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IN THE MATTER OF
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. IC]Cfll' - 3:2Lr
INCAPACITATED PERSON
JENNIFER CLOOS
An Alleged Incompetent
ORDER OF COURT
AND NOW, this l'llt day of ~, 1996, upon
review of the attached Petition, a hearing is scheduled in this matter
for II ~'r:LrL:_,} dr:1 ' the .;;1,(ic- day of OjJA_< ~6
1996, at .",q',.<!<? a.m.~'), in Courtroom U ."j- , Cumberland
County Courthouse, Carlisle, Pennsylvania.
Personal service of this Order and accompanying Notice and
Petition shall be caused to be made upon the alleged incapacitated
person by Petitioner in accordance with the Probate, Estates and
Fiduciaries Code. Notice shall also be given to all other persons and
entities required to be notified under the Code. Proof of service
shall be furnished at the above-scheduled hearing.
BY THE COURT,
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HI THE l\f\7':'ER OF
I~ THE COURT OF CO~MON PLE~S
COUNTY, PENNSYLV~NIA
Jr-nnifl1r C'l(l()~;
llu'l Al.LEGE~ I:ICCMPE'rE:IT
ORPH~~S' COURT DIVISION
HI RE !ro.
PE'I'I-:'ION fOR !\PPOI!ITME~lT OF ~
TEMPORARY GUARDIAN OF THE PERSON
PURSUANT TO 20 Pa. C.S,A. 5513
~e Feti:ion of Joan c100s
, res!'ect:ully
re!'resent.s:
1. 'lour Petitioner is
Joan C100s
.
2.
Jennifer Cloos
is cur:ently receiving care at
the residence of Joan and Timothy Cloos
3 .
Jennifer CLous
domiciled at
12 Cumberland
Estates Drive, Mechanicsburg, PA 17055
4,
Jennifer Cloos
is 27
years of age
having =een born on
September 7, 1968
5.
Jennifer Cloos
~ari:al s~atDs is
single,
never married
6. Those !,ersons, if any, who are
.1p-nn i fer CloDs.
next-of-~in and :heir re1~tionshi? :0 same, of whom your
Petitioner has ~nowLedge are as fc1:ows:
Joan Cloas. Jennifer's mother
Timothv C1oos, Jennifer's father
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IN THE MATTER OF
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-96-326
JENNIFER CLOOS,
an allegedly incompetent
IN RE: PETITION FOR APPOINTMENT OF A TEMPORARY GUARDIAN
OF THE PERSON PURSUANT TO 20 PA. C.S.A. 5513
BEFORE OLER. J.
ORDER OF COURT
AND NOW, this 24th day of April, 1996, upon
consideration of the petition for Appointment of a Temporary
Guardian of the Person pursuant to 20 Pa. C.S.A. 5513, and
following a hearing held at the Cumberland county courthouse at
which the allegedlY incapacitated person was present, Jennifer
Cloos is adjudicated an incapacitated person, and her mother,
Joan Cloos, residing at 12 Cumberland Estates Drive,
Mechanicsburg, cumberland county, pennsylvania, is appointed
temporary partial guardian of her person for the purpose of
executing a "2176 waiver" and any other necessary documents to
effect her daughter's admission into the facility operated by
Keystone Service systems, Inc. This appointment shall expire
following the accomplishment of this function. No bond shall be
required of the guardian.
Notice is hereby provided in person to Jennifer
Cloos of her right to appeal and to petition to modify or
terminate the guardianship.
3. Ms. Cloos, since birth, has been in the
profoundly to severely mentally retarded range.
4. As a result of that condition, Ms. Cloos's
ability to receive and evaluate information and make and
communicate decisions has been impaired to such a significant
extent that she is unable to meet essential requirements for her
physical health and safety in the form of deciding whether to
execute a "2176 waiver" for purposes of federal funding and
other documents necessary for her admission to a facility
operated by Keystone Services Systems, Inc.
5. Guardianship services are necessary for Ms.
Cloos, notwithstanding the personal assistance which she
receives from her mother and father and from services provided
by the county.
6. Based on the aforesaid condition of Ms. Cloos
and her lack of capacity to make and communicate decisions in
the regard mentioned, a temporary and partial guardianship with
respect to her person is required.
7. The duration of this guardianship shall be
until the guardian has executed the necessary "2176 waiver" and
secured Ms. Cloos's participation in the said program, if the
guardian feels that such measures are in the interest of her
daughter.
8. Pursuant to 20 Pa. C.S. section 5512.1(b), it
is found that Ms. Cloos is partially incapacitated and in need
of temporary partial guardianship services of her person.
9. The mother of Ms. Cloos is a person qualified
under 20 Pa. C.S. Section 5511(f) to serve as guardian of her
person.
10. It appears that Ms. Cloos's condition is of
an indefinite nature in terms of duration.
11. The foregoing Findings of Fact are made on
the basis of clear and convincing evidence.
DISCUSSION
The provisions respecting adjudication of
incompetency have recently been amended and are contained in 20
Pa. C.S. Sections 5501 et sea. Petitioner has substantially
complied with these provisions, and, based upon the foregoing
Findings of Fact, the following Order will be entered:
ORDER OF COURT
AND NOW, this 24th day of April, 1996, upon
consideration of the Petition for Appointment of a Temporary
Guardian of the Person Pursuant to 20 Pa. C.S.A. 5513, and
following a hearing held at the Cumberland County Courthouse at
which the allegedly incapacitated person was present, Jennifer
Cloos is adjudicated an incapacitated person, and her mother,
Joan Cloos, residing at 12 Cumberland Estates Drive,
Mechanicsburg, Cumberland County, Pennsylvania, is appointed
temporary partial guardian of her person for the purpose of
executing a "2176 waiver" and any other necessary documents to
RECEI~b; JUL 13 ~:y
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IN RF.: ,JENNIFER S. CLOOS
: IN TilE COllin OF COMMON I'LEAS
: OF ClH\1BEltLANI> COllNTY,
: I'ENNSYLVANIA
: OIU'IIANS' COllin DIVISION
II disllhlcd person
: NO. 191)(,-32(,:
On the Petition of Joan K. C100s
FINAL OIUlF.R OF eOlIRT
. 2005. upon review of the foregoing
r:
AND NOW. this .1.i. day of"
Petition in the above-referenced mailer to create and fund a Special Needs Disability Trust for
the benefit of Jennifer S. C1oos. it is hereby ORDERED. ADJUDGED and DECREED that the
Special Needs Disability Trust for the benefit of Jennifer S. Cloos. is established and approved in
the fon11 as presented to the Court. and Jmm K. Cloos, in her capacity as Trustee, is hereby
authorized to execute the trust agreement, thereby agreeing to be bound to the terms and
conditions thereof. 1\ is lilrther ordered tlmt Joan K. Cloos shall have the authority. in her
capacity as Trustee. to fund said Special Needs Disability Trust for the benefit of Jennifer S,
Cloos with Jennifer S. Cloos' Social Security income that is ensured each month tilr her monthly
living expenses.
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IN IU:: .JENNIFER S, CLUOS
: IN TilE COllin OF COMMON I'LEAS
: OF ClIl\tnERLANI> COlINTY,
: I'ENNSYLVANIA
: OIU'IIANS' CotJRT DIVISION
II dlslIhlcd pcrson
: NO, IlJ9CI-32c.
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On the Petitiun uf Juan K. Cluus
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PETITION FOR ORDER AUTIIORIZING TilE CREATION ANI> HINDING Of.'1\
SPECIAL NEEDS DISABILITY TRUST FOR TilE BENEFIT OF A IJISABU:O';
PERSON
AND NOW COMES Petitiuner, Juan K. Cluus, hy lInd through her atlUrlley. MlIriclle F.
Hazen, Esquire. and tiles the within Petitiun, and in suppurt hereut: avers as lil\1UWS:
I, Petitiuner is Juan K. Cloos uf 12 Cumherland Estates Drive. Meehanicshurg.
Pennsylvania 17050.
2, Jennifer S. Cloos, the disahled individual. is thirty-six (36) years uf age, her date
uf hirth heing September 7. 1961t Jennifer S. Cluus resides at a group hume lucated at III
Silver Spring Road. Meehanieshurg, Pennsylvania \7050.
3. Jennifer S. Clons' intestate heirs arc her naturnl parents. Timuthy N. Cluus utili
Juan K. Clons. currently residing at 12 Cumberland Estates Drive. Meehanicshurg, Pennsylvania
17050.
4. Jenniler S, Cluus is presently c1igihle lilr and is receiving guvernment henelits.
including Sucial Security and Medical Assistance hecause ufher physical health disahililies. She
is a disabled individual as delined in Title XVI uf the Sucial Seeurily Act. 42 1I.S.C.
* 13l12e(a)(3).
"
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5. Bccausc of JCllniler S. Cloos' physical disahilitics, shc is unahlc to hc cmploycd.
Jcnnifer S. Cloos' physical disahilitics ineludc: hcaring impairmcnt and ccrchral palsy. Shc is
also scvcrely mcntally rctardcd.
6. Jcnnifcr S. Cloos' asscts total approximately Eightcen Hundred Dollars
($1.800.00), consisting of a savings account.
7, Jennifer S. Cloos' gross income from all sources totals approximately Eight
Hundred Forty-two Dollars ($842,00) per month from Social Security,
8. Medical Assistanee covers Jennifer S. Cloos's prescription medication bills, and
her eligibility for the program is essential to her well-being.
9, Pursuant to 55 l'a.C.S.A. * 178,1 04. assets may be held in a trust for the benefit of
Jennifer S. Cloos without rendering her ineligible for public benefits, The funds would then be
available to supplement. not supplant. her public benefits,
10, Petitioner's attorney. Marielle F. Hazen, has drafted a Special Needs Disability
Trust in accordance with 42 U.S.l'. * I 396p(d)(4)(A) and 55 l'a,C.S.A. *178.7(1)(\), The trust
would receive the funds due to Jennifer S. Cloos from Social Security each month which are not
needed for her monthly support and maintenance. This is necessary to maintain her eligibility
for Medical Assistance which is a ncccssary public bencfit. The funds can bc used for Jennifer
S. Cloos' supplemcntalnceds as decmcd appropriate by thc Trustcc,
11. Thc trust is lor thc benclit of an individual undcr the agc of sixty-live (65) who is
disabled as defined by thc critcria in 42 U.S.l'. * 1382c(a)(3). A copy of the proposcd trust is
attached hereto as Exhibit "A".
IN RE: ,JENNIFER S, CLOOS
: IN TilE COllin OF COMMON PLEAS
: OF Clll\U1EIU.AND COllNTY,
: PENNSYLVANIA
: OJU'J1ANS' COllRT JlJVISION
II disllhled person
: NO. 191)(,-32(,
On the Petition of .lImn K. Cloos
CERTIFICATE OF SERVICE
I. Marielle F. Ilazen. Esquire, certify that on '';;:;''''L oj I I
.
. 2005, I served a true
and correct copy of thc within Petition to Crcate and Fund a Special Needs Disability Trust on
thc parties namcd below. by depositing same in the United States mail. eertilied mail. postage
prepaid as follows:
Timothy N, Cloos
(father of Jennifer S. Cloos)
12 Cumberland Estates Drive
Mechanicsburg, P A 17050
Timothy J. Cloos
(brother of Jennifer S. Cloos)
48 Gale Road
Camp Hill, PA 17011
Andrew A, Coates, Esq.
Senior Assistant Counsel
Room 1700
State Offiee Building
1400 Spring Garden SI.
Philadelphia, PAIl) 130
Respectfully Submillcd,
~oS
Date
l Jll(~
Marielle F. 11.lzcn, 'sq,
PA I.D, No, 6800)
2000 l.inglcstown Road. Suitc 202
Harrisburg. P A 17110
(717) 540-4332
TlMOTIIY N, ('LOOS is unahle to serve hereunder as successor Trustee. TIMOTIIY J.
CLODS. eurrelllly or -Ill (jale Road, ('amp Ilill. Pennsylvania 17011, shall serve hereunder as
Trustee wilh llllthe powers or Ihe lirst named Trustee with the 1()lIowing provisions.
FIRST:
A. During JENNIFER S, CLOOS' Iilctime, Ihe Trustee shall pay to or apply directly
ror JENNIFER S. CLOOS' benelit such parIs or all or none or Ihe net income and principal as
thc Truslee shall dclermine in the Trustee's sole and absolute discrclion ror the extra and
supplemental care of JENNIFER S. CLODS, suhject 10 the provisions of Item SECOND herein.
Any income which is nol distributed shall be accumulated and may hc (hut is not rcquired to be)
added 10 principal. In cxercising ils discretion. Trustee may consider all olher sources of incomc
and rcsources actually known 10 it 10 be available 10 JENNIFER S. CLOOS and all
circumstances and lactors decmed pertinent by the Trustee. In making discretionary
distributions to or lor the benelit of JENNIFER S. CLOOS. Trustee shall not consider the effect
such distributions may have upon the interest of any remainder beneliciary.
B. Upon the lirst to occur of JENNIFER S. CLOOS' death or the earlier termination
of this Trust, the Trustee shall pay to thc Commonwcalth of Pennsylvania. Department of Public
Welfare. or any successor agency. and/or any othcr stute which has provided JENNIFER S.
CLOOS with medical care under a state medical assistance program. as a bencliciary hereunder.
an amount which is equal to the lesser of the amount paid to JENNIFER S, CLOOS under such
plan or plans from the time or creation of this Trust until her death or earlier termination of this
Trust (as linally determined by such state or states). or the balance remaining in the Trust. in
accordance with 42 U.S.C. * l396p(d)(4)(A).
2
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C. Th~ Trust shall t~rminal~ upon JI'NNIFI'R S, ('LOllS' d~alh ami Ih~ Trust~~
shall distrihut~ any principal ami accumulatcd incomc r~mainiug in Ih~ Trusl. alicr th~
distrihution dir~ct~d in paragraph II.. to h~r ~Iolh~r, JOAN K, (,LOOS. "t'/' .'ilil,/)t'.I'.
SECOND:
A. Wh~r~v~r th~ Trusl~~ has thc discrction 10 dct~rminc whcth~r or 10 what ~xt~nt
principal or incom~ shall h~ dislrihut~d to or us~d IiII' lh~ h~nclil of JENNIFER S, CLODS. th~
Trust~~ shall consid~r th~ r~sourc~s and sourc~s of funds availahl~ to h~r through any state or
Icd~ral public assistanc~ program. In making this d~t~rmination. th~ Trustce shall considcr that
th~ purpose of this Trust is not to supplant public assistance h~n~lits, hut to supplemcnt thosc
bcnelits by providing only lilr JENNIFER S. CLODS' sp~cialnc~ds. that is. to providc thc extra
and supplcmcntul carc lilr JENNIFER S. CLODS which will not disqualifY hcr from any local,
state or fedcral bcnclits. No portion of thc principal or undistrihutcd incomc of thc Trust shall bc
considcrcd availahlc to JENNIFER S. CLOOS fill' dctermining eligibility for assistancc from any
local. statc or fedcntl governmcnt agcncy. departmcnt or progntm. If JENNIFER S. CLOOS
reccivcs assistance for basic maintenancc, support. carc or services. thc Trustcc is prohibitcd
from using or applying thc Trust ass~ts in an)' way that would jcopardizc such assistancc. In
making discrctionary distributions to or fill' the hcnclit of JENNIFER S. CLODS, Trustee shall
not consider the effcct such distrihutions may have upon the intcrcst of any rcmaindcr
beneliciary,
I I' the Trustee evcr pctitions thc Court to authorizc a distrihution from principal or to
am~nd or modify the terms of the Trust, notic~ shall he providcd to thc Dcpartmcnt of Public
WelHlre.
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B. Thc tcrm "spccial nccds" rcfcrs to thc maintcnancc of .IENNIFEI~ S. CLOOS'
good hcalth, safcty ami welfarc whcn, in thc discretion of thc Trnstcc. such nccds arc not
providcd hy any puhlic assistancc agcncy or othcr puhlic or privatc sourcc. Such nccds may
includc hut arc not limitcd to extra ami supplemcntal medical and dcntal eurc, physieul und
mcntal hculth earc. nursing und custodiul carc. thcrapies. nutrition, sociuli~.ution. transportution.
maintcnancc, cducution. cquipmcnt. irrcvocuhle hurial fund, thcrapcutie travel und rccrcution und
the Iikc over und uhove thc umount of hcnclits shc othcrwisc rcccives from any local, statc or
fedcrul governmcnt or from uny othcr privatc or puhlie source.
THIRD:
The Trustee is expressly uuthorized to receive additionul property from JENNIFER S.
CLODS or any other person, until JENNIFER S. CLODS reaches sixty-live (65) yeurs of age.
and to administer und distribute it us u part of this Trust.
FOURTH:
This is u discretionary. non-support Trust. No principal or income of thc Trust shall bc
anticipatcd. assigned. or cnclllllbcrcd. Thc Trust shull not bc liable lor uny dcbt, contract or
cngagcmcnt of any bcncliciary nor subjcctto any Icgul proccss. No purt of this Trust cstate shall
be construed as being subject to thc e1aims of thc bencliciary's voluntary or involuntary
creditors. The Trustcc shall dcny any rcqucst by any public or privatc cntity to disburse Trust
funds for support or other curc tlmt such cntity has thc obligution to provide to thc Trust
bcncliciary. Any discretion undcr this documcnt, if cxercised or not cxcrciscd. shall bc
eonclusivc upon all pcrsons conccrncd so long us such discrction is cxcrciscd in good fuith.
4
FIFTlr:
Upon JENNIFER S. C'LOOS' dc,llh. any principal or incolllc 10 which a bcncficiary
undcr Ihc agc of tll'cllly-onc (11) ycars hccolllcs cnlillcd ahsolutcly undcr thc lilrcgoing
provisions llIay nc\'crlhclcss hc rctaincd hy thc Trustcc in Trusl lilr Ihc bcncficiary until Ihe
beneficiary attains Ihe age of tll'enty-one (11) years and incollle llIay he accumulated and
invesled in accord,mce with Ihe investmenl powers givcn Ihe Truslee. The Trustee may apply
such part or all or none of thc incollle und principal as Ihe Trustee nUlY deterllline in the sole und
absolule discrelion of the Trustee lor the cduculion, SUpport und lI'eltilre of the beneficiury, by
the paYlllent of bills therefore or by direcl payment to the bencficiury or by puyment to uny
person selected by the Trustee 10 disburse such limds, whose receipt shall be u complete
discharge of the Truslee thcrefore. f I' the Trustee dctermincs Ihut it is impractical to udminister u
shure hcreunder. the Trustee muy in dischurge of ull duty hereunder deposit it in un interest-
beuring account in the nume of the beneficiary, wilh or Wilhout restriClions on withdrawal prior
to age twenly-one (1 I), us Ihe Trustce deellls appropriate or may pay Ihe bcneficiary's share to
the parent or other persoll having custody of the bcnefieiary, or may transfer Ihe funds to a
cuslDdian designated by Ihe Trustee for the beneficiary under the Uniform Transfers to Minors
Act of l'ennsylvunia or similur legisl,llion in any other jurisdiction. All funds nOI puid to or
applied for the beneficiary in uccordanee with the lilregoing provisions shall be paid 10 the
beneficiury at uge twenly-one (1 I) or to the beneficiury's personul represelllutive in Ihe evenl of
the beneficiary's deulh prior to uge twenty-one (11),
SIXTH:
If JENNIFER S, CLODS' testumenlury estate. exclusive of her residence und tungible
personal property. shull be insUmcienl to puy her debts. funeml expenses, und expenses of the
5
iIllminislralionof h~r ~slal~, Ih~ Trusl~~ nlay in th~ sol.' disn~lion of th~ Trusl~~ pay any pari or
all of su~h d~hts and ~sp~ns~s oul of Ih~ principal of Ihis Trusl hul non~ of said dcllls or
csp~ns~s shall h~ cnlin"ccahlc againslth~ Trusl~~ hy rcasonoflhis pro\'ision.
SEVENTlI:
All cslalc. inhcrilan~c and olh~r dcath las~s and any inlcrcsl and pcnaltics thcrcon
imposcd by rcason of JENNIFER S. CLOOS' d~alh on pl'Opcrty limning thc principal of this
Trust at JENNIFER S. CLOOS' dcalh shall bc paid out of thc principal of thc Trust without
apporliomncnt or rcimburscmcnt, In addition thc Truslcc shall ha\'c thc powcr hut not thc duty
to pay Ihllll thc principal of such Trusl. cithcr dircclly or to thc pcrsonal rcprcscntative of
JENNIFER S. CLOOS' cslatc, as much of such taxcs, and intcrcst and pcnaltics thcrcon, on thc
balancc ofhcr gross cstatc IiII' tax purposcs as thc Trustcc may dctcrminc in mdcr to Ibcilitatc thc
scttlcmcnt of JENNIFER S. CLOnS' cstatc. No hcncliciary shall bc rcquircd to rcllmd any part
of such taxcs, intcrcst or pcnaltics.
EIGlrnl:
All incomc dcri\'cd fl'Om asscts rccci\'cd as principal of this Trust during JENNIFER S.
CLOOS' Iifctimc which has accrucd whcn such asscts bccomc subjcctto this Trust but which is
rccci\'cd by thc Trustcc thcrcalicr. whcthcr thc samc is Icgally principal or incomc, shall bc
applicd in accordancc with thc pro\'isions hcrcin sctlilflh li)r thc distribution of income,
NINTH:
Thc Trustcc shall ha\'c thc lilllowing powcrs during thc administration and until thc
complction of distrihution of this Trust and any trusts hcrcundcr in addition to any powcrs given
thc Trustcc by law which thc Trustcc may cxcrcisc in thc solc discrction of thc Trustcc and
without Court appro\'al:
6
A. '('0 rclain ami ill\'cst in all limlls of rcal ami pcrsonal propcrty, inclllding stock,
common trust funds amI mlltual funds of any corporalc Irustcc hcrcundcr of any holding
company conlrolling thc corporalc trustcc. and including rcal propcrty 10 bc uscd as a rcsidcncc
suitablc for JENNIFER S. CI.OOS' spccialnccds nOlwithslamling thc faclthat such propcrty is
non-incomc producing. withollt rcstrictionto invcslmcnts authorizcd by law.
B. To join in any mcrgcr, consolidation. rcorganization. voting Irust plan or similar
action. llltd to dclcgale diserelionary powcrs or duties with respectthercto,
(, To sell at public or privatc sale IlJr cash or credit. to exchange. or to lease for any
period of time. any real or pcrsonal property. 10 give options liJr sales. exchanges or leascs and to
allocate premiums from the sale of options to income or principal.
D. To take any and all aelion which the liduciary dcems necessary to prevent. abate.
"clean up" or otherwise respond to any actual or potcntial violation of any federal. state or local
law. rule or ordinance affecting any property held in this Trust rclated to the generation. use.
treatment. storage, disposal. release, disehargc 01: or contamination by. any materials or
substances that arc prohibited or regulated by federal. state or local law or that pose a hazard to
the environment or human health, and to charge the expense thereof to principal or to income or
partly to each.
E, To borrow money from anyone. including a Trustee hereunder. and to mortgage
or pledge any assets as security thercliJre.
F. To compromise or sellle claims without obtaining JENNIFER S, CLOOS'
consent.
G, To make distribution in kind and to cause lllty share to be composed of cash,
property or undivided fractional shares in property different in kind from any other share, giving
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consi,kralion to such cslent as Ihe Truslee ,lelel'lllines to the rcdeml income las hasis of such
properly.
11. In the sole discrelionof Ihe Trustee to apply any paymenl of income or principal
10 which JENNIFER S. CLOOS is enlitled hereunder direclly Illr her henelit or to pay il III her
natural guardian or legally appointed guardian or such olher person as the Trustee selects to
disburse il for JENNIFER S. CLOOS' henelil. The reeeiplof the person so selec\ed shall be a
complete discharge of the Trustee therd.'re.
1. To repair and maintain any real or personal property and to charge the espense 10
income or prineiplll.
J. To apply to income or principal any corporate dislribulion which is described or
designaled by the corporation as a stock dividend or as a dislribulion which may be received
eilher in cash or in shares oflhe corporation atlhe option oflhe holder.
K. To arrange for Ihe services of any public or private organization established 10
assisl disabled persons. 10 monilor JENNIFER S. CLODS' living conditions. evaluate her needs
and idenlify available social. Iinancial. developmenlal or olher programs. wilhoul diminulion of
eompensalion olherwise properly payable to the Trustee and to charge the expense thereof either
to principal or to income or partly to each. without liability for any act or omission of any such
individual or organization or I"r any act or omission made in reliance on the advice of such
individual or organization provided such person or organization was retained with reasonable
care and prudence.
L. To retain legal or professional assistance in establishing and administering this
Trust and accomplishing its purpose. without diminution of compensation otherwise properly
payable to the Trustee and to charge the expense thereof either to principal or to income or partly
II
to each. and without liability lilr any act or omission of any such individual Illr any ael or
omission mmle in reliance on the advice of such individual provided such person or organization
was relained with reasonable care and prudence.
M.
N.
CLODS.
TENTH:
To register investments in nominee name or to hold investments in bearer liJrlll.
To purchase an irrevocable hurial account Illr the benelit of JENNIFER S.
All reasonable expenses in establishing. maintaining. adminislering. and defending Ihis
Trust. including bul nol limited to reasonable allorneys' Ices. accounting Ices, trustee's fees. and
eosls shall be proper charges tolhe Trusl.
ELEVENTH:
The silus of Ihis Trust is Pennsylvania and all questions perlaining to the validily.
eonslruetion. inlerpretation and administralion of this Trust shall be determined in accordance
wilh the laws of Pennsylvania and Ihe applicable laws of Ihe United Slales.
TWELFTH:
A. The Court having jurisdiclion of Ihis Trusl and the Trustee wilh Ihe approval of
said Court may amend Ihis Trust so thai it eonl,mlls with 42 U.S.C. *1396p(d)(4)(A) and any
rclaled slalules or regulalions, including stale stalules and regulations. eonsislent with the
provisions and purposes of OBRA '93 and any amendments thereto.
B. Anything hereinbefore to the contrary notwithstanding. the Trustee with the
approval of said Court. shall have the discretion to terminate this Trust at any time if the Trustee
in its sole and absolute discretion determines that the continuance of the Trust is impractical,
uneconomical or J'Jr other reasons unwise. Upon such early termination. the Trustee shall Iirst
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make any distribution required under Item FIRST. paragraph II. ami any remaining principal
shall be distributed directly to .lOAN K. CLOOS. 1'<'1' stirl'cs. in accordance with Ihe Order of
said Court.
TIIIRTEENTII:
This Trust shall be irrevocable. Notwithstanding any eonllllon law or statutory provision
to the contrary. neither JENNIFER S. CLODS nor any legal representative acting I,)r JENNIFER
S. CLOOS shall have the right to alter. amend or revoke any provision of this Trust. or to
withdraw any limds from this Trusl.
FOURTEENTH:
A. The Trustee. JOAN K. CLODS, or the successor Trustee. TIMOTHY N. CLODS,
or the alternate successor Trustee. TIMOTHY J. CLOOS. shall have the power to designate a
successor corporate or nonprolit Trustee to serve in his/her place if he/she is unable to servc or to
continue serving as Trustee.
B. Any corporate or nonprolit Trustee shall receive compensation for the
performance of its functions as Truslee hereunder in accordance with its schedule of fces in
effect from time to time during the period in which its services arc performed.
C. No Trustee shall be required to enter bond or other security in any jurisdiction.
IN WITNESS WIIEREOF. the Selllor. JOAN K. CLOOS. has caused this Dcclarlltion of
Trust to be executed:
Witness
JOAN K. CLODS, Senior
Witness
.lOAN K. CLODS. Trustee
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COMMONWEALTII OF PENNSYLVANIA
COUNTY OF DAUPIIIN
ss:
On
. 2005, belllfe me a Notary Public lor the Commonwealth
of Pennsylvania. personally appeared .lOAN K. CLODS. ns Selllor and Trustee. 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 oflicial seal.
Notary Public
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