(th~i'iidlii:y/certificate assigned herein. The Trustee shall be deemed to have accepted' this assignment upon feceipt by saId Trustees of a properly executed assignment in the Home Office of Homesteaders life Company and upon IssUance of t~e policy/certificate assigned hereunder. . "; '0 '. ~hiteIH,?meste~ders life Company Pink/Funeral Establishment Canary/Owner OHlC, 2001, All rights reserved. No use or reproduction without express permission. IN THE MATTER OF THE PERSON & ESTATE OF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA LOUIS MILLER AN ALLEGED INCAPACITATED PERSON: NO. 21-02-482 ORPHANS' COURT : ORPHANS' COURT DIVISION ORDER OF COURT AND NOW, this 15TH day of FEBRUARY, 2005, based upon the attached letter from Lindsay Baird, Esquire, court appointed counsel for Respondent Lewis Miller, his request for an audit is DENIED. Ms. Baird is directed to submit her invoice for legal services rendered to the Guardian of the incapacitated person who is authorized to pay it on behalf of Mr. Miller. Edward E. Guido, J. Anthony L. DeLuca, Esquire ) 113 Front Street P.O. Box 358 Boiling Spri.", Po, 17007 ' Lindsay Dare Baird, Esquire 37 South Hanover Street Carlisle, Pa. 17013 - c\ \ 1;,(\. C 0~., , ..:c 1.2L 2 ()cS :sld ;.,~, U1 I...D ~ . COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION O.c. NO. 21-02-482 r; ";.-~ r -I EST A TE OF LOUIS W. MILLER AN INCAPACITATED PERSON c_.:-: FINAL REPORT OF GUARDIAN OF THE PERSON ,-.j (_: .=~ r-..~~i 1. I, Blair Senior Services, Inc. (Name of Guardian) was appointed Plenary guardian of the person by Decree of Edward E. Guido, J., (Plenary or Limited) dated August 13, 2003. This is my final report for the period from August 1,2005 to January 24 , 2006. (the "Report Period"). 2. Age of the incapacitated person: 74 years. Date of Birth: August 18, 1931 3. Living arrangements: a. Last address of the incapacitated person: Hollidaysburg Veterans Home PO Box 319 Hollidaysburg, P A 16648 b. The incapacitated person's residence was: _ own home/ apartment ~ nursing home _ boarding home/personal care home _ guardian's home/ apartment _ hospital or medical facility _ relative's home (name, relationship and address) other: c. The incapacitated person has been in the present residence since, February 14, 2005 . If the incapacitated person has moved within the past year, state change and reason(s) for change: Louis was transferred from Personal Care to the Nursing Home facility of the Hollidaysburg Veterans Home due to a decline in his physical health and a need for a higher level of care. ~ d. Name and address of the incapacitated person's primary caregiver: Hollidaysburg Veterans Home PO Box 319 Hollidaysburg, P A 16648 4. The major medical or mental problems of the incapacitated person are as follows: Depression, sip Carcinoma (head and neck) with radical surgery, Old Acute Cerebrovascular Disease, Vascular Dementia, Chronic Artrial Fibrillation, Chronic Ethanol Abuse, Neurogenic Bladder, Hypothyroidism, Aspiration Pneumonia, Severe OralfPharyngeal Dysphagia with Aspiration, and Anxiety . 5. Specify what, if any, social, medical, psychological and support services the incapacitated person was receiving: Consumer had received care by registered nurses, licensed practical nurses, and certified nurses aides. He was also seen monthly and as needed by his Primary Care Physician, Dr. Janakiraman. Mr. Miller had participated in activities at the Hollidaysburg Veterans Home as much as he was capable. 6. It is my opinion as guardian of the person that the guardianship should: (Check One) continue be modified ---X- be terminated. (Briefly explain your response). Louis Miller expired January 24, 2006. 7. During the report period, I have visited the incapacitated person ~ times with the average visit lasting 0 35 *SEE ADDENDUM* (Hrs. Min.) The report 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. 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. Date: ~~~ 3 , 200$" ~~~ Signature David M. Slat, Executive Director Name of Guardian (type or print) Blair Senior Services, Inc., 1320 12th Avenue Address Altoona, Pennsylvania 16601 City, State, Zip (814) 946-1235 Telephone Number ADDENDUM Number and Lengths of time the guardian has visited Mr. Miller during the report period: 1. Direct Contacts -5visits lasting in duration from 15 minutes to 1 hour, totaling 3 hours and 00 minutes during the reporting period between August 1, 2005 through January 24, 2006. 2. Collateral Contacts - a total of 23 hours and 00 minutes during the reporting period between August 1, 2005 through January 24, 2006. 3. Total hours of contacts Direct and Collateral- 26 hours and 00 minutes during the reporting period between August 1, 2005 through January 24, 2006. .. J COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION O.c. NO. 21-02-482 (-=-~ L...:."".... r-:'~ -) C) ESTATE OF LOUIS W. MILLER AN INCAPACITATED PERSON . ~J (,.,1..) r<, FINAL REPORT OF GUARDIAN OF THE ESTATE I, Blair Senior Services, Inc. (Name of Guardian) was appointed Plenary guardian of the estate by Decree of Edward E. Guido / J./ (plenary or Limited) dated August 13 / 2003. This is my final report for the period from August 1 / 2005 to T anuary 24 / 2006. (the "Report Period"). I. SUMMARY A. Value of principal assets at the beginning of The Report Period? (See Inventory if first report, otherwise, last report) $ 13,463.90 B. Total amount of income earned during the Report Period? $ 13/541.83 C. Total amount of all expenditures made for care and maintenance of the Incapacitated Person during the Report Period? $ 13,668.79 (1) (2) From Principal From Income $ 126.96 $ 13/541.83 D. Total amount spent for all other purposes during the Report Period? $ 1,197.60 E. Total amounts remaining at the end of the Report Period? (1) Principal $ 12,139.34 (2) Income $ .00 (3) Total (1 & 2) $ 12,139.34 pj. I II. ADDITIONAL INFORMATION (If more space is needed, attach additional pages) A. Principal: (1) Total amount remaining at the end of the Report Period $ 12,139.34 (2) How is principal currently invested? (Please specify, i.e., real estates, certificates of deposit, restricted bank accounts, etc.): Interest bearing checking account at Citizens Bank ($ 12,139.34) (3) Have there been any expenditures from principal during the Report Period (check one) ~ YES NO (4) Did you receive any principal assets during the Report Period which were not included in the Inventory or a prior report filed for the Estate? (check one) YES ~ NO If you answered YES: (a) Did you receive Court approval prior to receiving additional principal? (check one) YES NO (b) State the sources and amounts of the additional principal you received: $ $ $ B. INCOME: (1) State sources and amounts of income received during the Report Period (i.e., Social Security, Pension, Rents, etc.): Social Security Veterans Pension Checking Account Interest Total income received during Report Period I (2) How is income currently invested? (Please specify, restricted bank accounts, client care account, etc.) Interest bearing checking account at Citizens Bank (Blair Senior Services Consumer Escrow Account) C. Specify what payments were made for the care and maintenance of the Incapacitated Person (i.e., clothing, nursing home, medicine, support, etc.) Nursing Home monthly payment, Health Insurance premiums, Medical expenses and Clothing. D. Specify what other payments were made during the Report Period. (Do not include any items stated in response to question C above.) Consumer spending money, Blair Senior Services' fees, and Legal fees. 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. Date: 7-~ a 3 .2006 ~J2 fAA~ Signature David M. Slat, Executive Director Name of Guardian (type or print) Blair Senior Services, Inc., 1320 12th Avenue Address Altoona, Pennsylvania 16601 City, State, Zip (814) 946-1235 Telephone Number 401-03 AlLEGHENY STREET P.O. BOX 415 HOWDAYSBURG, PENNSYLVANIA 16648-0415 814.695.7581 FAX: 814.695.1750 Other OffIces: 99 NASON DRIVE P.O. BOX 5 ROARING SPRING, PA 16673 814.224.5162 102 W, PENN STREET. SUITE 1 BEDFORD, PA 15522 B14.623.7B17 FAX: 814.623.8740 JAMES S. ROUTCH CLYDE O. BLACK, II BENJAMIN I. LEVINE. JR. J. MICHAEL DOREZAS MICHAEL B. MAGEE AMY ORR ROSENSTEEL MICHAEL P. ROUTCH KATHY J. MAUK W1LUAM R. BRENNER NATHAN W. KARN SUZANNE H. RHODES www.eveyroutchblack.com MERUi K. EVEY OF COUNSEL Reply to Hollldaysburg Office WRITER'S DIRECT DIAL: February 7, 2006 Register of Wills of Cumberland County Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 RE: Louis W. Miller, an incapacitated person Docket No.: 21-02-482 Dear Sir or Madam: Enclosed please find a final guardianship report to be filed on behalf of Blair Senior Services, Inc. in regard to Louis W. Miller, as well as a filing fee check in the amount of $15.00. Please time stamp the additional copies and return the same to me in the self-addressed, stamped envelope provided. Thank you for your attention to this matter. Please feel free to contact me if you have any questions or require any additional information. Sincerely, (/:;/1" . i'~'1 ' ,,'J V,L/[JA {iUA it'l r'\.. c{ '<---1 Amy Orr Rosensteel AOR/cab Enclosures EVEY, ROUTCH. 1LAa: DOIlEZAS. MAGEE" UVlNE UP COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION O.c. NO. 21-02-482 ESTATE OF LOUIS W. MILLER AN INCAPACITATED PERSON ANNUAL REPORT OF GUARDIAN OF THE ESTATE I, Blair Senior Services, Inc. (Name of Guardian) was appointed Plenary guardian of the estate by Decree of Edward E. Guido, J" (plenary or Limited) dated August 13 , 2003. This is my annual report for the period from August 1 ,2004 to Julv 31 C) ,0 -~J .~ = ~, ~:; G) I. SUMMARY A. Value of principal assets at the beginning of The Report Period? (See Inventory if first report, otherwise, last report) $ 17,233.85 ---') -~) - ,-1 :~ -"- -::r:J I'n "") b fj f~-h C'J " Cl , -f1 .., -~ ,-~., ~'i':-l 2005. (the "Report Period"). D . ". W -I B. Total amount of income earned during the Report Period? $ 26,696.48 c. Total amount of all expenditures made for care and maintenance of the Incapacitated Person during the Report Period? $ 23,107.68 (1) (2) From Principal From Income $ .00 $ 23,107.68 D. Total amount spent for all other purposes during the Report Period? $ 7,358.75 E. Total amounts remaining at the end of the Report Period? (1) (2) (3) Principal Income Total (1 & 2) $ 13,463.90 $ .00 $ 13.463.90 Jt; II. ADDITIONAL INFORMATION (If more space is needed, attach additional pages) A. Principal: (1) Total amountremaining at the end of the Report Period $ 13,463.90 (2) How is principal currently invested? (Please specify, i.e., real estates, certificates of deposit, restricted bank accounts, etc.): Interest bearing checking account at Citizens Bank ($13,463.90) (3) Have there been any expenditures from principal during the Report Period (check one) -L YES NO (4) Did you receive any principal assets during the Report Period which were not included in the Inventory or a prior report filed for the Estate? (check one) YES -L NO If you answered YES: (a) Did you receive Court approval prior to receiving additional principal? (check one) YES NO (b) State the sources and amounts of the additional principal you received: $ $ $ B. INCOME: (1) State sources and amounts of income received during the Report Period (i.e., Social Security, Pension, Rents, etc.): Social Security Veterans Pension Checking Account Interest Total income received during Report Period (2) How is income currently invested? (Please specify, restricted bank accounts, client care account, etc.) Interest bearing checking account at Citizens Bank (Blair Senior Services Consumer Escrow Account) C. Specify what payments were made for the care and maintenance of the Incapacitated Person (Le., clothing, nursing home, medicine, support, etc.) Nursing Home monthly payment, Medical expenses and Oothing. D. Specify what other payments were made during the Report Period. (Do not include any items stated in response to question C above.) Consumer spending money, Blair Senior Services' fees, Legal fees, and Prepaid Burial Fund. 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. Date: Au..~+ -3 .2005 ~ . . ~ c:::,.~ Signature David M. Slat. Executive Director Name of Guardian (type or print) Blair Senior Services. Inc., 1320 12th Avenue Address Altoona. Pennsylvania 16601 City, State, Zip (814) 946-1235 Telephone Number COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION O.C. NO. 21-02-482 EST ATE OF LOUIS W. MILLER AN INCAPACITATED PERSON ANNUAL REPORT OF GUARDIAN OF THE PERSON 1. I, Blair Senior Services, Inc. (Name of Guardian) , was appointed Plenarv guardian of the person by Decree of Edward E. Guido. J., (Plenary or Limited) dated August 13. 2003. This is my annual report for the period from AUlmst 1, 2004 to July 31 , 2005. (the "Report Period"). 2. Age of the incapacitated person: 73 years. Date of Birth: August 18, 1931 3. Uving arrangements: a. Current address of the incapacitated person: Hollidaysburg Veterans Home PO Box 319 Hollidaysburg, P A 16648 b. The incapacitated person's residence is: _ own home/ apartment l nursing home _ boarding home/ personal care home _ guardian's home/ apartment _ hospital or medical facility _ relative's home (name, relationship and address) other: c. The incapacitated person has been in the present residence since, February 14,2005 . If the incapacitated person has moved within the past year, state change and reason(s) for change: Louis was transferred from Personal Care to the Nursing Home facility of the Hollidavsbure Veterans Home due to a decline in his physical health and a need for a hieher level of care. d. Name and address of the incapacitated person's primary caregiver: Hollidaysburg Veterans Home PO Box 319 Hollidaysburg, P A 16648 4. The major medical or mental problems of the incapacitated person are as follows: Depression, sfp Carcinoma (head and neck) with radical surgery, Old Acute Cerebrovascular Disease, Vascular Dementia, Chronic Artrial Fibrillation, Chronic Ethanol Abuse, Neurogenic Bladder, Hypothyroidism, Aspiration Pnuemonia, Severe OralfPharyngeal Dysphagia with Aspiration, Anxiety and SfP Peg Tube Insertion. Louis receives all nutrition and hydration via Peg Tube. 5. Specify what, if any, social, medical, psychological and support services the incapacitated person is receiving: Consumer receives care by registered nurses, licensed practical nurses, and certified nurses aides. He is also seen monthly and as needed by his Primary Care Physician, Dr. Janakiraman. Mr. Miller participates in activities at the Hollidaysburg Veterans Home as much as he is capable. 6. It is my opinion as guardian of the person that the guardianship should: (Check One) ~ continue _ be modified _ be terminated. (Briefly explain your response). It is the opinion of the guardian that the guardianship must continue due to the incapacity of Mr. Miller. 7. During the past year, I have visited the incapacitated person 11 times with the average visit lasting 1 00 *SEE ADDENDUM* (Hrs. Min.) The report 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. 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. Date: f)u~+--3 .2005 ~J"~~ Signature David M. Slat, Executive Director Name of Guardian (type or print) Blair Senior Services, Inc., 1320 12th Avenue Address Altoona, Pennsvlvania 16601 City, State, Zip (814) 946-1235 Telephone Number ADDENDUM Number and Lengths of time the guardian has visited Mr. Miller during the past year: 1. Direct Contacts -11 visits lasting in duration from 15 minutes to 2 hours and 30 minutes, totaling 10 hour and 30 minutes during the reporting period between August 1, 2004 through July 31, 2005. 2. Collateral Contacts - a total of 32 hours and 15 minutes during the reporting period between August 1, 2004 through July 31, 2005. 3. Total hours of contacts Direct and Collateral- 42 hours and 45 minutes during the reporting period between August 1, 2004 through July 31, 2005.