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HomeMy WebLinkAbout02-0645 IN THE MA TIER OF THE PERSON AND ESTATE OF: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA CARL M. DEIBERT, AN ALLEGED INCAP ACIT A TED PERSON ORPHANS' COURT DIVISION NO. ~\-(;l- (~Lf5 PRELIMINARY DECREE AND NOW, this day of ,2002, upon consideration of the annexed Petition, it is hereby ORDERED AND DECREED that a Hearing on this matter is set for the " -t\ day of ~, 2002, at NO' ~ _ . !VI. O'clock in Courtroom No. S at the Cumberland County Courthouse, 1 Courthouse Square, Carlisle, Pennsylvania. r't ~ ~ I ~l+-- is appointed to represent the allegedly incapacitated person. J. IN THE MATTER OF THE PERSON AND ESTATE OF: : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CARL M. DEIBERT, AN ALLEGED INCAPACITATED PERSON ORPHANS' COURT DIVISION NO. ..;:>a- OOl-l.4s PETITION FOR APPOINTMENT OF EMERGENCY GUARDIANS OF THE PERSON AND NOW COMES THE PETITIONER, the Area Agency on Aging in and for Cumberland County, Pennsylvania who represents and avers as follows: 1. The Petitioner is the Area Agency on Aging, in and for Cumberland County, with its office located at 16 West High Street, Carlisle, Cumberland County, Pennsylvania. 2. The alleged incapacitated person is Carl M. Deibert, married man, age 79, who resides at 703 Alison A venue, Mechanicsburg, Cumberland County, Pennsylvania and has resided there with his wife for a period of one (1) year prior to the filing of this Petition. 3. The only known relatives of the alleged incapacitated person are: a. Marian E. Deibert - Wife 703 Alison Avenue Mechanicsburg, P A 17055 b. Christine L. Lemke - Daughter 130 Spring Drive Dillsburg, Pennsylvania 17019 c. Linda L. Deibert - Daughter 24 Butternut Lane Mechanicsburg, Pennsylvania 17055 '. 4. Carl M. Deibert, has, for at least three (3) months, been incapable of managing and caring for himself and his financial affairs. 5. Carl M. Deibert exhibits symptoms of mental incapacity, including but not limited to dementia. 6. Carl M. Deibert's mental incapacity prevents him from managing and caring for the affairs of his person and estate. 7. On or about June 10, 2002, Carl M. Deibert apparently fell from a chair, suffered a hip injury resulting in him being taken by ambulance to the Carlisle Regional Medical Center where he was admitted and stayed until his discharge on June 21, 2002 when he entered the Sarah Todd Nursing Home for rehabilitation. 8. On or about June 27, 2002, Marian E. Deibert was advised that Medicare coverage would terminate because her husband was not able to participate in the appropriate therapies for him. 9. On or about June 28, 2002, Marian E. Deibert arrived at the Sarah Todd Nursing Home and withdrew her husband from the facility against the recommendation of medical personnel there. " 10. Investigation by Petitioner's authorized representative indicated that, while Carl M. Deibert was at the Sarah Todd Nursing Home for rehabilitation, he required total care for eating, bathing, personal hygiene including toilet matters, transferring and ambulation. II. While at the Sarah Todd Nursing Home for rehabilitation, Mr. Deibert was also incontinent of bowel and bladder. 12. On or about July 5, 2002, Linda Deibert, daughter of Carl M. Deibert, went to see her father and found Mrs. Deibert outside, hanging up the wash, and upset about her husband. 13. Mrs. Deibert advised Linda Deibert that Carl M. Deibert had fallen in the house days ago and was on the floor. 14. When Linda Deibert attempted to go into the house to see her father, Mrs. Deibert tried to stop her by saying that he was fine, was resting and should not be disturbed. 15. When Linda Deibert entered the house, she found her father lying on the floor in his bedroom and was told by her mother that he had been there for three (3) days, that she was able to feed him a little, but that he would not eat anything on that day, July 5,2002, and just clenched his teeth. 16. While lying on the floor over that three (3) day period, Mrs. Deibert advised Linda Deibert that she would clean Mrs. Deibert and the surrounding carpet after his period of incontinence. 17. An ambulance was called by the daughter on July 5, 2002 and he was transported to Holy Spirit Hospital. 18. Investigation by the Petitioner's authorized representative indicated that Carl M. Deibert did not respond to command nor did he open his eyes when he was moved into the ambulance. 19. The Emergency Medical Technicians were advised that he had not eaten or drank anything for the three (3) day period. 20. Carl M. Deibert was admitted to Holy Spirit Hospital in Camp Hill, Pennsylvania on Friday, July 5, 2002 and Marian E. Deibert advised that her husband had falJen out of a chair onto the floor on July 2,2002 and that she had not been giving her husband his medications of aspirin and zyprexa. 21. While at Holy Spirit Hospital, Carl M. Deibert has been diagnosed with the following conditions: a. Large stage 3 decubitus area on the left thigh II X 8 cm, with black, necrotic tissue and two other open areas on the left thigh. b. Dementia; c. Prior Cardio Vascular Accident (stroke); d. Urosepsis (infection in the blood stream); e. Dehydration; f. Malnourishment; g. Rhabdomyolosis-muscle condition brought on by dehydration; and h. Was unresponsive for several days. 22. A psychiatric evaluation was conducted of Car! M. Deibert at Holy Spirit Hospital with the conclusion that Carl M. Deibert is not capable of making medical decisions and that he needs supervised, 24 hour, extended care facility level of care. 23. Carl M. Deibert, the alleged incapacitated person, is scheduled for discharge from Holy Spirit Hospital on Friday, July 19,2002. 24. The Petitioner believes and, therefore, avers that discharging Carl M. Deibert to his wife's care and return home would place him in imminent danger of death or serious bodily harm. 25. On or about July 15, 2002, Petitioner's authorized representative met with Mrs. Deibert and others and, when asked why she left her husband lying on the floor for four (4) days, she responded that "They told me to." She then added that she hears voices, that the voices told her to leave him lying there and that while he was lying on the floor he was "in a hospital." 26. On or about July, 2001, Mrs. Deibert made a bizarre telephone call to one of her neighbors which resulted in the call being investigated by the police. 27. Petitioner believes and, therefore, avers that Marian E. Deibert, wife ofthe alleged incapacitated person, is not capable of providing the appropriate care for her husband, Carl M. Deibert. 28. Petitioner believes and, therefore, avers that Carl M. Deibert should be placed in a nursing home facility. 29. Less restrictive alternatives are not available because there is no one able to care for him. 30. Christine M. Lemke and Linda 1. Deibert are willing to accept the appointment of Emergency Co-Guardians of the Person of Carl M. Deibert. 31. No other Court has ever assumed jurisdiction in any proceeding to determine the incapacity of Carl M. Deibert. 32. The failure to appoint Christine 1. Lemke and Linda 1. Deibert as Emergency Co-Guardians of the Person of Carl M. Deibert prior to his discharge from Holy Spirit Hospital on July 19, 2002 will result in irreparable harm to the person of Carl M. Deibert. WHEREFORE, Petitioner prays that this Honorable Court appoint Christine 1. Lemke and Linda 1. Deibert as Emergency Co- Guardians of the Person of Carl M. Deibert. Respe~tfullY Submitted, n /' /~~rYAs?;k~ ~~~y-L.DM 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 Emergency Guardians of the Person of Carl Deibert 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: .J\..>\'-I n. 2002- , d~*Y~ Janet Paull 1\ .. IN RE: CARL M. DEIBERT AN ALLEGED INCAPACITATED PERSON IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-2002-0645 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 ofthe petition which has been filed by AREA AGENCY ON AGING is attached. You are hereby ordered to appear at a hearing to be held in Court Room No. ~, Cumberland County Courthouse, Carlisle, Pennsylvania, on AUGUST 5 ,2002, at 4:00 ~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 a jury 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 C \ '. 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. By: 'rvtQ.,~~f C "iZtl.(,00J~tlv Ii ~1YJ/lllrjlpl~ Clerk, Orphans' Court Division ' I} Cumberland County, Carlisle, P A My Commission Expires 151 Monday, January, 2006 c IN THE MATTER OF THE PERSON AND ESTATE OF CARL M. DEIBERT, AN ALLEGED INCAPACITATED PERSON IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-02-645 ORDER OF COURT AND NOW, this 19th day of July, 2002, after hearing, we find by clear and convincing evidence that Carl M. Deibert is an incapacitated person. Christine L. Lemke and Linda L. Deibert are appointed co-guardians of the person of Carl M. Deibert and shall serve in this capacity until further order of court. Further hearing in this matter is scheduled for August 6, 2002, at 4:00 p.m. By the Court, J. , Anthony L. DeLuca, Esquire :?l1cu}jjJ.) For Area Agency on Aging \. f{ f( DL Mark Bayley, E~quire -~te~ For Carl M. De~bert II N '1/qQL Area Agency on Aging srs ,. l IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF THE PERSON AND ESTATE OF CARL M. DEIBERT, : NO. 21-02-645 ORPHANS' AN ALLEGED INCAPACITATED PERSON ORPHANS' COURT DIVISION AMENDED ORDER OF COURT AND NOW, this 19TH day of JULY, 2002, the order of court dated today scheduling a hearing for August 6, 2002, is amended to reflect that the hearing will be on MONDAY, AUGUST 5, 2002, at 4:00 p.m. in Courtroom #5. Edward E. Guido, J. Anthony L. DeLuca, Esquire For Area Agency on Aging Mark Bayley, Esquire For Carl M. Deibert Area Agency on Aging :sld IN THE MATTER OF THE PERSON AND : IN THE COURT OF COMMON PLEAS OF ESTATE OF: : CUMBERLAND COUNTY, PENNSYLVANIA CARL M. DEIBERT, AN ALLEGED INCAPACITATED PERSON: ORPHANS' COURT DIVISION NO. 21-02-645 CITATION TO THE ALLEGED INCAPACITATED PERSON To: CARL M. DEIBERT: We command you to appear at a hearing in the Orphans' Court of Cumberland County, to be held in Courtroom No. ~ of the Cumberland County Courthouse, on August 5. 2002, at 4:00 o'clock P.M.., to show cause why you should not be adjudged an incapacitated person and Permanent Plenary Guardians appointed for your person and estate. J. ......; IN THE MATTER OF THE PERSON AND : IN THE COURT OF COMMON PLEAS OF ESTATE OF: CUMBERLAND COUNTY, PENNSYLVANIA CARL M. DEIBERT, AN ALLEGED INCAPACITATED PERSON: ORPHANS' COURT DIVISION NO. 21-02-645 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, 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 Cumberland County, with its office located at 16 West High Street, Carlisle, Cumberland County, Pennsylvania. 2. The alleged incapacitated person is Carl M. Deibert, married man, age 79, who, up until recently, resided at 703 Alison Avenue, Mechanicsburg, Cumberland County, Pennsylvania but who now is a resident of ManorCare Nursing Home, 1700 Market Street, Camp Hill, Cumberland County, Pennsylvania. 3. On July 17, 2002, Petitioner filed a Petition for the Appointment of Emergency Guardians ofthe Person of Carl M. Deibert, an alleged incapacitated person. A copy of said Petition is attached hereto, marked as Exhibit "A" and incorporated herein by reference. 4. An Emergency Hearing was held on July 19, 2002 and, at the conclusion of said Hearing, the Court found that Carl M. Deibert is an incapacitated person and appointed Christine L. Lemke and Linda L. Deibert as Co-Guardians of the person of Carl M. Deibert. 5. A further Hearing is scheduled for August 5, 2002 at 4:00 P.M. before Judge Edward E. Guido in Court Room #5, Cumberland County Courthouse, Carlisle, Cumberland County, Pennsylvania for the purpose of appointing Permanent Plenary Guardians of the Person of Carl M. Deibert. 6. Christine L. Lemke and Linda L. Deibert are willing to accept the appointment of Permanent Plenary Co-Guardians of the Person of Carl M. Deibert 7. Petitioner believes and, therefore, avers that Carl M. Deibert's ability to receive and evaluate information effectively and communicate decisions in any way is impaired to such a significant extent that he is partially or totally unable to manage his financial resources. 8. Petitioner believes and, therefore, avers that Marian E. Deibert, wife of Carl M. Deibert, is not capable of handling the financial affairs of her husband. 9. Pennsylvania Guardianship Association, Inc., 1253 Wabank Road, Lancaster, Pennsylvania 17603 is willing to accept the appointment of Permanent Plenary Guardian of the Estate of Carl M. Deibert. WHEREFORE, Petitioner prays that this Honorable Court appoint Christine L. Lemke and Linda L. Deibert as Permanent Plenary Co-Guardians of the Person of Carl M. Deibert and Pennsylvania Guardianship Association, Inc. as Permanent Plenary Guardian of the Estate of Car! M. Deibert. Respectfully Submitted, ~6Z~ Anthony L. DeL ca, Esquire 113 Front Street P.O. Box 358 Boiling Springs, PA 17007 (717) 258-6844 VERIFICA nON I hereby verifY that the facts and information set forth in the foregoing Petition for Appointment of Permanent Plenary Guardians ofthe Person and Estate of Carl Deibert 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: <:::..)JvI sD 2.0cY2.. J ~~<2Y~ Janet Paull IN THE MATTER OF THE PERSON AJ.'ID ESTATE OF: : IN THE COURT OF COMMON PLEAS OF CUMBERLAt'ID COUNTY, PENNSYL V Mfu\ CARL M. DEIBERT, AJ.'1 ALLEGED INCAPACITATED PERSON ORPHAJ.'1S' COURT DrvrsroN NO. PRELINfINARY DECREE At';']) NOW, this day of , 2002, upon consideration of the 3JDleXed PetItIOn, it is hereby ORDERED Ae'ill DrCREED :}'31 a Hearing on this matter issetforthe ICj"t\ daYOf~,2002,at /4J(J',.j _ .,'nO'c\ockir: Courtroom No. S at the Cumberland County Courthouse, 1 Courthouse Square, Carlisle, Pennsylvania. JV1 ~ ~ I ~g. is appointed to represent the allegedly Lnc3.pac~tated person. L;~" c c ~- ~ ~ 1. '"i EXH:I:BIT "A" f.::~~~~~~~~~'?;~~--"~~-~~"~~-,--:;.-,/,,,-:,~~,-"'-~ ;"o'-:;_._-~- ,-:-- ,... ~._-~~ IN THE MATTER OF THE PERSON .","'iD ESTATE OF: IN THE COURT OF COMMON PLEAS OF CUMBERL",""TI COU1'iTY. PENNSYL VA~1A CARL M. DEIBERT, A~'1 ALLEGED INCAPACITATED PERSON ORPHANS' COliRT DrvrsloN NO J /- C.) -{ '!) PETITION FOR APPOINT'vlENT OF EMERGENCY GL\RDL"..NS OF THE PERSON A)jU "\IOYV' COMES THE PETITIONER. the Area "..genc\ or. ."..ging In and r~Y Cumberland County. Pennsylvania who represents and avas as rallo,,\s. The PetitlOner lS the Area .:-\genc~,i on Aging. in JTJ tor Cumber-Jane: County. .:~; 'ts ofr~c:: located at 16 \Vest High Stre::l. ('ar~lsl;::. C\irnoe<~;.nd COiJrE\-. Penr:S\;\:2:i:~:. The alleged ;ncapacl!:.1teJ person '5 Car! \1 De:be:""':. Tamed ::--::2n. age ~9. 'X;lU resides at -0.3 .-\.li5011.-\ venue. \fechamcsburg. Curnbe:-]a!1(: C~)Llnl'" P2nnsyh-:ln:2. 2n':~ has resided theloe \vlth his wife for a period 'Jfone (1'1 ':ear :)nor ~o :he fling of this . . - Petition , .J. The only known relatives of the alleged incapacitated person are: a. Marian E. Deibert - Wife 703 Alison A venue 'vlechanicsburg, PA 17055 b. Christine L. Lemke - Daughter 130 Spring Drive Dillsburg, Pennsylvania 17019 C. Linda L Deibert - Daughter 24 Butternut Lane Mechanicsburg, Pennsylvania 17055 4. Carl M. Deibert, has, for at least three (3) months, been incapable of managing and caring for himself and his financial affairs. 5 Carl M. Deibert exhibits symptoms of mental incapacity, including but not limited to .je:nenna. 6 Cari\l. Delbert '1 rnental mcapac:ty' pre',-en[s nlfn from nlana~~!:!g anci :aring r'or 'he J_f~':J.lrs ofhlS Dcrson cind -:Sldle Or:,~'r J.Dout :T~e :).21,,'il):::. Carl \1. Deice:'~ :il;pa.r'enr:~. :cli J.~hJ:!'. s~.t~fe:'='~-; J :~lD :nJ\Jry resulting 1n rlHT1 being taken hv ambulance :0 [he Carlisle Reg:oE:l: \kdIC3.: '::~r::e;- ',<",-ere ~e :~;15 :J0mrtted aDc s\ayec iJfltl: his ,-~i.3c:1J~~e on June::: ~. .20(<2'.';h-;;:~ ~':~ ~;:tered the Sarah Todd \:ursing Home for rehabi1iutlon. 8. On or about June 27. 2002, 'v[artan E. Delbert was advised that .'vledicare coverage would temlinate because her husband was not able to participate in the appropriate therapies for him. 9. On or about June 28, 2002, Marian E. Deibert arrived at the Sarah Todd "iursing Home and withdrew her husband from the facility against the recommendation of medical personnel there. 10. lnvestigation by Petitioner's authorized representative indicated that, while Carl \1. Deibert was at the Sarah Todd Nursing Home for rehabIlitation, he required total care for eating. bathing, personal hygiene including wi let maners. transferring and ambubtion I: \Vhlle at the Sarah Todd 'iursing Home :eh~1jl!:~,'iti('::;_ \!r Delber:_,.\~~S j!S(l mcontincnt <}fbo\vei Zlnd bladder. 1 = On 'Jr- about J)J~:; ). 20U2. linci:.: Deibe:-'u '-'~~L<S"_' \1 )e:l"~':':, ,:::.;:~- "-:e:" ~':~~her~'.nd t~lur:d \11"5. Del:,e~' ,_,:!tside. '...::-; iDS.:?- 1~" ~Lsh:.:.n(: ,'. \frs. Deiben adVIsed Linda Deibert :~h2t C'2.r: \[ De:':Je:-: :13.d ~alJen :n the ::o~15e days ago and was on the noor. j.! When Linda Deibert attempted to go into the house to see her father. '\[rs. Delbe:' tried to stop her by saying that he was [ine, was resting and should not be disturbed. 15. Wnen Linda Deibert entered the house. she found her father lying on the Hoar in his bedroom and was told by her mother that he had been there for three (3) days, that she was able to feed him a little, but that he would not eat anything on that day, July 5, 2002, and just clenched his teeth. 16. While lying on the floor over that three (3) day period, ylrs. Deibert advised Linda Deibert that she would clean Mrs. Deibert and the surrounding carpet after his period of incontinence. 17. ".II Clmbulance was called by tl,e daughter on July 5. 2002 and he was transporvcd to Holv Spirit Hospital. IS h\'~St1gatlOn by the Petitioner's Juthor:zeJ re~r~s,:ntJ.ti';;e ~ndlcat-ed that Car! \1 Oeiben jid :10t respond to ':01nrnJ~d no!' Jid he open II::; eyes '.\he:, he ',\"ClS ;l~o\'ed leu:) :':c .2!'~l;t:la.nce. >9 The En1ergency \kdic:!: TeCIu'licians '.\e:"c Jd\":scc ~h~.E :1<:: ':12(i :lot e3.~~':', 2nytbcg tor the three (3'; day period. 20. Carl M. Deibert was admitted to Holy Spmt Hospital in Camp Hill, Pennsylvania on Friday, July 5,2002 and 'vlarian E. Deibert advised that her husband had failen out of a chair onto the floor on July 2, 2002 and that she had not been giving her husband hIS medications of aspirin and zyprexa. 21. While at Holy Spirit Hospital, Carl y!. Deibert has been diagnosed with the following conditions: a. Large stage 3 decubitus area on the left thigh 11 X 8 em, with black, necrotic tissue and two other open areas on the left thigh, b. Dementia; c. Prior Cardio Vascular Accident (stroke); d. Urosepsis (infection in the blood stream): e. Dehydration: f. Malnourishment; g. Rhabdomyolosis-muscle condition brought on by dehydration: and h. \Vas unresponsive tor severa! d3\S !") A psychjatric evaluatlOn \vas conducted of Car: \1 Deibert dt Hoh Splnt t-10::i;:J',UI \v1r11 the conclusion that Car!:'v1. Deiber1 is :10~ '::1pabic _l:':nat-.:1ng medico.! Jcc:sions ~nd :hat 1.e needs supen lScl1. 2J DOllL cx:endeJ -:J.I... :':'C~ll~ . , . ~c\ej lJj care. Y':, Carl :\f. Deiber:. rhe alleged incapucr2[:d :)ers,_,q, 'S scheduled r~)r .jjsC::1arge ior:--: ~:)~~, Spint Hospital on Fnda:., hd: () ""'J. The Petitioner believes and, therefore, avers that discharging Carl \1. Deibe:c ;0 his wife's care and return home would place him in imminent danger of dearh or serious bodily harm. 25. On or about July 15,2002, Petitioner's aurhonzed representativ'e met with Mrs. Deibert and others and, when asked why she left her husband lying on the !loor for four (4) days, she responded that "'They told me to." She then added that she hears voices, that the voices told her to leave him lying there and that while he was lying on the floor he was "in a hospital." 26. On or about July, 2001, Mrs. Deibert made a bizarre telephone call to one of her neighbors which resulted in the call being investigated by the police. y' -' . Pewioner believes and, therefore, avers that Marian E. Deibert. wife of ~he alleged Jncapacitated person. is not capable of providing the appropnate care for her husband. Carl ,,1 Deibert. 1S. PetltlOner belie"v";:?s and. therefore. d\'ciS :h3.t Car] \1. Deibert sho~lic ce Jl2.c:.:>d in J :1~lrsiEg home facilit:,. :>) Less resrDctivc alternatives Jre :lot ,J..\"ailabie because there :5 110 c'~~e 2.bie w .:~~r~ , ~ !T. . 30, Christine ,,1. Lemke and Linda L Deiber; are willing to acceDt :he apDoi,,~mer,[ of Emergency Co-Guardians of the Person of Car! ,,1. Deibert. 31. No other Court has ever assumed Jurisdiction in any proceeding to determine the incapacity of Carl M. Deibert. " '? 0_. The failure to appoint Christine L. Lemke and Linda L. Deibert as Emergency Co-Guardians of the Person of Carl \;1. Deibert prior to his discharge from Holy Spirit Hospital on July 19. 2002 will result in irreparable hanD to the person of Carl \;1. Deibert. \VHEREFORE. Petitioner prays chelt ,his Honorable Court appomt Christine L. Lemke and Linda L Deiben ].5 Emergency C'o-- (Ju::.rdiJ.ns of the Person ofCurl.\,l. Delbert. 9~sDectfu[1>' Subrrlltted. --- ~:,...( /" I '/ /' / . I I. ".j .~--,:..-<./ \ / /~"-~"L . ~n:hon: L De L'u\.: 2.. ESl'...I;: 1 i 3 Front Street D () Box 3.:'8 Gelling Spr:ngs, p_~\ - .., ~ -j ~53-6S..1~ _:<.,=:; ~~. C.c::t,_ . . .. " . VERITICA nON I hereby verify that the facts and information set forth in the foregoing Petition for Appointment of Emergency Guardians of the Person of Carl Deibert are true and correct to the best of my knowledge, information, and beljef j understand that any false statements contained herein are subject to the penaltIes of i 8 Pa. C.S Sectlon -1901. relating to unswom falsification to authonties. T::ne: P:lull ____ ________..__m____________ _______ f ---- IN THE MATTER OF THE PERSON AND ESTATE OF CARL M. DEIBERT, AN ALLEGED INCAPACITATED PERSON IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-02-645 ORDER OF COURT AND NOW, this 5th day of August, 2002, after hearing, we find by clear and convincing evidence that Carl M. Deibert is an incapacitated person. Christine L. Lemke and Linda L. Deibert are appointed permanent plenary co-guardians of the person of Carl M. Deibert. Pennsylvania Guardianship Association, Inc., is appointed permanent plenary guardian of the estate of Carl M. Deibert. The pennsylvania Guardianship Association, Inc., shall be entitled to the payment of a reasonable fee. In the event that this is not a Medicaid case, the guardian of the estate shall submit annual statements to the Court detailing fees charged and the work performed. By the Court, E. Guido, J. Anthony L. DeLuca, Esquire For Area Agency on Aging Mark F. Bayley, Esquire For Carl M. Deibert Area Agency on Aging srs " ~ AUTHORITY TO PAY COURT APPOINTED COUNSEL 1. COURT o District Justice }( Common Pleas 0 Appellate 0 Other 3. FOR IDJ.(t.i')APPEllATE) 4. AT 'SU:V/STATE). . \ ^ f', 11 "-../ (O~\\'LSUL ,/t- 6.~!:LTHE,A:~SE. OF u\ \ 11/\ _ De~b2f t 7. CHARGE/OFFENSE IPURDON CITATION) ~V\ \~IL-' ~. vs 9. PROCEEDINGS (Describe briefly) 11. PERSON REPRESENTED I .' , ' \ _' 1 0 Oelel"ldal"lt - Adult uvc'\. \ c-.\.~ C\II\~V\\~ 2 0 Defendant.Juvenile 1 3 0 Appellanl 4 0 Appellee 5 0 Habeas Pefitioner 6 0 MaterialWllness T 0 Parolee Charged With Violation 10. PERSON REPRESENTED (Full Name) 8 0 Probationer Charged Will'l Violation I CD,\ \ ~\.;\ Df'; ~crf 9 Jii Oth"A\IeSQ~.\ Sl,\(:CjlC.CkkJ AUG 0 7 700<' ~ ~ ~ 2. VOUCFJ~ 6657 6. }\U,DG,,: ;~DE l r..... {J/~;2.>f1- (~.i{/-OSU 8. 0 PETTY OFFENSE o FELONY 0 MISDEMEANOR 12.'e1VlLDOCKET NO. Or p0"" So ___ 'c..1 - O'L-(:,Lf-2J 13. CRIMINAL DOCKET NO 14. APPEALS DOCKET NO. 16. NAME OF ATTORNEY/PAYEE AND MAILING ADDRESS M c..i'L .I25Lo,--r \e () t.~ S1- u ii' c. \S.=) S. \-\C,v<c'/<?C S+. C c,l' "c;\e , ~A. /7e\( 'S App! Date ,\ v \ 'I t:~(GvL"I J C:. (U I J C' NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE 17. TELEPHONE No. 2'-11 (,076 CLAIM FOR SERVICES OR EXPENSES 19. SERVICE DATES HOURS t- o:: :J o U Z a. Arraignment and/or Plea b. Preliminary Hearing c. Motions and Requests d. Bail Hearings e. Sentence Hearings I. Trial 9. Revocation Hearings h. Juvenile Hearings I. Appeals Court j. Other (Specify on additional SheetsJG\..-'c...~J ~<-..V\.'Sl~', ~ . TOTAL HOURS,.. 1.'-" 7-i'l-0(.. t ;?..5-0Z. X~?;;RHOUR ~ $ 1;' \ 0 D s.:c A\-\-c.L\.",d <;~j- 20A. TOTA.l OUT OF COURT COMPo /' X~'5pERHOUR =$ I Co9J .7) 20. a Interviews and conferences b. Obtaining and reviewing recorda c. Legal research and brief writing d. Investigative and omer work (Specify on additional sheets) '<-1'\ ....... 00:: ....:J :JO OU TOTAL HOURS = 21. ITEMIZATION OF REIMBURSABLE EXPENSES MileaQe $.25 per mile x I.-Jr, AMI. PER ITEM 10..DO 0:: W :I: .... o 22. CERTIFICATION OF ATTORNEY/PAYEE Has compensalion and/or reimbursemenl for work In this cae. previously been applied for? 0 YES a(NO II yes. were you paid? 0 YES 0 NO If yes, bywhom were you paid? How much? Has the person represented paid any money to you, or to your knowledge anyone else. In connection with the matter for which you were appointed to provide represerl,illlon?~ YES tf NO If yes, give details on additional sh~ets I swear or affirm the truth or conectness J,;' \ ^. ':;. ~ - G:.:,> - z._ ::~::;;~"::~ S~::::,:':, "'. ~Omey/P.'.. G/~ J ~ :'. """'"' I Juoo. ",.. ~ .0.,., 0 1 [ l;I ,.. Copy 1 - Mail to Court Administrator at completion of service 18. SOCIALSECUAfTYNO OR EIN NO L 0-()O~(3cGg AMOUNTS CLAIMED Multiply rate per hour limes total hours 10 obtain ~ln Cour1~ com. pensation. Enter lotal below. 19A TOTAL IN COURT COMPo Multiply rate per hour times total hours. Enter total "Oul of Cour1~ compensation below. 21A. TOTAL ITEMIZED EXP. -$ \0.00 23. GRAND TOT~L CLAIMED -$ ZS''t. IS 24. DEDUCT. PRIOR PYMTS. =$ - 25. NET AMOUNT CLAIMED =$ Ls'J.7':J 27. AMT. APPROVED ~ = $.). ~,..,..... '" , . I 20(d.) 7-18-02 7-18-02 7-18-02 7-18-02 7-29-02 7-31-02 8-3-02 8-6-02 Total: Review petition Attempt to contact Anthony Deluca Phone wi Anthony Deluca Visit client at Holy Spirit Hospital Review orders Phone wi Anthony Deluca Review petition Miscellaneous .3 .05 .3 2.2 .2 .1 .3 .3 3.75 hs Nl' ING HOME ADMIS J INQUIRY DATE:~~.=2.L-- Name SS# / J7 7 ~/ ..1 ;;{ R t? (J PermilnenlAddress' 7/.5 -? ,.4L/sr7",y/t/C) 7(EcA_-2U"/',-,<:,,dt/~G, I.J /7('t<-.\~ Telephon.L 717) c:::; '? 7 _ Cf R!:,5 Bu1hdate:, 7' 8'-,2" Marital Status )t4.(.e~f.Qion: /' //-r-"?,cE,Ll/f Name of Spouse: 11.4 jl ;',4 h' F P r- ; CJ Elf' I Is applicant a U.S, Citizen?& N NAME RELATIONSHIP HOME # WORK # n~n 0UL~nL JL~V~~Lv I U.A" 1.1-' .../'.&- ...,..!.'-"'-' Primary Contact: Secondary Contact: Power of AlIomay: 71 A- R ;,4 IV .Eft /6J?R"t- " TE A- 1-1 c-:: / If! " 11(' hJ/~ ;:- . (717) ~9'7 .:Jerli'6 / ~ .c">' '-.J1.sr6'~ 7b/~ a.2it .- Family PhYSician: AdmissiOn Requested: ~ Includes Heallh Care Clause? _ Y N NO POA - /,;Z <:) ~ /'-- 6"""',....,1-- ,~C; ,C i 0 L E ~ ~ ,0 ;-r4 L Address . Phone _Short-term _Long .term _Uncertain PASSAR: Ive any complications from Ihe PASSAR process anticipated? YES NO Other hospital or nursing home slays in Ihe last 60 days? _NO ~ Yes Specify: (!1f~J..ic,LE~C)..Urtl1l.l'1Foir ""L C~rV7.t:-.e _ SARA /n-r,fl FA-I',; ">-r ~ " Is applicanl presently hospitalized? _NO Hospital: c> i ffuJf'<;wc Primary Insurance: ~ES If yes specify: Social WorkmC)1i ,oR Ii' ; Admission date: -1/ .-9-w' K. Phone 7-S 6~ /~ 3-..3<> 7,J>' INSURANCE INFORMATION ... please includa policy numbers, group number. phone numbers Secondary Insurance: Prescription Plan~ R. Long Term Care Insurance: . MONTHLY INCOME: Pension 7:J. r;, 0 0 Social SeCUrity~ /, ~:J 1 ' () () Annuity Income: ~ ~' ASSETS: NAME OF BANK AMOUNT Checking: 4....61.- ~ I R. S r . ~ .y~ 60('), Cl 0 1'\..Il.'IAtI &, " ,'-fI~;I,.sr?/...,..;",,(( 9 7bO~OO Savings:,SYA-TP 1:""l\>L~UFr-')UG:Olr(L..~ ' 'Z- ~I .---/ ' C.O.D.'s ' other: ~ Life Insurance ---- ./ Face Value Policy Owner: ~ Who is Covered: .~ Real Estate: No..0'ES:Location 7/.J...-5 4L/stJl\1 I/;.JF /Y113c!..h value,s/-.:],,;- z:-~.,...o. ""~ - ;' I ~ . Have any assets been transferred in the last three years? NO ~ES_ If yes, list asset and date of transfer Person Completing this form: ~.4 f< i.4 tV E fie'I/f&"G rRelationship 10 applicant plea print ;' ~ ;.- ..form /1122 inlUtatGd 4/97; revised 11/98, 2J99 EXHIBIT PC1--,h011..U'S , 'ffi...S I 4 ,~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION INRE: MARIAN E. DIEBERT NO. 21-02-1138 DATE OF APPOINTMENT 1/13/03 INVENTORY OF ASSETS DATE: 06/4/03 C)c. -::: (n d :0 :::::; ", S7WO~ DESCRIPTION 0' (MONTHLY) L. 52~.'tiO SOCIAL SECURITY , c:: z I CUSTODIAL ACCOUNT @ PAGA 0\ 317420.27 :J;::;:o '.,' ..' BANK 1 CHECKING ACCOUNT - 79~1:84 ~ " PERSONAL NEEDS ACCOUNT 00.00 PENSION 00.00 TOTAL CASH ASSETS HELD FOR WARD (BY PAGA) 317,420.27 TOTAL MONTHLY INCOME 528.00 TOTAL MONTHLY COST OF CARE 2500.00 TOTAL MONTHLY GUARDIANSHIP FEE 250.00 Narrative: PAGA was appointed guardian of the person and the estate on 1/13/03. P AGA has acquired or has documented all known assets for the ward. This wards Social Security benefits have been redirected to P AGA . P AGA acquired and disbursed funds on her behalf. Mr. Diebert died on 5/2/03. He had Real property co-owned with his wife, Marion. PAGA is the guardian ofthe person and estate for Mrs. Diebert. The property was sold at public auction on 5/30103 for $147,000.00. This amount is above the assessed value of the property. That transaction is now pending court approval from Judge Hoffer, Cumberland Co. P A. Carl. Diebert's assets transferred to Marion Diebert per his will at his death. " , Pennsylvania Guardianship Association Inc. PAGA PO Box 7295, Lancaster, PA 17604 (717)-299-4568 I (717)-940-7599 FAX# (717)-299-5540 I certity under the penalties of 18 Pa. C.S. sls 4904 (relating to unsworn falsification to authorities ) that the information contained in this report is true and correct to the best of my knowledge, information and belief. DATE: ~/"'/~:$ is//~o. 6,4 !i ' 19nature President Position '. ITEMIZED CATEGORY REPORT 1/ l' 0 Through 6/30' 3 PAGA_CUS-PAGA Custodial 6/ 4' 3 Date Num Description Memo Category Page 1 -------- ------ ------------------ ------------- --------------- - ----------- Clr Amount 2/11' 3 2/11' 3 2/12' 3 2/25' 3 3/31' 3 4/ 3' 3 4/ 3' 3 4/ 3' 3 4/ 3 I 3 5/ 5' 3 6/ 4' 3 INCOME/EXPENSE INCOME DEIBERT, MARION 3007 ET 3039 3071 3157 S R8223 R8224 R8225 R8226 R8235 ET HALL SERVICES MARION DIEBERT PLATINUM PLUS FOR PLATINUM PLUS FOR PAGA GENERAL ACCOU DEPOSIT DEPOSIT DEPOSIT DEPOSIT DEPOSIT DEPOSIT TOTAL DEIBERT,MARION TOTAL INCOME TOTAL INCOME/EXPENSE DEIBERT,MARION/ DEIBERT, MARION/ 403647000030- DEIBERT,MARION/ 403647000030- DEIBERT,MARION/ DEIBERT,MARION/ 1/2 BANK / IR DEIBERT,MARION/ BANK TRANSFER DEIBERT,MARION/ BANK TRANSFER DEIBERT,MARION/ BANK TRANSFER DEIBERT,MARION/ REAL ESTATE S DEIBERT,MARION/ BANK TRANSFER DEIBERT,MARION/ -2,313.45 10,000.00 -639.57 -111.50 -1,500.00 24,966.20 2,408.67 28,462.48 52,663.83 300.00 203,183.61 317,420.27 317,420.27 317,420.27 ----------- ----------- .. c. , IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION INRE: CARL M. DIEBERT NO. 21-02-645 DATE OF APPOINTMENT 8/5/02 INVENTORY OF ASSETS DATE: 06/4/03 G('~' ~ ~; " 8 ::0 ~J n ~S DESCRIPTION L, c=: .' $"1\MotJNr SOCIAL SECURITY (MONTHLY) 0'\ 1824.00 , ~ " CUSTODIAL ACCOUNT @PAGA ~"".. 00.QO .. BANK / CHECKING ACCOUNT \0 00.00 PERSONAL NEEDS ACCOUNT as of3/31/02 00.00 PENSION 00,00 TOTAL CASH ASSETS HELD FOR WARD (BY PAGA) 00.00 TOTAL MONTHLY INCOME 1824.00 TOTAL MONTHLY COST OF CARE 00.00 TOTAL MONTHLY GUARDIANSHIP FEE 250.00 Narrative: PAGA was appointed guardian of the person and the estate on 8/5/02. P AGA has acquired or has documented all known assets for the ward. This wards Social Security benefits have been redirected to go to ManorCare Camp Hill, P A. P AGA acquired and disbursed funds on his behalf. Mr. Diebert died on 5/2/03. He had Real property co-owned with his wife, Marion. PAGA is the guardian of the person and estate for Mrs, Diebert. The property was sold at public auction on 5/30/03 for $147,000.00. This amount is above the assessed value of the property. That transaction is now pending court approval from Judge Hoffer, Cumberland Co. P A. Carl. Diebert's assets transferred to Marion Diebert per his will at his death. '. . Pennsylvania Guardianship Association Inc. PAGA PO Box 7295, Lancaster, PA 17604 (717)-299-4568 I (717)-940-7599 FAX# (717)-299-5540 I certifY under the penalties of 18 Pa. C.S. sls 4904 (relating to unsworn falsification to authorities) that the information contained in this report is true and correct to the best of my knowledge, information and belief. lJATE: 0/'-1103 1Sl'k- a- A)'(~ 19nature President Position Recorci ." R-' ' IN THE COURTO~F 1~~O:t1t~~AS OF DAUPHIN COUNTY, PENNSYLVANIA ORPHANS' COURT DMSION l.' INRE: ~I:tnin~acitatedperson FILENO.;:) 1-02-& LIS Fmelt ( GUARDIAN OF THE ESTATE <\"Ml'TTT-A!:: REPORT [20 Pa.C.S.A. 5521 (e)] FROM Avt1J~'.5 ,2002. TO r:/J.- ,2003 1) I am the _Limited ./' Plenmy Guardian of the Esl4te of my ward, named above. I was appointed Guardian by Order of the Court dated ALUM,,( .5 DJ. which _was ~ was not modified by Court Order(s) datedV I . 2) Is the incapacitated person still living? N 0 If no, answer the followin~:A (a) DateofDeiith m({Lj 2, ZCXJ3 (b) Place of Death f\.(lt(1o((JJ.-(e COj?lp\,\,\\ (e) Name of Administrator/trix or Executor/trix (d) Date Guardian of the Person filed the last Annual Report NoNe PLEASE ANSWER THE FOLLOWING QUESTIONS WHETHER THE INCAPACITATED PERSON IS LIVING OR DECEASED. 3) My initial Inventory was filed on ~ k /0 "3 and listed a total estate value of $ - 0 . The Inventory listed a total monthly income of $ ~ 3/1(; C5Z> comprised of the following: i) At the 6g date of this reporting period, my initial balance on hand was C.A. - 28 ~ 01GuJ~ 5) During this reporting period, the following reflects all sources of income (other than social security) received by me for my ward: (Add additional pages if needed) Date Received 1. 2. 3. 4. s. 6. Source of Income TOTAL Amount 6) During this reporting period, ,the following retlects all payments I have made for my ward: (Add additional pages if needed) ,Date 1. 2. 3. 4. s. 6. To Whom Paid Reason for Payment Amount TOTAL 7) The present principal assets of my ward are: 1. Descriution of Asset Present Value 2. h ~o J! 1=1-', Soe~ 't 3. 4. 5. 6. TOTAL 8) The present amount and sources of income for my ward are: Source of Income Amount of Income (Indicate whether monthly, quarterly, annually) L 2. 3. 4. 5. 6. 9) The regular monthly expenses of my ward which I pay are: To Whom Paid Amount L 2. 3. 4. 5. 6. Fh .+: 10) 1 havelhave not (circle one) petitioned the Court for permission to invade principal to meet the needs of my ward. (If applicable) The fonowing expenses of my watd have been paid from principal: To Whom Paid Puroose Amount 1. 2. 3. 4. 5. 6. 11) 1 havelhave not (circle one) paid myself compeosation for services I rendered as guardian. The amount 1 Paid myself totaled $ "3'3f1sD' 00 and was calculated at the rolfo~ rate: $ J /J7) . (1) per weekl~circle one). + 600 ~ 'fe.-a- 12) Check the correct response and complete, if appropriate. / --L There will be no need for extraordinary expenditures on behalf of my ward in the next (12) months. _ There well be a need for extraordinary expenditures on behalf of my ward in the next (12) months because: 13) Check the correct response and complete, 'if appropriate. ---C.A. My ward receives monthly social security benefits directly. _ B. 1 am the designated payee to receive my ward's social security benefits. Ic. The designated payee of my ward's social security benefits is whose address is ~. Ct'~ 0 ~ 1. JJ and is/is not (circle one) related to my ward as (insert relationship). 14) Please note any concerns about the incapacitated person's physical 'ilr mental well being or the finances that the Court should know. dec eCLS(' (~ 15) I / am am not guardian of the incapacitated person's person. If yes, report is attached. I certify under the penalties of petjury that the information contained in this report is true and correct to the best of my knowledge, information and belief. Name: IS/v-- .0. 6foVtfi TelephoneNo.(Home)(7I1L:.Y9-'fS'v? Address:- (Work)(] i 7') ZC1'i . 'i r&!l PA 1:;1 JtlPf)'ilN~fflP MSOt. P,'':". "?') Lancaster, PAil Ov4. 7295 PA GUARDIANSHIP ASSOC. P.O.BOX 7295 Lancaster, PA'17604-7295 ITEMIZED CATEGORY REPORT 1/ I' 0 Through 6/30' 3 PAGA_CUS-PAGA Custodial Page 1 6/ 4' 3 Date Num Description Memo Category Clr Amount -------- ------ ------------------ ------------- --------------- - ----------- INCOME/EXPENSE INCOME DEIBERT, CARL ------------ 12/ 9' 2 2857 MANORCARE CAMP HIL DEIBERT, CARL/CO -14,473.39 12/ 9' 2 2859 NEIGHBORCARE PHARM DEIBERT,CARL/ME -349.52 12/1.:L' 2 2893S PAGA GENERAL ACCOU GDN FEE DEIBERT,CARL/GU -1,750.00 12/12' 2 R5566 DEPOSIT BANK TRANSFER DEIBERT,CARL/BA 22,786.23 12/12' 2 R5567 DEPOSIT BANK TRANSFER DEIBERT,CARL/BA 14,607.12 12/12' 2 R5568 DEPOSIT BANK TRANSFER DEIBERT,CARL/BA 123,799.82 12/18' 2 2920 GEORGE TROUT FIX DOOR DEIBERT,CARL/FI -300.00 1/ 9' 3 295 METRO MED SERVICES DEIBERT,CARL/TR -128.00 1/ 9' 3 2935 NEIGHBORCARE PHARM #50385 CARL D DEIBERT,CARL/ME -175.72 1/ 9' 3 2958 MANORCARE CAMP HIL DEIBERT,CARL/CO -12,784.78 1/15' 3 2962 TINA LEMKE DEIBERT,CARL/PE -34.85 1/21' 3 2982 JOHNSON,DUFFIE,STE DEIBERT,CARL/LE -1,543.00 2/ 5' 3 3000 HARRISFIELD DEIBERT,CARL/HO -4,526.75 2/ 6' 3 3003S PAGA GENERAL ACCOU GUARDIAN FEE DEIBERT,CARL/GU -500.00 2/11' 3 3008 REGISTER OF WILLS INVETORY FEE DEIBERT, CARL/CO -10.00 2/11' 3 ET MARION DEIBERT DEIBERT,CARL/BA -10,000.00 2/12' 3 3019 NEIGHBORCARE PHARM #50385 CARL D DEIBERT,CARL/ME -175.72 2/18' 3 3051 MANORCARE CAMP HIL DEIBERT,CARL/CO -6,231.00 3/ 6' 3 3110 NEIGHBORCARE PHARM #50385 CARL D DEIBERT,CARL/ME -29.57 3/12' 3 3140 MANOR CARE CAMP HIL DEIBERT,CARL/CO -6,239.00 3/27' 3 3156 PLATINUM PLUS FOR 403647000030- DEIBERT,CARL/TA -193.99 3/31' 3 3157 S PAGA GENERAL ACCOU DEIBERT,CARL/GU -500.00 4/ 3' 3 R8223 DEPOSIT BANK TRANSFER DEIBERT,CARL/BA 24,966.20 4/ 3' 3 R8224 DEPOSIT BANK TRANSFER DEIBERT,CARL/BA 2,408.67 4/ 3 ' 3 R8225 DEPOSIT BANK TRANSFER DEIBERT,CARL/BA 28,462-47 4/ 3' 3 R8226 DEPOSIT BANK TRANSFER DEIBERT,CARL/BA 52,663.82 4/ 9' 3 3206 NEIGHBORCARE PHARM #50385 CARL D DEIBERT,CARL/ME -172.77 4/29' 3 3233 MANORCARE CAMP HIL DEIBERT, CARL DEIBERT, CARL/CO -6,231.00 5/ 5' 3 R8234 DEPOSIT SALE OF CAR DEIBERT,CARL/SA 300.00 5/14' 3 3308 NEIGHBORCARE PHARM #50385 CARL D DEIBERT,CARL/ME -211.66 6/ 4' 3 3345 PAGA GENERAL ACCOU GUARDIAN FEE DEIBERT,CARL/GU -250.00 6/ 4' 3 ET MARION DIEBERT TRANS TO WIFE DEIBERT,CARL/BA -203,183.61 ----------- TOTAL DEIBERT,CARL 0.00 ----------- TOTAL INCOME 0.00 ----------- TOTAL INCOME/EXPENSE 0.00 ----------- ----------- . ITEMIZED CATEGORY REPORT 1/ l' 0 Through 6/30' 3 PAGA_CDS-PAGA Custodial 6/ 4' 3 Date Num -------- ------ ------------------ ------------- ----------------- - -_.~-~~-- Clr An\ount Description Memo INCOME/EXPENSE INCOME DEIBERT, CARL 12/11' 2 2893S 2/ 6' 3 3003S 3/31' 3 3157 S 6/ 4' 3 3345 PAGA GENERAL ACCOU GDN FEE PAGA GENERAL ACCOU GUARDIAN FEE PAGA GENERAL ACCOU PAGA GENERAL ACCOU GUARDIAN FEE TOTAL DEIBERT,CARL TOTAL INCOME TOTAL INCOME/EXPENSE Category DEIBERT,CARL/GUAR DEIBERT,CARL/GUAR DEIBERT,CARL/GUAR DEIBERT,CARL/GUAR Page 1 -1,750.00 -500.00 -500.00 -250.00 -3,000.00 -3',000. C\\ -3,000.00 --------- --------- ~ . IN THE COURT OF COMMON PLEAS OF DAUPHIN COUNTY, PENNSYLVANIA ORPHANS' COURT DMSION INRE: CO'/ \ !vI",OlfbC:c\- , an incapacitated person FILE NO. 21- () 2 - Co 45 F/f1/iv I GUARDIAN OF PERSON ANNUAL REPORT [20 Pa. C.S.A. 5521 (c)] FROMA(,{0U:\t5, 2001:. TO . J 1. 1 am the _ Limited ~lenary Guardian of the Person of my ward, named above. 2. I was appointed Guardian by Order of the Cowtdated~U,,tS; i)2.~, ;;hich__~ ../was not modified by Court Order(s) dated < - 8 :P ~ _ .~l ~ 3. Is the incapacitated person still living? _~ tJ '- . C' ~ If no, answer the following: I (a) Date of Death? Mo.,y ;L /dcfJ3 a> (b) Place of Death? IYIrAflOl (eVe (lo..m()/0 II ~'-'. (c) Name of Administrator or Executor? ,",::, (d) Date Guardian of the Person filed the last Annual Report? N.o f\J Ii' ,200_ () 4. If the incapacitated person is still living, answer the following questions: (a) Date Guardian of the Person filed the last Annual Report? (b) Current address of the incapacitated person (c) Current age Date of birth of incapacitated person (d) The incapacitated person's residence is: Ward's own residence _ Nursing Home _ Hospital or Medical Facility _ My home/apartment Relative's Home _ Boarding Home (e) The incapacitated person has been living there since Ifmoved within the past year, state from where and the reason for the change CA. - Zl - " (t) I rate hislher living arrangement as: Excellent _ Average Explain: _ Below Average (g) I believe he/she is: _content with the living situation _unhappy with the living situation _unaware of the living situation 5. Physical health (a) Current physical condition of the incapacitated person is: Excellent Good Fair Poor (b) Hislher major physical health problems are as follows: (c) During the past year, his/her physical condition has: remained about the same. _ imP1:oved. Explain _ worsened. Explain (d) During the past year, he/she received the following medical treatment (include check-ups and dental work): Date Ailment Type of treatment Doctor's name 6. Mental Health (a) The incapacitated person's condition is excellent _ good _ poor (b) His/her major mental health problems are as follows: ~ (c) During the past year, hislher mental condition has: . remained about the same. _ Improved. Explain _ Worsened. Explain (d) During the past year, treatment or evaluation by a psychiatrist, psychologist or social worker _ was _ was not provided. Such mental health services are briefly described as: 7. Social Activities / Services (a) HisIher current social condition is: excellent _ good fair _poor (b) During the past year, hislher social condition has: _ remained about the same. _ improved. Explain. _ worsened. Explain. (c) During the past year he/she has participated in the following activities: recreational educational social _ occupational _ no activities available. _ he/she refuses to participate in any activities. _ he/she is unable to participate in any activities. 8. Visitation (al During the east year. I visited himlher as follows: (b) The average amount of time I spent on each visit was (c) The last time I visited was on date 9. During the last year I have performed the following activities on behalf the incapacitated person: . " 10. I believe he/she has the following unmet needs: 11. The guar~p -:- sqould '/should not be continued without modification ~me: oece~\pd 12. Please note any concerns about the InCapacitated person's physical or mental well being or the fin..nr.es that the Court should know. 13. I J am _ am not guardian of the incapacitated person's estate. If yes, my report is attached. I certify under the penalties of perjury that the infonnation contained in this report is true and correct to the best of my knowledge, information and belief. ~ LJ-~ Sl'i tore of the GUardian of e Person Date: ,,1ZN 0;:)00;..'7; I Name: bv.- D. A(~ Address: PA GUARDIANSHIP ASSOC. P.O.BOX 7295 lancaster, PA 17884-7295 . Telephone # (Home)C117) 01"1'1- l.jS bY {Workif?/7\ dqq- "f~ (Pt"