Lycoming County Orphans' Court Rule L14.5

L14.5. Forms.

A. The Petition to Adjudicate Incapacity and for the Appointment of a Guardian. The petition to adjudicate incapacity and for the appointment of a guardian referred to in Lyc. Co. O.C.R. L14.2F shall be substantially in the following form:

IN THE MATTER OF:

________________________,
An alleged incapacitated person

) IN THE COURT OF COMMON PLEAS OF
) LYCOMING COUNTY, PENNSYLVANIA
) ORPHANS’ COURT DIVISION
)
) NO. ________________

PETITION TO ADJUDICATE INCAPACITY PURSUANT TO 20 Pa.C.S. §5511 AND FOR THE APPOINTMENT OF A GUARDIAN OF THE PERSON/OR OF THE ESTATE OF ______________________

TO: The Honorable Judge of the Lycoming County Court:

The petition of (name of petitioner) respectfully states:

1. Name and current address of petitioner:

2. Petitioner's relationship to and interest in the alleged incapacitated person's welfare:

3. Name, age, residence and post office address of the alleged incapacitated person:

4. Name and address of person or institution providing residential services to the alleged incapacitated person:

5. Names and addresses of spouse, parents and all persons who are sui juris individuals and who would be entitled to share in the estate of the alleged incapacitated person if that person died intestate:

6. Names and addresses of medical, social, residential, and other service providers:

7. State whether respondent has or has not been a member of the United States armed services and whether he or she is or is not receiving any benefits from the United States Veterans Administration:

8. State whether any court has ever assumed jurisdiction in any proceeding to determine the competency or capacity of the respondent, and whether any guardian of the person and/or estate has ever been appointed:

9. The name and address of respondent's attorney, if known, or the attorney known to represent the respondent on other legal matters:

10. The reason why guardianship is sought:

11. A description of the functional limitations and physical and mental conditions of the alleged incapacitated person:

12. Allegations of fact regarding the services being utilized to meet essential requirements for the alleged incapacitated person's physical health and safety, to manage the person's financial resources or to develop or regain the person's abilities:

13. Allegations of fact regarding the type of assistance required by the person and as to why no less restrictive alternatives would be appropriate:

14. Allegations of fact regarding the probability that the extent of the person's incapacities may significantly lessen or change.

15. For each type of guardian being requested, the name and address of the person or entity whom petitioner asks to be appointed as guardian:

16. An averment that the proposed guardian has no interest adverse to the alleged incapacitated person:

17. Qualifications of proposed guardian:

18. The specific areas of incapacity over which it is requested that the guardian be assigned powers:

19. If guardian of the estate is being sought, the petition shall also include the gross value of the estate and net income from all sources to the extent known:

WHEREFORE, petitioner prays this Honorable Court to grant the following relief:

______________________
(Petitioner)

B. The status report on legal representation referred to in Lyc. Co. O.C.R. L14.2G shall be substantially in the following form:

IN THE MATTER OF:

________________________,
An alleged incapacitated person

) IN THE COURT OF COMMON PLEAS OF
) LYCOMING COUNTY, PENNSYLVANIA
) ORPHANS’ COURT DIVISION
)
) NO. ________________

STATUS OF ALLEGED INCAPACITATED PERSON’S LEGAL REPRESENTATION

1. The Petition to Adjudicate Incapacity and for the Appointment of a Plenary Guardian of the Person and the Estate in the above-referenced matter was filed with this Honorable Court on _____________________ [date] (or is being filed herewith).

2. Service of the Petition to Adjudicate Incapacity and for the Appointment of a Plenary Guardian of the Person and the Estate was served on the alleged incapacitated person on _____________________ [date] (or has not been served to date).

3. The Hearing on the Petition to Adjudicate Incapacity and for the Appointment of a Plenary Guardian of the Person and the Estate has been scheduled for _____________________ [date] (or has not been scheduled yet).

4. Counsel for the alleged incapacitated person (is) (is believed to be): [name, address, and telephone number] or Petitioner does not believe that the alleged incapacitated person is represented by counsel.

5. According to Petitioner’s knowledge and belief, the assets of the alleged incapacitated person consist of approximately $_____________________.

66. Petitioner requests that counsel for the alleged incapacitated person be appointed by this Honorable Court and pursuant to 20 Pa.C.S. § 5511(c), be compensated by Lycoming County or Petitioner requests that counsel for the alleged incapacitated person be appointed by this Honorable Court and that counsel for the alleged incapacitated person not be compensated by Lycoming County.

Dated:

Respectfully submitted,

_________________________
Petitioner/Counsel for Petitioner
[address]
[telephone number]

C. The proposed order referred to in Lyc. Co. O.C.R. L14.2G shall be substantially in the following form:

IN THE MATTER OF:

________________________,
An alleged incapacitated person

) IN THE COURT OF COMMON PLEAS OF
) LYCOMING COUNTY, PENNSYLVANIA
) ORPHANS’ COURT DIVISION
)
) NO. ________________

ORDER

AAND NOW this _______ day of ________, _______, upon consideration of the attached status report, _____________________ is hereby appointed as counsel for the alleged incapacitated person. Counsel for the alleged incapacitated person ______ shall______shall not be compensated by Lycoming County. A certified copy of this order shall be served on the alleged incapacitated person, counsel for the alleged incapacitated person, and all persons who are sui juris individuals and would be entitled to share in the estate of the alleged incapacitated person if he or she died intestate at that time.

BY THE COURT,

______________________
JJ.