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HomeMy WebLinkAbout11-16-07 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 2007-00916 rO (") ~O ,::;:1) i~l:Eo _oj "i> r- t..~: z rn ::.: (Ii ~ CT\ 000 0011 " The undersigned, PAUL M. HEMLER, being the husbaJii ~ ELIZABETH B. HEMLER, by his duly appointed agent under power ~ attornEW' dated January 31, 2002, intending to be legally bound, makes the following ...;.,J disclaimer: IN RE: ESTATE OF ELIZABETH B. HEMLER, DECEASED "" c::::I = -...I :z: o -<:: :0 ....D rT" f,; C) G)O l:;::-l :'u :~CJ rO'-l ;11 :':1} 0 DISCLAIMER ('"")0 , !!-n .-- -". F-:'; C") r-- m (,,0 c..:) "n Disclaimant hereby disclaims all right, title and interest he may have in household furniture, furnishings, books, pictures, jewelry, silverware, automobiles, wearing apparel and all other articles of household or personal use or adornment and all policies of insurance thereon which would have passed to Disclaimant pursuant to the provisions of Item V (b) of the Last Will and Testament of Elizabeth B. Hemler dated April 4, 2007. This Disclaimer is irrevocable and unqualified. A true and correct copy of the Power of Attorney of Paul M. Hemler appointing his daughter, Mary H. Garbarino is attached hereto and made a part hereof as Exhibit "A", and the specific power to disclaim any interest in property is granted in (v) on page 2 thereof. IN WITNESS WHEREOF, the undersigned has set his hand and seal this /3'Hl day of 17oU'{IYfLlJ.-vL., ,2007. ~~ p ~() Witness ~jJ~leOA PAUL . HEMLER, by his agent MARY H. GARBARINO under Power of Attorney dated January 31, 2002 ~ COMMONWEALTH OF PENNSYLVANIA I SS COUNTY OF On this, the /3ftday of f\/ av'~ 2007, before me, a Notary Public, the undersigned officer, personally appeared MARY H. GARBARINO as Power of Attorney for Paul M. Hemler, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and notarial seal. ~~ Nota PublIc My Commission Expires: (SEAL) F PENNSYLVANIA COMMONWEALTH 0 NOT ARIAL SEAL Public C'iNTHIA J. R~Em:~:~d County Lemoyne Boro., .u February 3, 2008 My Commission Expires POWER OF ATTORNEY NOTICE THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR AFPROV AL BY YOU. THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY. YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME INCAPACITATED, UNLESS YOU EXPRESSLY LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY. YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGENT'S FUNDS. A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR AGENT IS NOT ACTING PROPERLY. THE POWERS AND DUTIES OF AN AGENT UNDER A PO\VER OF ATTORNEY ARE EXPLAINED MORE FULLY IN 20 Pa.C.S. Ch. 56. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOu. I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND ITS CONTENTS. DATE: I/JIIo-2- I / f;f~MM~R ~ KNOW ALL PERSONS BY THESE PRESENTS, that I, PAUL M. HEMLER, of Hampden Township, Cumberland County, Pennsylvania, have made, constituted and appointed and do hereby make, constitute and appoint my daughter, MARY H. GARBARINO, my true and lawful agent and attorney-in-fact and surrogate to make health care and medical treatment decisions for me. My agent may, for me and in my name and on my behalf, do and perform all matters and things, transact all business, make, execute and acknowledge all contracts, orders, deeds, writings, assurances and instruments which may be requisite or proper to effectuate any matter or thing appertaining or belonging to me, including without limitation: (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) (x) (xi) (xii) (xiii) (xiv) (xv) (xvi) (xvii) (xviii) (xix) (xx) (xxi) (xxii) the right to make limited gifts, to create a trust for my benefit, to make additions to an existing trust for my benefit, to claim an elective share of the estate of my deceased spouse, to disclaim any interest in property, to renounce fiduciary positions, to withdraw and receive the income or corpus of a trust, to sell or transfer ownership of insurance policies on my life, to represent me in all matters involving federal, state, and local taxes, to engage in real property transactions, to engage in tangible personal property transactions, to engage in stock, bond and other securities transactions, to engage in commodity and option transactions, to engage in banking and financial transactions, to borrow money, to enter safe deposit boxes, to engage in insurance transactions, to engage in retirement plan transactions, to handle interests in estates and trusts, to pursue claims and litigation, to receive government benefits, and to make an anatomical gift of all or part of my body, with the same powers, and to all intents and purposes with the same validity as I could, if personally present; hereby ratifying and confirming whatsoever my agent shall and may do, by virtue hereof. In addition, the agent appointed by this Power of Attorney shall be authorized to make health care and medical treatment decisions for me which shall include, but not be limited to the following: 1. To authorize my admission to a medical, nursing, residential or similar facility and to enter into agreements for my care at the expense of my estate; - 2 - 2. To authorize medical and surgical procedures; 3. To authorize the administration of pain relieving drugs or other medical or surgical procedures calculated to relieve my pain even though their use may lead to permanent physical damage, addiction or even hasten the moment of (but not intentionally cause) my death and to authorize unconventional pain relief therapies which my agent believes may be helpful to me; 4. To withhold consent to any medical care or treatment (including medical and surgical procedures); 5. To revoke or change any consent previously given or implied by law for any medical care or treatment (including medical and surgical procedures); 6. To arrange for my removal from any medical or nursing facility; and 7. To grant, in conjunction with any instructions given under this power, releases to hospital staff, physicians, nurses and other medical and hospital administration personnel who act in reliance on instructions given by my agent or who render written opinions to my agent in connection with any matter described in this power from all liability for damages suffered or to be suffered by me; to sign documents titled or purporting to be a "Refusal to Permit Treatment" and "Leaving Hospital Against Medical Advice," as well as any necessary waivers of or releases from liability required by any hospital or physician to implement my wishes regarding medical treatment or non-treatment. This Power of Attorney shall not be affected by any disability on my behalf, including the event that I become incompetent to handle my affairs. In the event that legal proceedings concerning my incapacity, within the meaning of Chapter 54 of the Pennsylvania Probate, Estates and Fiduciaries Code, or for the appointment of a guardian of my estate and/or person are commenced, I nominate the agent appointed by this Power of Attorney for consideration by the court having jurisdiction of those proceedings for appointment as the guardian of my estate and/or person, and I request the court to make its appointment in accordance with this nomination, except for good cause or disqualification. - 3 - My agent may delegate anyone or more powers granted herein to one or more persons and on such terms as the agent may designate and specify. In the event that the agent appointed above shall be unable, unwilling or cease to act as my agent, then I nominate, constitute and appoint my daughter, ANNE H. TAYLOR, as my agent. IN WITNESS WHEREOF, and intending to be legally bound hereby, I have hereunto set my hand and seal this ,",/ day of J~ ' 2002. WITNESS: 17J~ r &) ifa-J~, ~ PAULM. HEMLER (SEAL) ACKNOWLEDGMENT I, MARY H. GARBARINO, have read the attached Power of Attorney and am the person identified as the agent for the principal. I hereby acknowledge that in the absence of a specific provision to the contrary in the Power of Attorney or in 20 Pa.C.S. when I act as agent: 1. I shall exercise the powers for the benefit of the principal. 2. I shall keep the assets of the principal separate from my assets. 3. I shall exercise reasonable caution and prudence. 4. I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal. DATE: 1/3/ /{}~ -m~ II ~M' MARY . GARBARINO COMMONWEALTH OF PENNSYLVANIA COUNTY OF c~ SS: On this, the 31At day of , 2002, before me, the undersigned officer, personally appeared PAUL M. HEMLE who being duly sworn according to law, deposes and says that the foregoing Power of Attorney is his act and deed and that he desires the same to be recorded as such. IN WITNESS WHEREOF, I hereunto set my hand and notarial seal the day and year aforesaid. ~~LL- N otar ublic (SEAL) My Commission Expires: i.',j I 1',,! C\{:"~+iTrA \j. j\Jc,~'ry i:~'t}! _,<: r-iin f:.~)r(). Cumbprl~/:,d C.OI ;" \ (:DrnF: ,.'~-'n_ ?