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Home My WebLink About11-14-06 IN RE: EDNA S. CHASE : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, : PENNSYLVANIA : ORPHANS' COURT DIV][SION an alleged incapacitated person : NO. ~\ \)~ \C)()~ On the Petition of Deborah McHugh 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, Deborah McHugh, 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. Edna S. Chase, the alleged incapacitated person, currently resides at The Gardens of The Bridges at Bent Creek, 2100 Bent Creek Boulevard, Mechanicsburg, P A 17050. She is 79 ~,,-, years old, her date of birth being July 16, 1927. 2. ;() - ;~ ,j ..._.J .-........ .- Edna S. Chase is married to Rodney Chase, but they have been livin.~$epai@ely - r1 .r c::"" ,'.'::-:::-", - for two years. It is not known whether divorce proceedings have currentIy beefi-uTytl;-py ~ney: _:~; Chase. --,j -'''"1 -. j ,11 f'.,.') I. _~ _' , I 3. Rodney Chase has signed a consent form, agreeing to the appointment of Deborah McHugh as the guardian of the person and estate for Edna S. Chase. See attached Exhibit A. 3. Edna S. Chase is not a patient in a mental hospital. ~ 4. The Petitioner is Deborah McHugh of 3609 Weymouth Drive, Mechanicsburg, Pennsylvania 17050, and she is the daughter of Edna S. Chase. Edna S. Chase has three (3) children. 5. The names and addresses of those persons who would be the intestate heirs (or next of kin) of Edna S. Chase are as follows: Rodney Chase (spouse) 200 Lake Avenue, N.E., Apt. 525, Largo, FL 33771 Deborah McHugh (daughter) 3609 Weymouth Drive, Mechanicsburg, PA 17050 Cynthia L. Horan (daughter) 46 Everett Street, Manchester, NH 03104 Victoria J. Sweet (daughter) 242 E. Union Boulevard, Bethlehem, PA 18018 6. The names and addresses of the person or institutions providing residential services to Edna S. Chase are as follows: The Gardens of The Bridges at Bent Creek 2100 Bent Creek Boulevard Mechanicsburg, P A 17050 7. The names and addresses of other service providers are as follows: None. His primary physician is: Dr. Kenneth Conner, M.D. Conner Rich Associates 207 House Avenue, Suite 101 Camp Hill, PA 17011 (717) 761-8331 8. Edna S. Chase was not a member ofthe Armed Services of the United States and is not receiving benefits from the United States Veterans Administration. 9. The Petitioner asks that she, Deborah McHugh, be appointed as Guardian of the person and estate of Edna S. Chase. The proposed guardian is the daughter of Edna S. Chase. 10. The proposed guardian has no interests which are adverse to the interests of Edna S. Chase. 11. Petitioner believes, and therefore avers, that no Court has l;lver assumed jurisdiction in a proceeding to determine whether Edna S. Chase is incapacitated. 12. Petitioner believes, and therefore avers, that Edna S. Chasl;l has not previously had a guardian appointed, nor is a guardianship hearing pending in any other Jiurisdiction. 13. The reasons why this guardianship are being sought are as follows: Edna S. Chase is unable to manage her financial affairs or to make decisions regarding health care/medical decisions, due to Alzheimer's disease. 14. The functional limitations and physical mental condition of Edna S. Chase are: Edna S. Chase is not able to manage her financial affairs, nor is she able to make competent decisions as far as her welfare is concerned. Edna S. Chase is not able to communicate nor is she:: able to perform any of her 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: Edna S. Chase is not competent to execute a power of attorney. Edna S. Chase previously executed a power of attorney in Largo, Florida on December 20, 1996, in which she named her daughter, Deborah McHugh as her Agent. However, the original power of attorney document cannot be located and a copy of the document is not sufficient to allow Deborah McHugh to act as the Agent for Edna S. Chase. No less restrictive alternatives are available to adequately provide for the physical and financial care of Edna S. Chase. 16. The Petitioner requests that the guardian be granted powers to act for Edna S. Chase in the following specific areas: financial management, divorce proceedings, 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 daughter of Edna S. Chase. The proposed guardian loves and cares for her mother. 18. The gross value of the Estate of Edna S. Chase is approximately Two Hundred Fifty Eight Thousand Dollars ($258,000.00). Edna S. Chase's net income from all sources totals approximately Two Thousand One Hundred Forty-Eight Dollars ($2,148) per month. ($879 from Social Security, and $1269 from pension). Petitioner respectfully requests that the Court, under Section 5511 of the Probate, Estates and Fiduciaries Code, issue a Citation to Edna S. Chase, Edna S. Chase's next of kin, The Bridges at Bent Creek (health facility), and to such other persons as the Court directs, to show cause why Edna S. Chase should not be adjudged to be an incapacitated person and plenary guardian of her person and estate be appointed. Respectfully submitted, JAN L. BROWN & ASSOCIATES Date: [I/,,?/O& , '1/ ..~;' ~ . . I y: J . queline A. Kelly, Esq . e l\.ttorney for Petitioner Attorney ill No. 91973 845 Sir Thomas Court, Suite 12 Harrisburg, Pennsylvania 17109 (717)541-5550 IN RE: EDNA S. CHASE : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, : PENNSYLVANIA : ORPHANS' COURT DIVISION an alleged incapacitated person : NO. CONSENT TO APPOINTMENT OF DEBORAH MCHUGH AS GUARDIAN 1. McHugh. The name of the proposed guardian ofthe person of Edna S. Chase is Deborah 2. McHugh. The name of the proposed guardian ofthe estate of Edna S. Chase is Deborah 3. I, Rodney Chase, agree to this appointment of Deborah McHugh as guardian of the person and estate of my wife, Edna S. Chase. Dated: ~ ~J ~~ ~JI.~M Rodney Clf3se IN Kt:: ~DNA S. CHASE 1. McHugh. 2. McHugh. : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, : PENNSYLVANIA : ORPHANS' COURT DIVISION an alleged incapacitated person : NO. CONSENT TO APPOINTMENT AS GUARDIAN The name of the proposed guardian ofthe person of Edna S. Chase is Deborah The name of the proposed guardian of the estate of Edna S. Chase is Deborah 3. 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 fidUCi"Z!JI Dated: loll q I ~ 0 tJ V . Deborah M(:Hugh 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. COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN On this, the I q -;I\- day of 0 cftJ h{r ,2006, before me, the undersigned officer, personally appeared Deborah McHugh 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. SWORN to and subscribed before me this ;qrh day of Ock he, ,2006. 1.~ COMMONWEALTH OF PENNSYlVANIA NOTARIAL SEAL JACQUElINE A. KEILLY, NOTARY PUBUC lOWER PAXTON TWP., DAUPHIN COUNlY MY COMMISSION EXPIRES DEC. 17,2007 IN RE: EDNA S. CHASE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION an alleged incapacitated person : NO. On the Petition of Deborah McHugh JOINDER I, Cynthia L. Horan, join in this Petition to Appointment of Guardian of the Person and Estate of an Alleged Incapacitated Person filed by Deborah McHugh to have Deborah McHugh named as Guardian of Edna S. Chase. Witness: ~a~ COMMONWEALTH OF PENNSYLVANIA : SS: COUNTY OF DAUPHlN ON THIS, the K day of Oc.Jvbe.-r-- ' 2006, befofl::l me a Notary Public for the State of Pennsylvania, personally appeared CYNTHIA L. HORAN, known to me to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. ) . ~~ COMMONWEALTH OF PENNSYLVANIA NOTAR:IAl SEAL JACQUELINE A. KElly' NOTARY PUBLIC LOWER PAXTON TWP., DAUPHIN COUNlY MY COMMISSION miRES DEC. 17,2007 IN RE: EDNA S. CHASE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA : ORPHANS' COURT DIVISION an alleged incapacitated person : NO. On the Petition of Deborah McHugh JOINDER I, Victoria J. Sweet, join in this Petition to Appointment of Guardian of the Person and Estate of an Alleged Incapacitated Person filed by Deborah McHugh to have Deborah McHugh named as Guardian of Edna S. Chase. Witness: M (.,H (J~ 10- COMMONWEALTH OF PENNSYLVANIA : SS: COUNTY OF "Dcwph"'n : ON THIS, the ,~ day of _nO VlN\\:;e ( ,2006, before me a Notary Public for the State of Pennsylvania, personally appeared VICTORIA J. SWEET, known to me to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. ~~liJ.~.~ tlC)WML IUL 1E1H~1~ Notary I~ CRY OF tIMRIll1Jl8,IWIIl. COUN'IY MfCOmmlllllOl, ~ Dee 24, 2007 SP 4'-131(6-98) COMMONWEALTH OF PENNSYLVANIA NOTIFICATION OF MENTAL HEALTH COMMITMENT The Uniform Firearms Act. 18 PA C.S. 6105 (C)(4) specifies that it shall be unlawful rer any person adjudicated as an incompetent or who has been involuntarily committed to a mental institution for inpatient care and treatment under Section 302, 303, or 304 of the Mental Health Proce\Jures Ad of Juri 9, 1976 (P.L.817, No. 143) to possess, use, manufacture control, sell or iraflsfer firearms. This would indude adjudication of incapacity pursuant to 20 Pa.C.SA. 95501. Pursuant to the Pennsylvania Mental Health Procedures Act, Sectio~ 109, notification shall be transmitted to the Pennsylvania State Police by the jud~e, 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, Att.enUon: Firearm Unit, 1800 Elmerton Avenue, Harrisburg, PA 17110. NOTE: The envelop;l shall bil marked "CONFIDENTIAL" Place an .X. on either Involuntary Commitment or Adjudicated Incompetent INVOLUNTARY COMMITMENT ADJUDICATED INCOMPETENT x Date of Involuntary Commitment or Adjudicated Incompetent INDIVIDUAL INFORMATION (!NDIVIDUAL INVOLUNTARILY COMMITTED OR ADJUDICATED INCOMPETENT) LAST NAME Chase FIRST Edna MIDDLE S. JR, ETC. MAIDEN NAME Sweet ALIAS DATE OF BIRTH July 16,1927 SOCIAL SECURITY NUMBER 179-20-0825 SEX F RACE Whih:> HEIGHT 5 I 4 " WEIGHT 130 lbs HAIR white EYES hazel ADDRESS 2100 Bentcrppk lkllllE'vard, Mechanicsburg, Pl\ 17050 NOTlFICA TION BY (Please print name, address, area code, and phone number of agency or county court.) County Submitting Notification County Mental Health and Mental Retardation Administrator County Mental Health Review Officer Physician Certifying Necessity of Involuntary Commitment ( Required in accordance with Section 61 05(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 ............... ~r1t............J. J,.L.I.,I..I,............... ~ ... ...ol.....J......._____ NOTIFlCATION OF PHYSICIAN'S DETERMINATION THAT NO SEVERE MENTAL DISABILITY EXISTS The physician shall provlde signed confirTnaUon of the ceterminauon of the lack of severe mental disabilitylcllcwing the initial exan1lnalion under Section 302(b) of the Mental Health Proce\Jures Act and pursuant to the Uniform Firearms Act, Sec'Jon 6111.1 (g)(3). Notice shall be transmitted by the physician to the Pennsylvania State Police through the coun~1 mental health and mental retardation administrator or mental health review officer. '" Name of Physician (Please print.) Signature of Physician Date