HomeMy WebLinkAboutRule 39-14.8.1 Guardian Acknowledgment Form1
39th Jud. Dist. O. C. Rule 14.8.1 Guardianship
Acknowledg ment Form
At the time of the entry of the decree appointing the guardian, the court-appointed
guardian shall initial, sign, and file the Guardian Acknowledg ment of Duties and
Liabilities Form, as follows:
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GUARDIAN ACKNOWLEDGMENT OF DUTIES AND LIABILITIES
I, the undersigned guardian, court-appointed on _______________ (date),
acknowledge that as guardian I have broad, but not unlimited powers, duties, and
liabilities as set forth generally in 20 Pa. C.S.A. §5501 et seq. and more
specifically acknowledge my duties and liabilities under 20 Pa. C.S.A. §5521 as
follows:
As Guardian of the Person, I shall:
Assert the rights and best interests of my ward . (20 Pa. C.S.A. §5521(a))
__________
Respect to the greatest possible extent my ward's expressed wishes and
preferences. (20 Pa. C.S.A. §5521(a)) __________
In Re:
______________________________
Orphans’ Court
No.:________________
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Where appropriate, deve lop a plan of supportive services to meet my ward's needs.
(20 Pa. C.S.A. §5521(a)) __________
Encourage my ward to participate in all decisions which affect my ward, to act on
his or her own behalf whenever he or she is able to do so, and to develop or
regain, to the maximum extent possible, capacity to manage his or her
personal affairs. (20 Pa. C.S.A. §5521(a)) __________
As Guardian of the Estate, I shall:
Take possession of, maintain, and administer each asset of my ward, and make all
reasonable expenditures and efforts to preserve the estate. __________
Within three months, file an inventory and appraisement of my ward's real and
personal property, and a statement of any property that I expect to acquire
thereafter. (20 Pa. C.S.A. §5142). (Electronically through the
Guardianship Tracking System, or in paper form through the Register
of Wills office, along with the appropriate filing fee.) __________
Comply with the provisions outlined in 20 Pa. C.S.A. §5521(b). __________
In addition to the above duties, as Guardian (either of the Person or the E state),
I shall:
Exercise my powers for the benefit of my ward. __________
Keep my ward's assets separate from my assets. __________
Exercise reasonable caution and prudence. __________
Keep a full and accurate record of all actions, receipts, and disbursements on
behalf of my ward. __________
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File a report at least once within the first 12 months of appointment and at least
annually thereafter electronically through the Guardianship Tracking System
or on forms available in the Clerk of the Orphans' Court office attesting to
the information required by 20 Pa.C.S.A. §5521(c). (Filing fee will be
charged for paper filings.)
File a final report within 60 days of my ward's death or adjudication of capacity.
(20 Pa. C.S.A. §5521(c)(2)) __________
I acknowledge I have been made aware of the Guardianship Tracking System
(GTS). __________
I acknowledge if I, as an individual, am seeking guardianship of three or more
incapacitated persons I must be certified as provided in 20 Pa. C.S.A.
§5511(f)(2)(i)-(ii) and provide proof of the certification to the Court prior to
my third guardianship appointment consistent with 20 Pa. C.S.A.
§5511(f)(2).
I understand that such certification may be waived through the filing of a petition
pursuant to 20 Pa. C.S.A. §5511(f)(3). __________
I understand that consistent with 20 Pa. C.S.A. §5512.2(a) a review hearing may be
held if the incapacitated person, any interested party, or I petition the court
for a hearing for reason of a significant change in my ward's capacity, a
change in the need for guardianship services, or my failure to perform my
duties in accordance with the law or failure to act in the best interest of my
ward.
As Guardian of the Person and/or the E state, I understand and acknowledge that
any breach of my duty to my ward, such as but not limited to asset
misappropriation, may result in civil and even criminal liabi lity. __________
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I understand and acknowledge that to the extent my guardianship of my ward is
limited, I have only those powers and authorities delineated in the Court’s
Appointment Order and my ward shall retain all other legal rights consistent
with 20 Pa. C.S.A. §5512.1(g).
I further acknowledge this fully executed Guardian Acknowledgement Form shall
be filed with the Orphans’ Court at the time of appointment. __________
I verify that the foregoing information is correct to the best of my
knowledge, information and belief; and that this verification is subject to the
penalties of 18 Pa.C.S. §4904 relative to unsworn falsification to authorities.
Date ____________________ ___________________________________
Signature of Guardian
____________________________________
Name of Guardian (type or print)
____________________________________
Address
____________________________________
City, State, Zip
____________________________________
Office Phone Number
____________________________________
Cell Phone Number
____________________________________
Email Address
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Adopted by Order of Court, April 17, 2024
Published in the Pennsylvania Bulletin, 54 Pa.B. 2221, Pa.B. Doc. No. 24-580, April 27, 2024