HomeMy WebLinkAbout06-05-06 (3)
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IN THE COURT OF COMMON PLEAs CUMBERLAND COUNTY, PENNSYL VANIA
IN RE:
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PETITION FOR THE APPOINTMENT
OF A PE~1ANENT GUARDIAN OF
THE PERSON AND EST ATE
ORPHANS' COURT DIVISION
PATRICIA J. SHAY,
AN ALLEGED
INCAPACITATED PERSON.
PRELIMINARY ORDER OF COURT
S~ day of ~ , 2006, the foregoing Petition
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having been presented in open Court, upon consideration thereof and on motion of Doreena
AND NOW, this
Craig Sloan, Esquire, for the Petitioner, it is ORDERED and DECREED that a Citation be
issued by the Register of Wills and directed to PATRICIA J.SHA Y, to show cause why a
Permanent Guardian of her Person and Estate should not be appointed, returnable the
17 ~ay of ~ ' 2006 at '3 ,'f) Do' clock, P.M., Prevailing
Time, in the Cumberland County Court of Common Pleas, Orphan's Court Division, Court
Room No" ?, Cumberland County Courthouse, One Courthouse Square, Carlisle,
Pennsylvania 17013-3387.
The time and place of this hearing on the petition for the Appointment of a Permanent
Guardian of the Person and the Estate of Alleged Incapacitated Person are fixed for the
11~ay of >> ,2006 at 3. 'tlOo'clock, P.M., Prevailing Time, in the
Cumberland County Court of Common Pleas, Orphan's Court Division, Court Room
No. :,
, Cumberland County Courthouse, One Courthouse Square, Carlisle, Cumberland,
Pennsylvania 17013-3387. At least (20) twenty days' written notice of the hearing on the
Appointment of the Permanent Guardian of her Person and Estate shall be given to PATRICIA J.
SHAY, the alleged incapacitated person, by serving her personally with the Citation and this
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Order of Court and a copy of the foregoing Petition together with an explanation of the content
and terms of the Petition. Additionally, at least (20) days' written notice of the petition and
hearing on appointment of a permanent Guardian shall be given to the following: All persons
residing within the State of Pennsylvania who are sui juris and would be entitled to share in the
estate of the Alleged Incapacitated Person if she were to die intestate; to the person or institution
providing residential care to the alleged incapacitated person; and to the following other parties
in interest: All next of kin. Such notice of the permanent hearing to persons other than the
Alleged Incapacitated Person shall be made Cit:~C~'.'I}) hy registered or certified mail.
Per C . am,
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lnRe: PATRICIAJ. SHAY
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 21-06-0492
CERTIFICATE OF SERVICE OF ORDER
ORDER DATE: 06-08-06
JUDGE'S INITIALS: EEG
TIME STAMP DATE: 06-09-06
IN RE: PRELIMINARY ORDER OF COURT-AND A CITATION
"""""""""""""""',"""""""""""""""""".."""""""""""""""",,','"""""""""
SERVICE TO:
DOREENA CRAIG SLOAN ESQ, CHARLES E SHAY JR.CORY L SHAY AND
TRACY D SHAY-SNYDER
METHOD OF MAILING:
ENVELOPES PROVIDED BY:
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o HAND DELIVERED
o OTHER_
o PETITIONER
o JUDGE
[8J CLERK OF ORPHANS COURT
MAILED: 06-9-06
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SERVICE TO:
METHOD OF MAILING:
ENVELOPES PROVIDED BY:
o USPS
DRRR
D HAND DELIVERED
D OTHER_
o PETITIONER
D JUDGE
D CLERK OF ORPHANS COURT
MAILED: Q
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Clerk of Orphans' Court
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IN RE: PATRICIA J. SHAY
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
An alleged incapacitated person
NO. 21-06-0492
IMPORT ANT NOTICE
CITATION WITH NOTICE
A petition has been filed with the Court to have you declared an Incapacitated Person. If the
Court tinds you to be an Incapacitated Person, your rights will be affected, including your right to
manage money and property and to make decisions. A copy of the petition which has been filed by
Tracy D. Shay-Snyder is attached.
You are hereby ordered to appear at a hearing to be held in Court Room No. J, Cumberland
County Courthouse, Carlisle, Pennsylvania, on July 17 ,2006, at 3:00 rM. to tell the
Court why it 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
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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 tinds 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 a may appoint the Guardian requested.
By:
erk, Orphans' Court Division
Cumberland County, Carlisle, P A
My Commission Expires 1 st Monday,
January, 2010
Date:06-09-06
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IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
INRE:
ORPHANS' COURT DIVISION
PATRICIA J. SHAY
No. ~ \ -'Ol~ - () L\:C~d-
AN ALLEGED
INCAPACITATED PERSON.
PETITION FOR THE APPOINTMENT
OF A PERMANENT PLENARY GUARDIAN
OF THE PERSON AND ESTATE
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Filed on Behalf of Petitioner:
TRACY D. SHAY-SNYDER
Our Matter No.
Counsel of Record for this Party:
CAPOZZI AND ASSOCIATES, P.C.
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Doreena Cnfig Sloan, Esquire
Attorney ID No. 44880
2933 North Front Street
Harrisburg, P A 17110
(717) 233- 4101
(717)233-4103
Attorneys fur Petitioner
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IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
IN RE:
) ORPHANS' COURT DIVISION
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No.
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PATRICIA J. SHAY,
AN ALLEGED
INCAPACITATED PERSON.
PETITION FOR THE APPOINTMENT
OF A PERMANENT GUARDIAN
OF THE PERSON AND ESTATE
IMPORTANT NOTICE / CITATION WITH NOTICE
A PETITION HAS BEEN FILED WITH THIS COURT TO HAVE YOU DECLARED AN
INCAP ACIT A TED PERSON. IF THE COURT FINDS YOU TO BE AN INCAP ACIT A TED
PERSON, YOUR RIGHTS WILL BE AFFECTED, INCLUDING YOUR RIGHT TO
MANAGE MONEY AND PROPERTY AND TO MAKE DECISIONS. A COPY OF THE
PETITION, WHICH HAS BEEN FILED BY ATTORNEY DOREENA CRAIG SLOAN,
ESQUIRE, IS ATTACHED.
YOU ARE HEREBY ORDERED TO APPEAR AT A HEARING TO BE HELD IN
COURTROOM NO. CUMBERLAND COUNTY COURTHOUSE, ONE
COURTHOUSE SQUARE, CARLISLE, PENNSYLVANIA 17013-3387, ON
AT O'CLOCK, .M. TO TELL THE COURT
WHY IT 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
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
EV ALUA TION BE CONDUCTED AS TO YOUR ALLEGED INCAPACITY.
IF THE COURT DECIDES THAT YOU ARE AN INCAPACITATED PERSON, THE
COURT l\1AY APPOINT A GUARDIAN FOR Y01J, BASED ON THE NATURE OF ANY
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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 OR FULL POWER 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 OR 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:
Clerk, Orphans' Court
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IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
INRE:
) ORPHANS ' COURT DIVISION
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PATRICIA J. SHAY,
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AN ALLEGED,
INCAPACITATED PERSON.
PETITION FOR THE APPOINTMENT
OF A PERMANENT GUARDIAN OF
THE PERSON AND ESTATE
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Petition For The Appointment Of A Permanent Guardian
Of The Person And The Estate Of An Alleged Incapacitated Person' .'"
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AND NOW comes Petitioner, TRACY D. SHAY -SNYDER, through her attorneys, DeSena
Craig Sloan, Esquire, of Capozzi and Associates, P.C., and presenting this Petition to this
Honorable Court for the Appointment of a Permanent Guardian of the Person and the Estate of
PATRICIA J. SHAY, an Alleged Incapacitated Person, representing as follows:
1. Petitioner, TRACY D. SHAY-SNYDER is the natural daughter of PATRICIA J. SHAY
and currently resides at 2713 Columbia Avenue, Camp Hill, PA 17011.
2. PATRICIA J . SHAY is currently a resident of Claremont Nursing and Rehabilitation
Center, a long-term care facility that is licensed to participate in the Medicaid and
Medicare programs.
3. The Alleged Incapacitated Person is PATRICIA J. SHAY, a 72-year-old female residing
pernlanently at Claremont Nursing Home. Her date of birth is October 23, 1933 and her
Social Security number is 210-26-9049.
4. Petitioner is an interested party because the Petitioner is the natural daughter of
PATRICIA J. SHAY who, by information and belief, holds one of two existing Powers
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5. PATRICIA J. SHAY, by information and belief, gave a second Power of Attorney to her
husband Charles E. Shay, who as a fiduciary has a statutory and moral obligation to act in
the best interests of the Alleged Incapacitated Person.
6. The Alleged Incapacitated Person was admitted to Claremont Nursing and Rehabilitation
Center, 1000 Claremont Road, Carlisle, P A 17013-8805, on February 4, 2005. Her prior
residence was 2713 Columbia Avenue, Harrisburg, P A 17011.
7. The Alleged Incapacitated Person is diagnosed with, among other things, Senile
Demensia Alzheimer's Type and delusions.
8. The Alleged Incapacitated Person has never served in the Armed Forces of the United
States of America.
9. The Alleged Incapacitated Person does not generally comprehend her surroundings to
such an extent that she requires consistent supervision in her activities of daily living. As
a result of her condition, the Alleged Incapacitated Person requires specific one-on-one
assistance with grooming, transferring, ambulation, toileting and bathing.
10. The Alleged Incapacitated Person is incapable of handling her personal affairs, however
minor, and if called upon to grant informed consent to any medical procedure she would
be unable to grant it because of her inability to comprehend the nature of the procedure.
Additional information is set forth in the competency affidavit, prepared by her treating
physician Dr. Ernest Josef, 1830 Good Hope Road, Enola, PA 17025, and incorporated by
reference attached hereto, and marked Exhibit "A."
11. The Alleged Incapacitated Person is not expected to recover from her current condition to
become sufficiently independent to return to the community.
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12. The Alleged Incapacitated Person has the following living next of kin:
Charles E. Shay Jr. (Spouse/POA) Tracy D. Shay- Snyder (Daughter/POA)
1926 Longboat Drive 2713 Columbia Avenue
Lakeland, FL 33810 Camp Hill, P A 17011
Cory L. Shay (Son)
328 Ridge Road
Grantville, P A 17028
13. Petitioner believes that she is the most appropriate person to serve as Guardian because
she cared for PATRICIA J. SHAY solely during the two years preceding her admission
to the nursing home; she actively participates in her mother's medical care; visits on a
regular basis, and is willing to make informed medical, personal, and financial decisions
in the best interest of Mrs. Shay.
14. Petitioner avers that Charles E. Shay Jr. has continuously refused to pay for the costs of
providing the needed care to his wife, Patricia J. Shay, and has also continuously refused
to provide information to the Department of Public Welfare to aid them in properly
determining Patricia J. Shay's eligibility for Medical Assistance.
15. The current bill for the provision of nursing home services exceeds $23,265.25 and Mr.
Shay continues to refuse to pay any portion of the bill for the care of his wife.
16. The aIIeged incapacitated person has an interest in property currently listed in the sole
name of her husband, Charles E. Shay Jr., which is located at 1926 Longboat Drive,
LakeIand, Polk County, FL., with the most recent assessed value being $116,170.00.
17. Various checking accounts, CD's and other financial instruments are or were held in the
names of Charles E. Shay 11'. and/or Patricia J. Shay and Tracy D. Shay-Snyder, some of
which Petitioner has learned were converted by Charles Shay either to his own personal
use, to new account(s), or to remodel his girlfriend's Florida home and to prevent access
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by Tracy D. Shay-Snyder, as Power of Attorney, to pay for ongoing nursing home
services for Patricia J. Shay.
18. Charles E. Shay Jr. holds a power of attorney for the alleged incapacitated person which,
on information and belief, was executed simultaneously with the power of attorney held
by Tracy D. Shay-Snyder.
19. Petitioner applied for Medical Assistance benefits on behalf of The Alleged Incapacitated
Person and was originally denied due to excess resources and the failure or refusal of
Charles E. Shay Jr. to provide verification of income, assets and expenses.
20. During the application for benefits process, the Cumberland County Assistance Office
conducted a Resource Assessment for Patricia 1. Shay and deemed that the couple's
accounts totaled $37,464.85 of which Mr. Shay's share was calculated to be $19,020.00
and Patricia Shay's share was $18,444.85 which was to be used to pay for her nursing
home care.
21. Charles E. Shay Jr., as husband and Power of Attorney, was properly notified of the
County Assistance Office's Resource Assessment and has failed or refused to release
Patricia Shay's resource share and has advised Petitioner that he will not pay for
anything.
22. Medical Assistance benefits for Patricia J. Shay have been approved pending the
appointment of a Guardian.
23. Th(;~ Incapacitated Person, Patricia Shay receIves Social Security in the amount of
$822.00 per month that is directly deposited into her joint account with Tracy D. Shay-
Snyder who then uses it to pay on the ever-increasing bill for nursing home services for
Patricia J. Shay.
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24. Petitioner requests the Guardian be assigned the following powers below described:
a. Making Medical decisions, which would include but not be limited to:
1. medication, antibiotics, hydration, tube feeding, respirator use;
11. situations related to the active dying process;
111. hospice selections;
IV. selecting or replacing the attending physician;
v. skilled care and acute care placement;
b. Maintaining order in the financial affairs of the Alleged
Incapacitated Person, which would include but not be limited to:
1. establishing the guardianship bank account;
11. marshalling the alleged incapacitated person's assets;
111. paying bills for the alleged incapacitated person, including
bills for nursing care and services;
IV. making bank deposits;
v. writing checks for expenses;
VI. performing all other acts necessary to avoid waste with
respect to the assets of the alleged incapacitated person.
25. Petitioner knows of no available less restrictive alternative to the establishment of a
Permanent Guardian of the Person and Estate of the Alleged Incapacitated Person.
26. The Proposed Guardian is Petitioner, Tracy D. Shay-Snyder, of 2713 Columbia Avenue,
Camp Hill, P A 17011.
27. Tracy D. Shay-Snyder, having no interest adverse to the Alleged Incapacitated Person,
has agreed to act as Guardian of her Person and Estate if this Honorable Court shall so
appoint. The executed Consent of the Proposed Guardian is attached to this Petition and
marked Exhibit "B."
28. If appointed by this Honorable Court, the Guardian will act in compliance with
regulations promulgated under COUli Order in Pennsylvania Bulletin 931, et seq., April
19.1975.
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29. An Application for Medical Assistance was initially denied by the Department of Public
Welfare because the application for benefits was incomplete due to the inability of
PATRICIA J. SHAY, the alleged incapacitated person, and Tracey D. Shay-Snyder, as
Power of Attorney to provide the required information and the consistent failure or
refusal of Charles E. Shay Jr. husband and other Power of Attorney, to provide the
required information.
30. The current bill for nursing home services exceeds $23,265.25.
31. As a Medicaid recipient, the Alleged Incapacitated Person is required to maintain total
assets of not more than $2,500.00.
32. As a Medicaid recipient, the Alleged Incapacitated Person will receIve a personal
allowance of $40.00 a month.
33. 20 Pa.C.S.A. 95515 states "... provISIOns relating to a guardian of an incapacitated
person and her surety shall be the same as are set forth in the following provisions of this
title relating to a personal representative or a guardian of a minor and their sureties:..."
Section 5122 (relating to when bond not required).
34.20 Pa.C.S.A. 95122 (d) states "in all other cases, the court may dispense with the
requirement of a bond when, for cause shown, it finds that no bond is necessary."
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\VHEREFORE, Petitioner respectfully requests this Honorable Court to:
1. Award a Citation directed to PATRICIA J. SHAY and others as the Court sees fit to
show cause why PATRICIA J. SHAY should not be declared an incapacitated person and
why a Permanent Guardian of her person and Estate should not be appointed;
2. Appoint Tracy D. Shay-Snyder as Permanent Guardian of the Person of PATRICIA 1.
SHAY.
3. Dispense with the requirement that the Proposed Guardian obtain a bond.
4. Decree as null and void the current Power of Attorney held by Charles E. Shay, Jr.
Respectfully submitted,
CAPOZZI AND ASSOCIATES, P.C.
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IN THE COURT OF COMMON PLEAS CUl\1BERLAND COUNTY. PENNSYLVANIA
IN RE:
) ORPHANS' COURT DIVISION
)
) No.
)
) PETITION FOR THE APPOINTMENT
) OF A PERMANENT GUARDIAN OF
) THE PERSON AND EST A TE
)
PA TRICIA J. SHAY,
AN ALLEGED
INCAPACITATED PERSON.
VERIFICA TION
I, TRACY D. SHAY-SNYDER, Petitioner in this matter, do hereby depose and state that
the facts contained in the foregoing Petition are true and correct to the best of my knowledge,
infonnation and belief. I understand that false statements made herein are subject to the
penalties of 18 Pa.C.S.A. Section 4094, relating to unsworn falsification to authorities.
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Tracy D.~hay-Snyder
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHAN'S COURT DIVISION
IN THE MATTER OF PATRICIA J. SHAY,
an Alleged Incapacitated Person No.
Petition for the Appointment of a Permanent
Guardian of the Person and Estate
Affidavit of Dr. Ernest Josef in Support of Petition to
Adiudicate PATRICIA J. SHA Y, an AlleQed Incapacitated Person
1. My name is Dr. Ernest Josef
2. My occupation is as a physician.
3. My business address is 1830 Good Hope Road, Enola, PA 17025.
4. My educational background is as follows:
a. State Medical! Graduate School
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b. State Undergraduate
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5. I am licensed by the State of Pennsylvania as Mer; {c#- t?o en "-
6. I specialize in F4/MfIt..r ""tJ1Jtc.t~e.
7. I am affiliated with Claremont Nursing and Rehabilitation Center
8. I have been affiliated with Claremont Nursing and Rehabilitation Center since Jpt-r If~:3
9. I first met PATRICIA J. SHAY in C-t./.ffltr' ""'W( A/U"J"/~ + Pt#4-(/~L" r4fN"v c~
10.
I last met with PATRICIA J. SHAY on
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11. 1 last reviewed PATRICIA J. SHAY'S chart on '-71- .?~~
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12. PATRICIA J. SHAY'S pertinent diagnoses are: ~ A?7~ - E'Nfl,!1,r 4,1/
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PATRICIA J. SHAY currently takes the medications on the list attached to this Affidavit. __ r iI
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EXHIBIT
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15.
PATRICIA J. SHAY'S prognosis is: ~ fair
good
16.
The extent of PA TRIQIAJ. SHAY'S ability to communicate is as follows:
a. Verbally \POOj-,; fair good
b. In Writing (PQQi. fair good
c Other Means (poor', fair good
D X ~ 0 0 VI c;y )1 f tr I
17.
The extent of PATRICIA J. SHAY'S ability to receive information is as follows:
a. Reading: <poou fair" good
b. Hearing: poor ( fair) good
18.
PATRICIA J. SHAY is capable of independently performing ONLY the following activities of
daily living. (Circle all that apply)
\ a~.)Eating. t~ LJ>Ltv-~:J
b. Grooming
c. T oileting
d. Transferring
e. Bathing
19.
PATRICIA J. SHAY has emotional limitations in the form of:
lJ~W5/0.,Jb
20. PATRICIA J. SHAY is ABLEIUNABLEto interact socially on any meaningful level.
If ABLE, then please describe: Although limited by her dementia.
21. PATRICIA J. SHAY does not generally comprehend her surroundings to such an
extent that she requires consistent supervision in her activities of daily living. As a
result of her condition, she requires specific one- on- one assistance with grooming,
transferring, ambulation, toileting and bathing. She absolutely could not manage any
of her own activities of daily living without supervision or assistance. @F
22. fJA TRICIA J. SHAY IS I@capable of handling her financial and personal affairs,
however minor. She requires total assistance in these areas. (VtF
23. P ~,TRICIA J. SHAY, if called upon to grant informed consent to any medical procedure,
however minor or straightforward, would be unable to grant it because of her inability to
comprehend the nature of the procedure. (]1F
24. PATRICIA J. SHAY absolutely cannot actively and effectively participate in monitoring and
managing her own medical care and medication. She requires supervision in this area. @F
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Exhibit "A"
25, PATRICIA J. SHAY's limitations relevant to this guardianship proceeding are not likely to
improve neither in the immediate future nor over time, To the extent relevant change is likely,
it will be, in my opinion, expressed with reasonable medical certainty, for the worse. (j)/F
26, I have been made aware of the statutory definition of "incapacitated person" under
Pennsylvania law. (fJF
27, My opinion, based on my examinations of PATRICIA J. SHAY and my review of her medical
records, expressed with reasonable medical certainty, is that PATRICIA J. SHAY is totally
incapacitated as to matters affecting her person, CD'F
28, My opinion, based on examinations of PATRICIA J. SHAY and my review of medical records,
expressed with reasonable medical certainty, is that she is totally incapacitated as to matters
affecting her financial affairs. dJ1
29, Based on the opinions that I have expressed, my opinion, expressed with reasonable medical
certainty, is that PATRICIA J. SHAY requires the appointment of a guardian of her person and
estate. (l)F
30. My opinion is that PATRICIA J. SHAY could possibly be harmed if she were required to attend
her guardianship hearing, however, I feel this point is moot because PATRICIA J. SHAY would
not be able to contribute in any way to the hearing. @F
31. My opinion is that PATRICIA J. SHAY would not understand nor benefit from participation in a
court hearing regarding a determination of her capacity to handle her own personal and
financial affairs. (J)F
I, Dr, Ernest Josef, being duly sworn according to law deposes and says that I make this Affidavit
on behalf of PATRICIA J. SHAY and that the facts set forth in the foregoing Affidavit are true and correct to
the best of my knowledge, information, and belief,
I verify that the statements in this Affidavit are tlue and correct. I understand that false
statements herein are made subject to the penalties of 18 Pa.C.S.A. S 4904 relating to unsworn
falsification to authorities.
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Sworn to and subscribed before me this ;)
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Dr. EmesrJosef.......------;/-
day of ,J u"nt\ // J 2006,
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Date: ft,-S",()[,
My Commission Expires:
COMMONWEALTH OF I"'I::NNSil.VANiA\
Notarial Sea! '
Amy A. Reavey, Notary Public
I City Of Hanisburg, Daupl.in County'
I My Commission Expires ,June 23. 2008:
IMemb~'r, Po; :'1r''lylv l'M7"-;::-;~:;~-,.~--;~:;-,:';;;~'.:
16
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CUMULATIVE DIAGNOSES SHEET
,------..or-
I CATE ACTNEPROBLEMS
'2/04/05 SOAT -.5t1;1 L W'U1ijfyt--- /H2h(',/~7LjIJt..
2/04(05 HTN J/-{jPt/k()5)Y~
2/04/05 Hyperlipidemia 4e
2/04/05 PVD f'er/jJhen-L/ ~!i'(Si{i(ul: t:2~d-{t''Z..t
2/04/05 Seizure disorder? (no seizures> 20 yrs per daughter)
2/04/05 Pacer/murmur 12/27/04
2104/05 Depression (chronic since early adulthood)
2/04/05 MI
Ily'() (cV'ell" t2 0 T//1 /' I
-q,4'J ._L! t c;r( . J / '. "J
u/
2/04/05 Ambulatory dysfunction
2/04/05 Anemia
2/04/05 Failure to thrive
2/04/05 PneumonIa
10/04 G i bleed
VOS Barrett's esophagus; hiatal hernia
9/30/05 Dysphagia
10/7/05
-If ;Jfb
Allergies
ORIF left wrist
(XC l-L.;.1/{T\/'--<J
Pneumovax: v
Positive Mantoux:
Positive Serology
Date: 2/7/05
Date of Tx.:
Date of Tx :
~
'hysician Signature:
Date:
Shay, Patricia
#4538
ICO-9 CODE Or. Initial I DATE RES?L VEO PROBLEM::
331.0/29410
401.9
272.4
4439
V450117852
311
410.92
7812
285.9
783.7
486
.5789
530.85/553.3
787.2
V5419N45,4
0/
10/3/05 Pneumonia resolved
. 10/3/05 GI bleed resolved
?.. ~ ~(,
Address-a-graph
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CNRC:..2/~___.________
Physician must sign and date the bottom of thlsrorm at adrn'ss'on. AU dlagnos" added after the
adm~tting diagnoses must be initialed by the physician in the appropriate column.
EXHIBIT
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"\ Name vlln I J
In 11\....I,.".Ln tJ
flM r Z)'\"JAI"" Z) UI(U~1(
ORIGINAL
COpy
Ciiii>
Pl-IARMERI (
rDA Tf
I
i" iJ'~/17 /060
APR06
MEDICA TION ORDERS OTHER ORDER
STATUS:
R PER MEDICAL OIRECTIVE ~
I 10/22/03 . ole Rxl CODE
r MCRUSHADlE "EOS MAY BE CRUSHED ON
./
l . .
7A-7P 03/05/05 DIC Dr derl 00011 RE
UEEKLY BLOOD PRESSURE ~EDHESDAY ORTHOSTATIC DIP ~
'I lIST ijEDNESDAY DF EACH MONTH ~ TO:
I
l I 01
02107/05 OlC Rxl 177488.03 RTN
ZOCDR 10 M' TADLET (SInUASTATIH) fO
.' 1 TABLET BY MOUTH EVERY EUENIN~
vi
DIET
/9: OOA 02104/05 OlC RxI 177485.03 RTN RE
/ ARICEPT 10 MG TABLET (OOHEPEZIl HCL)
1 TABLET BY' MDUTH ONCE DAILY (SOAT> / ACll
ACT
9:00A 11/07/05 PIC Rxt 174866.00 RlM
/ ASPIRIH 81 MG TABLET CHEU (ASPIRIN)
/ 1 TABLET BY MOUTH ONCE DAILY (PVP) /
nrscE
YEA
9:00A 03/03/06 D/C Rxl 182796.00 RTM FlU
I CITALOPRAn HDR 40 nG TADLET (FOR CELEXA 40 nG TAOLET)
1 TABLET BY MOUTH ONCE DAILY (DEPRESSIDN) ~TAKE ~I FlU
lOnG TAB TO:: SOMG DllSE* V (;IUl
l I
, 9: OOA 03/03/06 DIG Rx' 182797.00 HTM YEA
CITALOPRAM HDR 10 nG TADLET (fOR CELEXA 10 nG TADLET)
1 TABLET BY nDUTH OHCE DAILY (OEPRESSIOH) ~TAKE ~I RES
40nG TAO TD= ~OI1G OnSElE J P.T
9:00A 06/07/05 DIC Rxt 166637.00 RTH
lORATADINE 10 MG TABLET (FOR CLARITIM 10 nG TABLET)
1 TABLET OY MOUTH ONCE DAILY (RUNNY NDSE) RESTO
~ RHP
9: OOA 02104/05 D/C RxI 177t:!8l\.03 RTH
I METDPROLDL 2S nG TABLET (nETDPRDLDL TARTRATE) LAD 0
5:00P 1 TADLET BY MOUTH TUleE DAILY KSUO VOR LDPRESSORM rLP
(HnO ~
Dnp
9:00A 02104/05 ole RxI 177486.03 RHI
HAnENDA 10 nG TABLET <nEnAMTINE HCL) ~ fAS
5:00P 1 TABLET BY MOUTH TUleE DAILY (SDAT) nOH
EUE
------------- ~-
>---
~RESCR!n[R S;GHATURE
~lIIEU[D n '
(
SIOENT IS INCAPABLE OF UNDERSTANDING DIAGNDSIS
PLAN Df CARE & RESIDENTS RIGHTS. DUE
DEnENTIA
~
SCONTIHUE ALL PREVIDUS DRDERS. vi
LLDU AUTDMATIC STDP DRDER POLICY ~
ORDERS: ./
GULAR JSOO~ ~~D 'F u.ct ~
UITIES: /
IVITY LEUEl:
LLANEDUS DRDERS: V
RLY INFLUENZA VACCINE
DffICE VISIT ENDDSCOPY CEHTER IH 1 YEAR~
PACEMAKER CHECKS AT MDFFITT HEART VASCULAR
UP AS SCHEDULED ~
RLY PPD DUE 2/06 ~
IDENT nAY CD LDA ijITH MEDICATIONS ~
. [VAL ~ TX AS IHDICATEO~~
RATIUE NURSING:
UNTIL GOALS "n/J)~I trlob
RDERS: J
,AST ,ALT EUERY YEAR ~ 1/07
EVERY 6 MONTHS ~3JI jDb /
lING BLDDD SUGAR AND LIPID PANEL EVERY THREE
THS TIMES OHE UHE UITH DDSAGE CHANGES, THEN ~
RY SIX MO~THS TD "DHITOR rOR ADVERSE SIDE ~
llTS RELATED TO -HRaUEd7 ~ 7/06
I DA TE L-( -J..4 -6(,
I
DATE '-1/ /t.? b
~
rOem"
JDSEF, ERNEST M
(IH PLflN- pes
NH RES'-04~3S
EXHIBIT
717-732-8877
~SEX'. f DD[l- H1L23/1933
RES CDDE- 032~1
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UHEEZIHb,PNEunDMIAf SDATfPEPRESSIONhHYPERlIPIDEnIA
RtM1,AMO. OYSr,AHEM A, rA LURE Tn TH~IUE,GI
rH
------ --------- - . --~------------
Wf; ALLERGIES
APf~06
ORIGINAL
COpy
(ilia)
III'
PHARMERII
( DA TE
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"- 0 3/17/06" ./
~~~~l-)11I SHAY, PATRICIA J
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PHYSICIAN'S ORDER
MEDICATION ORDERS OTHER ORDER
9:00A 02/04/05' ole Rxt 1774B7.03
NDRUASC 5 nG TABLET (AnLODIPIHE DESYLATE)
1 TAOLET UY MOUTH O~CE DAILY (HTN)
RTll
/
REHABILITATIVE PDTENTIAl:
M~REHABILITATIUE PDTENTIAlM~
GODD___fAIR___PDDR___MAIHTEHAHCE_X_
/
9:00A 06/06/05 OlC __ Rxl 175352.05 RTN
DnEPRAZDLE 10 nG CAPSULE OR <rOR PRILDSEC 10 ne CAPSULE
1 CAPSULE BY nDUTH EVERY nDRNING (H/D GI BLEED)
wwDD NOT CRUSH~~ ~
.: *RESIDEHT REQUIRES NURSING fACILITY SER~S
CDNTINUE INDIVIDUALIZED RESIDENT DRDERS ~
.r
9:00A 02/04/0S ole Rxl 158549.00
OHE-TABLET-DAILY (FOR nUlTIVITAnIH TABLET)
1 TAOLET BY MOUTH ONCE DAILY (UITA~IH SUPPLEnENT)
V
RTM
I HAVE REVIE~ED AND APPRDVE THE ABDVE DVERALL PLAN
Of CARE .../
/
9:00A OS/25/05 DIC Rxl 175654.04
SERDAUEL 100 nG TAaLET (QUETIAPIHE FunARATE~
1 TABLET BV MOUTH EUERY nDRNING ~TAKE ~ X 25MG
TAOS TD= 150MG ~ns[* (SDAT UI DElU $)
RTM
nAY USE GENERIC SU~STITUTIOM UNLESS OTHERUISE
INDICATED ~
9:00A OS/25/05 Die
SERDAUEL 25 ne TABLET TIAPINE FunARATE)
2 TABLETS BY MOUTH ~ MG) EUERY MDRNING *TAKE UI
100Mb TAB TO= 1~ G DDSE~ (SDAT WI DELUSIONS)
RTN
HURSING ORDERS:
fDLLD~ SKIN & UOUND PROTOCOL fOR ALL SKIN
CONDITIONS
/
Rxl 177489.03 RTM
SEROQ 300 "e TABLET (QUETIAPIHE funARATE)
1 ILET [(V nOUTH DHCE DAILY AT liP" (SDAT I.l!
LUSIDHS)
02/22/05 Die Rxl 179071.02 RTN
LISINDPRIL 5"' TAD (FDR PRINIUIl 5 ne TABLET)
5:00P 1 TABLET BY MOUTH EUERY EUENING MM HDLD ~r SYST
B/P BLOOD PRESSURE (100 M* FDR HTM ~
P 01/16/06 Die Rxl 179363.00 PRH
;R ACETAnINOPHEN 325 ne TABLET (fDR TYLENOL 325"' TABLET)
~ N 2 TABLETS (650nC) BY MDUTH EUERY 4 HOURS AS HEEDED
fOR C/O PAIH DR DISCDMfDRT ~
)3 02105/05 Dle RxI 158862.00 PRH
R AHTI-DIARRHEAL 2 nG CAPLET (FOR InODIun A-D 2neJPLET)
H 2 CAPLETS BY MDUTH INITIALLY THEN 1 CAPLET BY
MOUTH AS HEEDED AFTER EACH UHFORMED STOOL *NAX
16t1G/24HRM
P 02/21/06 DIe ________ Rxl 1B1791.00 PRH
R PHEHADOZ 25 nG SUPPOSITORY (rDR PHEHERGAN 25 nG SUPPDSI
H INSERT 1 SUPPOSITORY RECTALLY EVERY 6 HDURS AS
HEEDED FOR NAUSEA I VOMITING ~
_----. J~________ ~_______________________ ___~_______
~RESCRIBER SIGNATURE DATE ~ -;H)~
[VIE.l.(IJL!i.'r'~1l.P ~ , m;...It ttJJ-l DAlL _~~.&Jg~____JtrnI1LUL \... --DAlE
1 ~~I;~~~~U~~~'I~~E~~~~ ~~I~~~NiE:D IN tHE PHAR A rs MONTHLY RfPORfS 0 NO IAREGUL RITlES N ED
(;f1Ir~.:f.u"!~.) [] "'51"N"I(;>NI IRReGUlARITIES NOTED
~ X' 'f.!qJq (.. 0 SIGNIFICANT IRAEGULARITIES NOTED
'" PHARMACY DATE
COaCTOR DIAGNOSIS DHR son DR f.lHEEZIHG,PHEUtllJHIAf SDATfI)EPRESSIDHJ,HYPERlIPIDEnIA
IDSEf, ERNEST M 717-732-8877 PACER nU"URtnI,A~n. DYSf,AHEn A) FA LURE TO THKIUE,GI '
I BLEEO,PVD,H H
tIN PI AK- pes SEX-- f l)~l0I2311933
NH RESi-OlJ53B RES CODE- 03251 ALLERGIES HD KHDI./H DRUG ALLERGIES
(DATE---- -- --. - '\
l~ 00/17/0 ~
APR06
rn , ",\";,,..,- .;I Uft.UJ;ft.
ORIGINAL
COpy
".alt,e ~._.. J .... ..--....... -
MEDICATION ORDERS OTHER ORDER
0?/23/05. ole Rxt
NURSING CARE PROfILE & RESIDENT CARE PLAN fOLLO~ED
THRDUGHDUT THIS SHIFT - INCLUDING OUT HDT LlnITED
TO PERSDNAL PRDTECTIVE Ep.UIPnENT IN PLACE1 SAFETY
ALA I'l ICT .
INTERVENTIDHS1 GRDDMING, ORAL ~ NAIL CARE
7A-7P 10/24/03 DIe Ord~r' 00013
nON SKIN ASSESSMENT - TOTAL DDDY SKIN ASSESSnENT ONCE
UEE~LY + If DK - If SOMETHING FOUND ~
l
~ 17 ,...", -' .&JL 3 00 ~ P,O
~~~~zr- \J PRESCRIOER SIGNATURE
~t.D l5b~TL ~1-LC7l-<l)
If/3)fJ "
12, . <""'"' () HOTED .,[{Y
U-.Yi L l C0\ T R I ('..) ~ F-.. /J
(QL)rr,0 ~ BIO~Ou~
RElII(~ED BY
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~ &JLVLiLtu:1i L(S
~~~
c;ita~ ~..> 1IzC(/~
I
__J. ________~~_____________________._. ___.___ _ __________________
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~DT AI. IX: 18 TUlII.. IDUTlKEI: 15 TIT'" PII: ~ ,,'"oc. """"", ~'m "COw," ^"' WO"",,,,",,", "'~"' ,""co,"" "ro~m
TOTAL III TinT: 0 TITAt.'D TilT: 0 ANY IRREGULARl1lES AHE DQ(;UMCNTEQ IN IHE PHARMACISt'S MON]Hl' HEPORIS
;
( DOCTOR
IJIlHF I ERMEST I'!
tIN PLAH- pes
NH RESI-04538
X
PHARMAf:Y
DATE
(.ii!j~
PHARMERI
DATE t( ')4- 1>"
DATE l{/~1 ~
DATE /1 r"l-" 1
~
o NO IR;lEGL1:".l\prm:-; NOTrr
o INS\GNIF\CANl IRREGULAAITlES NO-'-ED
o SlfiNif-lCANT If~RF(]ULARITlES NOTED
717-732-8877
DIAGNOSIS (}~F: SOil DR UHEEZIHG IPHEUtlDHIAt SI)ATfI)EPRESSIO>>,(HYPERLIPIDEnIA
PACER "U"URtnI,A"~. DYSf)AHEn AI fA LURE TO TH~IVE.GI
filEED,PVO,H H .
S D' - r D rw -:-_..1!lL2 3 / 1 9 B
RES CIJDE- 03251
ALLERGIES HO KHDI.lH DRUG ALLERGIES
~'U^I,I D^TrrTr'T^ I
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IN THE COURT OF COMMON PLEAS CUl\IBERLAND COUNTY, PENNSYLVANIA
IN RE:
) ORPHANS' COURT DIVISION
)
) No.
)
) PETITION FOR THE APPOINTMENT
) OF A PERMANENT GUARDIAN OF
) THE PERSON AND THE ESTATE
)
PATRICIA J. SHAY,
AN ALLEGED
INCAPACiTATED PERSON.
CONSENT OF THE PROPOSED GUARDIAN
I, Tracy D. Shay-Snyder, do hereby certify that I am willing to act as the Permanent
Guardian of the Person and Estate of PATRICIA 1. SHAY, if the Court shall so appoint me.
Further, I do hereby certify that I am not a fiduciary of any estate in which the alleged
incapacitated person has an interest, nor have I any interest adverse to the alleged incapacitated
person.
I am an adult and read and write the English language.
The facts and opinions contained herein are true and correct to the best of my knowledge,
infonnation and belief.
) }
::'/1,,/)1,
~--' if'....J I \_ ~"
Date'
'" ..)~C-4>'- J\ \. if dy
~racyi. Sh:y-Snyd~~
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,
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Sworn to and subscribed before me this
IC---P'\
I ;) day of
(r~.l(
I
,2006.
My Commission Expires:
COMMONW'EAL TH Of- PENNSYLVANIA
I Notarial Seal I
Amy A. Reavey, Notary Publl~
I City Of Harrisburg, Dauphin County
I My Commission Expires June 23, 2008
Member, Pennsylv?!rli? t,"!:oci<!tio'1 Of Not.art~~
EXHIBIT
/ ~
I'':)
J
,
Ii)
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'-
-
,
IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
fNRE:
) ORPHANS' COURT DIVISION
)
) No.
)
) PETITION FOR THE APPOINTMENT
) OF A PERMANENT GUARDIAN OF
) THE PERSON AND THE ESTATE
)
PATRICIA J. SHAY,
AN ALLEGED
INCAPACITATED PERSON.
ORDER OF COURT DETERMINING INCAPACITY AND APPOINTING
PERMANENT GUARDIAN OF THE PERSON AND ESTATE
AND NOW, this
day of
, 2006 a hearing in
this case having been held on
, 2006 and it appearing to the Court that
PATRICIA J. SHAY, would be harmed by her presence at the hearing, and further finds from the
testimony:
1. That PATRICIA 1. SHAY suffers from Alzheimer's Dementia which totally impairs
her capacity to receive and evaluate information effectively and to make and
communicate decisions concerning her management of financial affairs or to meet
essential requirements for her physical health and safety.
2. That there are insufficient supports available to assist PATRICIA J. SHAY in
overcoming such limitations and that there exists no less restrictive mechanism for
decision making than the appointment of a Permanent Guardian of her Person and
Estate.
3. That based on the total incapacity of PATRICIA J. SHAY, to receive and evaluate
information effectively and to make or communicate decisions, a Permanent
Guardian of the Person and Estate is required on a permanent basis.
19
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.
NOW THEREFORE, based on the clear and convmcmg evidence supporting the
foregoing findings, it is ORDERED, ADJUDGED and DECREED that PATRICIA J . SHAY
be and hereby is adjudged a totally incapacitated person. It is further ORDERED, ADJUDGED
and DECREED:
TRACY D. SHAY-SNYDER is appointed Permanent Guardian of the Person and Estate
ofP A TRICIA 1. SHAY.
The Power of Attorney given by PATRICIA J. SHAY to CHARLES E. SHAY, JR., is
hereby rendered NULL AND VOID AND OF NO EFFECT.
The Permanent Guardian of the Person and Estate shall have full authority to consent to
the general care, maintenance and custody of PATRICIA J. SHAY without exception.
The Permanent Guardian of the Person and Estate shall assure that PATRICIA J. SHAY
receives appropriate services and shall assist her in developing self-reliance and independence.
If there is a safe deposit box in the name of the incapacitated person alone or in the names
of the incapacitated person and another or others, said safe deposit box shall not be entered by
the Guardian except in the presence of a representative of the financial institution where the box
is located or in the presence of a representative of the Orphans' Court Division. The
representative present at the time of entry shall make or cause to be made a record of the
incapacitated person's property, and said record shall be filed with the Clerk of the Orphans'
Court Division. None of the incapacitated person's property may be removed until after the
aforesaid inventory is completed.
If the safe deposit box is jointly owned, five (5) days notice of the proposed entry shall be
given to the other owners by the Guardian.
20
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An Inventory must be filed within
days. A report by the Guardian of the
Person and Estate shall be filed within
days and annually thereafter in a form
approved by the Orphans' Court Divisions.
No Surety Bond is required.
PATRICIA J. SHAY, an incapacitated person, has the right to appeal this Order of Court
by filing exceptions with the Clerk of the Orphans' Court Division within ten (10) days of the
date of this Order or to petition this Court for a hearing to review or terminate the adjudication of
incapacity and guardianship herein established.
If PATRICIA J. SHAY was not present at the hearing on the adjudication of her
incapacity and appointment of a guardian then Petitioner shall serve upon and read to PATRICIA
J. SHAY the Statement of Rights attached to this Order of Court and marked as Exhibit "A".
Proof of Service of the Statement of Rights shall be filed by the Guardian with the Clerk of the
Orphans' Court within ten (10) days of the date of this Order.
BY THE COURT:
J.
21
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STATEMENT OF RIGHTS
AN ORDER HAS BEEN ENTERED BY A JUDGE OF THE COURT OF COMMON
PLEAS OF CUMBERLAND COUNTY, ORPHANS' COURT DIVISION, WHEREBY YOU
HAVE BEEN ADJUDICATED AN INCAPACITATED PERSON AND UNABLE TO CARE
FOR YOURSELF AND/OR MANAGE YOUR PERSONAL AFFAIRS. YOU HAVE THE
RIGHT TO FILE EXCEPTIONS WITHIN TWENTY (20) DAYS OF THE DATE OF THE
COURT'S ORDER WITH THE ORPHANS' COURT OR THE RIGHT TO FILE AN APPEAL
WITHING THIRTY (30) DAYS OF THE DATE OF THE COURT'S ORDER WITH THE
SUPERIOR COURT. IN THE EVENT THAT YOU FILE EXCEPTIONS AND THEY ARE
DENIED, YOU HAVE A RIGHT TO FILE AN APPEAL TO THE SUPERIOR COURT
WITHIN THIRTY (30) DAYS OF THE DATE OF THE DENIAL OF THE EXCEPTIONS.
IN ADDITION, YOU MAY PETITION THE COURT AT ANY FUTURE TIME TO
MODIFY OR TO TERMINATE THE GUARDIANSHIP IF THERE IS A CHANGE IN YOUR
CAPACITY OR IF YOUR GUARDIAN FAILS TO PERFORM HIS/HER DUTIES IN
ACCORDANCE WITH THE COURT'S ORDER.
IF YOU WISH TO APPEAL THE ORDER OR TO PETITION THE COURT TO
MODIFY OR TERMINATE THE GUARDIANSHIP, YOU ARE ENTITLED TO BE
REPRESENTED BY AN ATTORNEY. IF YOU DO NOT HAVE AN ATTORNEY, THE
COURT MAY APPOINT ONE TO REPRESENT YOU. IF YOU CANNOT AFFORD AN
ATTORNEY, THE SERVICES OF AN ATTORNEY WHOM THE COURT MAY APPOINT
FOR YOU WILL BE PROVIDED AT NO COST TO YOU.
Exhibit "A"
22