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Home My WebLink About11-06-06 an alleged incapacitated person : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, : PENNSYLVANIA : ORPHANS' COURT DIVISION : NO. ~ \- tJ\o- ()qW IN RE: DAVID L. MAYS On the Petition of Wanda Mays PETITION FOR APPOINTMENT OF GUARDIAN OF THE PERSON AND ESTATE OF AN ALLEGED INCAPACITATED PERSON TO THE HONORABLE PRESIDENT JUDGE OF SAID COURT: NOW COMES, Petitioner, Wanda Mays, by and through her attorney, Jacqueline A. Kelly, Esquire and files the within Petition for the Appointment of Guardian of the Person and Estate of an Alleged Incapacitated Person, and in support hereof, avers as follows: 1. David L. Mays, the alleged incapacitated person, currently resides at Health South Rehabilitation Center, 4950 Wilson Lane, Mechanicsburg, P A 17055. He is 68 years old, his date of birth being September 12, 1938. 2. David L. Mays is married. 3. David L. Mays is not a patient in a mental hospital. 4. The Petitioner is Wanda Mays of 173 Creek Road, Newville, Pennsylvania 17241, and she is the spouse of David L. Mays. David L. Mays has three (3) children. ,"-.....l 5. The names and addresses of those persons who would be the intesla~~ heirs e9i _ -=,-1 -~: next of kin) of David L. Mays are as follows: ~ c~\ C0 Co.';) ce Wanda Mays ( spouse) 173 Creek Road, Newville, P A 17241 Margo L. Mays (daughter) 93 Churchill Avenue, Arlington, MA 02476-7845 Brett D. Mays (son) 799 Nissel Lane, New Cumberland, P A 17070 Ellen M. Shultzabarger (daughter) 214 N. Broad Street, Lititz, PA 17543 6. The names and addresses of the person or institutions providing residential services to David L. Mays are as follows: Health South Rehabilitation Center 4950 Wilson Lane Mechanicsburg, P A 17055 7. The names and addresses of other service providers are as follows: None. His primary physician is: Dr. Lawrence B. Zimmerman, M.D. Internists of Central P A 108 Lowther Street, P.O. Box 107 Lemoyne, P A 17043-0107 (717) 774-1366 8. David L. Mays was a member of the Armed Services of the United States but is not receiving benefits from the United States Veterans Administration. 9. The Petitioner asks that she, Wanda Mays, be appointed as Guardian of the person and estate of David L. Mays. The proposed guardian is the spouse of David L. Mays. 10. The proposed guardian has no interests which are adverse to the interests of David L. Mays. 11. Petitioner believes, and therefore avers, that no Court has ever assumed jurisdiction in a proceeding to determine whether David L. Mays is incapacitated. 12. Petitioner believes, and therefore avers, that David L. Mays has not previously had a guardian appointed, nor is a guardianship hearing pending in any other jurisdiction. 13. The reasons why this guardianship are being sought are as follows: David L. Mays is unable to manage his financial affairs or to make decisions regarding health care/medical decisions, due to surgery being performed on a benign brain tumor which resulted in a coma. 14. The functional limitations and physical mental condition of David L. Mays are: David L. Mays is not able to manage his financial affairs, nor is he able to make competent decisions as far as his welfare is concerned. David L. Mays is not able to communicate nor is he able to perform any of his activities of daily living without total assistance. 15. The following steps have been taken, in order to find less restrictive alternative to the appointment of a guardian: David L. Mays is not competent to execute a power of attorney. No less restrictive alternatives are available to adequately provide for the physical and financial care of David L. Mays. 16. The Petitioner requests that the guardian be granted powers to act for David L. Mays in the following specific areas: financial management and medical and health care affairs including care and placement decisions, access to all medical records and power to make all decisions regarding medical treatment and life support. 17. The proposed guardian has the following qualifications: The proposed guardian is the wife of David L. Mays. The proposed guardian loves and cares for her husband. 18. The gross value of the Estate of David L. Mays is approximately Seven Hundred Twenty Thousand Dollars ($720,000.00). David L. Mays's net income from all sources totals approximately Three Thousand Six Hundred Forty-Four Dollars ($3,644) per month. ($986 from Social Security; $668 from Pennsylvania State pension; and $1,990 from military pension). Petitioner respectfully requests that the Court, under Section 5511 of the Probate, Estates and Fiduciaries Code, issue a Citation to David L. Mays, David L. May's next of kin, Health South Rehabilitation Center (health facility), and to such other persons as the Court directs, to show cause why David L. Mays should not be adjudged to be an incapacitated person and plenary guardian of his person and estate be appointed. Respectfully submitted, JAN L. BROWN & ASSOCIATES Date: /0-/3- o~ L-; By} Jac ueline A. Kelly, Esquire Attorney for Petitioner Attorney ill No. 91973 845 Sir Thomas Court, Suite 12 Harrisburg, Pennsylvania 17109 (717)541-5550 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND ~\- D\~.()C\m . Il.~"- On this, the I ') day of 0 c::to bu , 2006, before me, the undersigned officer, personally appeared Wanda Mays who, being duly sworn according to law, does depose and say that the facts set forth in the foregoing Petition are true and correct to the best of her knowledge, information and belief. IN WITNESS WHEREOF, I hereunder set my hand and official seal. ( o Cf6l)(~1 ,2006. SWORN to and subscribed before me this I~tt-- day of ~D.~ COMMONWEALTH Of PENNSYlVANIA NOTARIAL SEAL JACQUELINE A. KEllY, NOTARY PUBLIC LOWER PAXTON TWP., DAUPHIN COUNlY MY COMMISSION EXPIRES DEC. 17, 2007 :",.,.~-, ,.:~,., CT""I --{J r ..., .-) I 7-1 ~. - VERIFICA nON I verify that the statements made in this Petition are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. ) / / ~'_......"._._.'" ~'""' 1 -) c~ , .", , -- ., IN RE: DAVID L. MAYS an alleged incapacitated person : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, : PENNSYLVANIA : ORPHANS' COURT DIVISION : NO. ~ \ - CJ\~- \:p, '6U CONSENT TO APPOINTMENT AS GUARDIAN 1. Mays. 2. Mays. 3. The name of the proposed guardian of the person of David L. Mays is Wanda The name of the proposed guardian of the estate of David L. Mays is Wanda The proposed guardian speaks, reads and writes the English language. 4. The proposed guardian does not have an interest adverse to the alleged incapacitated person. 5. The proposed guardian is not a fiduciary, or officer or employee of a corporate fiduciary of an estate in which the alleged incapacitated person has an interest; and is not the surety, or officer or employee of a corporate surety of such fil~ciio . / Ih .) Dated: 10-\3-oiO l~{I{'<:t~ Wanda Mays,r / I . ~) -J ....:. ... 1 :-'-j ~ .) [N RE: DAVID L. MAYS an alleged incapacitated person IN THE COURT OF COMMON PLbAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION NO. ~ \ - ()\o- QC\W On the Petition of Wanda Mays JOINDER I, Brett D. Mays, join in this Petition to Appointment of Guardian of the Person and Estate of an Alleged Incapacitated Person filed by Wanda Mays to have Wanda Mays named as Guardian of David L. Mays. Witness: ~ O;z" , / ( ~ ..~:r- r '-) ---) COMMONWEALTH OF PENNSYLVANIA COUNTY OF IiJll~ ON THIS, the m day of &.~ , 2006, before me a Not~rY Publi~;'for the State of Pennsylvania, personally appeared BRETT D. MAYS, known to me to be the person whose name is subscribed to the within instrument and acknowledged that he executed the same for the purposes therein contained. : SS: IN WITNESS WHEREOF, I have hereunto set my hand and official seal. '1 )~ N c NOTARIAL SEAL KELLY S PANI\IEBAKER Notary Public SlJSQUEHt,NNA TWP,DAUPHIN COUNlY My Commission Expires Mar 10, 2009 IN Kb: DAVID L. MAYS an alleged incapacitated person IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION : NO. ~ \ - ()\c- oq<w On the Petition of Wanda Mays JOINDER I, Ellen M. Shultzabarger,join in this Petition to Appointment of Guardian of the Person and Estate of an Alleged Incapacitated Person filed by Wanda Mays to have Wanda Mays named as Guardian of David L. Mays. Witness: &~ ~ ~ ELLEN M. SHULTZABARGER COMMONWEALTH OF PENNSYLVANIA COUNTY OF O<lu. P~\ / VL ON THIS, the n day of rQ()Jo h {' ti\L , 2006, before me a N~t~ry Pub1i8 for the State of Pennsylvania, personally appeared ELLEN M. SHULTZABARGER, krr~wn to ~ to be the person whose name is subscribed to the within instrument and acknowledged that she \ _...- executed the same for the purposes therein contained. : SS: IN WITNESS WHEREOF, I have hereunto set my hand and official seal. 4Q~J2 J!;j~/ Notary P ic .,~.............~~~~~~...--.....--,,, NOTARIAL SEAL WENOY L. " "1'Y Public (;Sty of Hams.. "I County, PA ." Commission Expires January 8, iJJ1l11 IN RE: DAVID L. MAYS IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION an alleged incapacitated person : NO. '~ \ - b\o- \J~ '4:) On the Petition of Wanda Mays JOINDER I, Margo L. Mays, join in this Petition to Appointment of Guardian of the Person and Estate of an Alleged Incapacitated Person filed by Wanda Mays to have Wanda Mays named as Guardian of David L. Mays. Witness: l~l~lu STATE OF MASSACHUSETTS : SS: COUNTY OF 5l\ F ("0/ Jr ON THIS, the LK day of Oe-to.e €/L. ,2006, before me a Notary Publi~ for the State of Massachusetts, personally appeared MARGO L. MAYS, known to me to be the person whose name is subscribed to the within instrument and acknowledged thafshe)executed the same for the purposes therein contained. ' IN WITNESS WHEREOF, I have hereunto set my and and official seal. 'elL;, f~. ;!(!1:c COMMONWEALTH OF PENNSYLVANIA ~\-6\c' Oq'J) SP 4.~31(6-96) NOTIFICATION OF MENTAL HEALTH COMMITMENT The Uniform Firearms Act. 16 PA. C.S. 6105 (c)(4) specifies that it shall be unlawful for any person adjudicated as an in<:ompetent or who has been involuntarily committed to a mental institution for inpatient care and treatment under Section 302, 303, or 304 01 the Mental Health Procedures Act 01 July 9,1976 (P.L.a17, No. 143) to possess, Use, manulacture, control. sell or traflsfer firearms. This would indude adjudication 01 incapacity pursuant to 20 Pa.C.SA 55501. Pursuant to the Pennsylvania Mental Health Procedures Act. Section 109, notification shall be transmitted to the Pennsylvania State Police by the judge, mental health review officer or county mental health and mental retardation administrator within SEVEN days of the adjudication, commitment or treatment by first dass mail to the Pennsylvania State Pollee, AttenUon: FIrearm Unit. 1800 Elmerton Avenue, Harrisburg, PA 17110. NOTE: The envelop<) shall bo marked .CONF1DENTlAL" Place an .X. on either Involuntary Commitment or Adjudicated Incompetent INVOLUNTARY COMMITMENT ADJUDICATED INCOMPETENT .x Date of Involuntary Commitment or Adjudicated Incompetent INDIVIDUAL INFORMATION (INDIVIDUAL INVOLUNTARILY COMMITTED OR ADJUDICATED INCOMPETENT) LAST NAME Mays FIRST David MIDDLE L. JR., ETC. MAIDEN NAME ALIAS DATE OF BIRTH September 12, 1938 SOCIAL SECURITY NUMBER 278-32-1264 SEX M RACE Whi te HEIGHT 6 I 'NEIGHT 240 lbs HAIR brown EYES blue ADDRESS 173 Creek Road, Newv~lle, PA 17241 , NOTIFICA TJON BY (Please print name, address, area code, and phone number of agency or county court.) County Submit1ing Notification, _ f- ", c~un~ M~nt~1 H~althand Mental Retardation Administrator County Mental Health Review Officer , . PhysIcian CertifyIng Necessity of Involuntary Commitment (Required in accordance with Section 6105(c)(4) of the Uniform Firearms Act) Hospital! Facility Providing Treatment! Address Judge SIGNATURE OF NOTIFYING OFFICIAL DATE Court Case Number Date of Court Order " ", ..1.....1....)".........,..........................,.............. .............-..-.--*-..........---...............~...........*__......._*_____......... .......l.J.... "...______.---____**..~~.......... NOTIFlCATJON OF PHYSICIAN'S DETERMINATION THAT NO SEVERE MENTAL DISABILITY EXISTS The physidan shall provide signed confinnation of the deteimination of the lack of severe mental disability following the initial e):amination under Section 302(b) of the Mental Healtl1 Procedures Ad and pursuant to the Unifonn Firearms Act, Section 6111.1 (g)P). Notice shall be transmitted by the physician to the Pennsylvania State Police through the count'! mental health and mental retardation administrator or mental health review officer. ' Name or Physician (Please print.) Dale JAN L. BROWN. ESQUIRE' JACQUELINE A. KELLY, ESQUIRE 'ADMITTED IN PA AND DISTRICT OF COLUMBIA JAN L. BROWN & ASSOCIATES ATTORNEYS AND COUNSELORS AT LAW OLOE ENGLISH GAP 845 SIR THOMAS COURT SUITE 12 HARRISBURG, PA 17109 EMAIL jlbassoc@verizon.net TELEPHONE (717) 541-5550 FACSIMILE (717) 541-9223 BREN DA F. KEPHART. LEGAL ASSISTANT PAULA K. WHITE, LEGAL ASSISTANT JUDITH A. EBERSOLE. ADMINISTRATIVE ASSISTANT November 3,2006 , C:~, Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 t"-..,.'", "..,' J Re: David L. Mays G) To Whom It May Concern: Enclosed for filing is an original and two copies each of a Petition for Appointment of Guardian of the Person and Estate of an Alleged Incapacitated Person and corresponding documentation. Enclosed is a check in the amount of $50.00 for the filing fee. Please return a time-stamped copy for my file in the envelope provided. If you have any questions, please feel free to contact my office. Thank you for your attention to this matter. Sincerely, (t' cliU/,-cuJ),I1L Lt .1<lE..r} ~ L.. . ( Jacquelme A. Kelly , .j cc: Wanda Mays Enclosures NOV 0 7 2006~i Iy- IN RE: DAVID L. MAYS : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, : PENNSYLVANIA : ORPHANS' COURT DIVISION an alleged incapacitated person ~\- b\1>-Oq~ : NO. On the Petition of Wanda Mays REOUEST FOR ASSIGNMENT OF NON-JURY PROCEEDING We hereby request that this matter be assigned for judicial disposition. We certify that the following matter is ready for judicial disposition. Captions of related cases and names of judges previously assigned: None Respectfully Submitted, JAN L. BROWN & ASSOCIATES II/310ft; Date acq line A. Kelly, Esq. PA LD. No. 91973 J an L. Brown & Associates 845 Sir Thomas Court, Suite 12 Harrisburg, PAl 71 09 (717) 541-5550 ~ ~ (~..~J 1l.;s 1" t: - C.,I,) 't.,' r J ' d ~ I vl. du fl(' 5. ,.. J J t.1 c~ J ~ -t- - 1/ (. J ~ ~' Ii 1"-1 1:, >cL.cJ .\..),~~..., v>o. . 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