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8.2 |
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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).
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J.
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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.
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PETITION
The Petition of Harriet Dunn respectfully states that:
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1.
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Petitioner is the sister of Jane R. Dunn (the "alleged incapacitated person"). |
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2.
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The alleged incapacitated person was born August 16, 1924, is a widow, and resides alone at 261 Horse Hair Street, Philadelphia, Pennsylvania. |
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3.
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The following persons are all of the alleged incapacitated person's living next-of-kin: |
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4.
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Because of advanced age, physical illness and senility, the alleged incapacitated person lacks sufficient capacity to make or communicate responsible decisions concerning her person. | |||||||||
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5.
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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. | |||||||||
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6.
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The proposed guardian of the alleged incapacitated person is Joan Smith, the sister of the alleged incapacitated person, of 1200 Locust Way, Philadelphia, Pennsylvania. | |||||||||
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7.
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The proposed guardian has no interest adverse to the alleged incapacitated person. |
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8.
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No other court has ever assumed jurisdiction in any proceeding to determine the competency of the alleged incapacitated person. |
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9.
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No other guardian has been appointed for the estate or person of the alleged incapacitated person. |
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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.
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Respectfully submitted, |
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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..." |
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: | |||
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Joan Smith
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