Petition for Appointment of Emergency Guardian of the Person in Accordance with 20 Pa. C.S.A.§5513

Current through March 1, 2017

PRELIMINARY DECREE

Now,__________ , 20_______ , upon consideration of the annexed Petition, it is hereby ORDERED and DECREED that a Citation is awarded, directed to Jane R. Dunn, to show cause why Joan Smith should not be appointed Emergency Guardian of her Person for the purpose of authorizing any surgical or other medical procedures necessary in her opinion for the health and welfare of Jane R. Dunn; the hearing thereon to be held in Room_________ , City Hall, Philadelphia, Pennsylvania, on________ , 20_____ , at _______ ____.m.

Petitioner shall cause to be served (by personal service) the Citation with Notice and Petition, pursuant to the provisions of 20 Pa. C.S.A. § 5511(a) upon the alleged incapacitated person at least __________ hours prior to the court hearing. The contents and terms of the Citation with Notice and Petition shall be explained to the maximum extent possible in language and terms of the alleged incapacitated person is most likely to understand in accordance with the provisions of 20 Pa. C.S.A. § 5511(a). An Affidavit of Service containing specific averments as to the above requirements shall be presented at the beginning of the court hearing.

If any next of kin can be located, at least _____ hours notice of the court hearing, together with a copy of the Petition shall be given personally, by telegram, or, by overnight mail to all persons who are sui juris and would be entitled to share in the estate of the alleged incapacitated person if she died intestate, to the person or institution providing residential services to the alleged incapacitated person, in accord with the provisions of 20 Pa. C.S.A. § 5511(a).

The alleged incapacitated person shall be present at the court hearing unless it is established by clear and convincing medical evidence that her physical and mental condition would be harmed by her presence in court in accordance with the provisions of 20 Pa. C.S.A. § 5511(a).

____J.

DECREE

Now, ______ , 20________ , upon consideration of the annexed Petition,

after hearing held following Notice as directed by the Court, the Court finds that Jane R. Dunn currently lacks sufficient mental capacity to make or communicate responsible decisions concerning her person, and that failure to appoint an Emergency Guardian will result in irreparable harm to her person; it is therefore ORDERED and DECREED that Henry Doe is appointed Emergency Guardian of the person of Jane R. Dunn and may authorize any surgical or other medical procedures necessary in his opinion for the health and welfare of Jane R. Dunn.

Such guardianship is to be in effect for a period of seventy-two (72) hours from the date of this Decree or until further order of Court.

____J.

PETITION

The Petition of Harriet Dunn respectfully states that:

1. Petitioner is the sister of Jane R. Dunn (the "alleged incapacitated person").

2. The alleged incapacitated person was born August 16, 1924, is a widow, and resides alone at 261 Horse Hair Street, Philadelphia, Pennsylvania.

3. The following persons are all of the alleged incapacitated person's living next-of-kin:

Joan Smith

1200 Locust Way

Philadelphia, PA 19103

Sister

Henry Doe

P.O. Box 1234

Boston, MA 12345

Brother

4. Because of advanced age, physical illness and senility, the alleged incapacitated person lacks sufficient capacity to make or communicate responsible decisions concerning her person.

5. Petitioner is advised by medical personnel that the alleged incapacitated person is in need of immediate surgical or other medical procedures necessary for her health and welfare, including to repair a pulmonary aneurism, to avoid irreparable physical deterioration and damage to her health.

6. The proposed guardian of the alleged incapacitated person is Joan Smith, the sister of the alleged incapacitated person, of 1200 Locust Way, Philadelphia, Pennsylvania.

7. The proposed guardian has no interest adverse to the alleged incapacitated person.

8. No other court has ever assumed jurisdiction in any proceeding to determine the competency of the alleged incapacitated person.

9. No other guardian has been appointed for the estate or person of the alleged incapacitated person.

Wherefore, Petitioner respectfully requests this Court to award a Citation, directed to the alleged incapacitated person, with notice thereof to be given to her next of kin and to such other persons as this Court may direct, to show cause why Joan Smith should not be appointed as Emergency Guardian of her Person for the purpose authorizing any surgical or other medical procedures necessary for the health and welfare of Jane R. Dunn.

Respectfully submitted,

Joan Smith

CONSENT OF GUARDIAN

I hereby consent to act as Emergency Guardian of the Person of Jane R. Dunn, an alleged incapacitated person, for the purpose of authorizing any surgical or other medical procedures necessary for the health and welfare of Jane R. Dunn.

I reside at 1200 Locust Way, Philadelphia, Pennsylvania, and am a housewife and the sister of the alleged incapacitated person.

I am a citizen of the United States and can speak, read and write the English language.

Dated:

Joan Smith

Note: Under 20 Pa. C.S.A. § 5513, "only such notice of the petition and hearing shall be required as shall appear to the court to be feasible in the circumstances..."