HomeMy WebLinkAbout05-21-08
IN RE: EDITH MAYO
: IN THE COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY,
: PENNSYLVANIA n
: ORPHANS' COURT DIVISIONs~
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An incapacitated person
: NO. 21-05-1012
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On the Petition of KEVIN L. ELLIS and DOROTHY ELLIS
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PETITION TO RELEASE BOND
AND NOW come Petitioners, Kevin L. Ellis and Dorothy Ellis, by and through their
attorney, Marielle F. Hazen, Esquire, of Hazen Elder Law, and file the within Petition to Release
Bond and in support hereof aver as follows:
1. By Order of this Court dated December 29, 2005, KEVIN L. ELLIS and
DOROTHY ELLIS, were appointed the Co-Guardians of the Estate of EDITH MAYO. (A copy
of the Final Order is attached hereto as Exhibit "A")
2. In the Guardianship Order dated December 29,2005, a bond in the amount of One
Hundred Thousand Dollars ($100,000.00) was required to be posted by the Co-Guardians of the
Estate.
3. The Co-Guardians secured a Bond through Penn National Insurance at Bond
Number SB 319896. (A copy of the Bond is attached hereto as Exhibit "B")
4. EDITH MAYO resides in a long term care facility and her resources have been
depleted to approximately Eight Thousand Dollars ($8,000.00) paying for her care. The Co-
Guardians are in the process of applying for Medical Assistance for EDITH MAYO.
5. Because there are no longer funds to protect, and because EDITH MAYO's
remaining funds and her income will need to be applied towards her care, the Co-Guardians need
to cancel the guardianship bond. Penn National Insurance Surety Company will not do so
without a release from the Court. The insurance company is demanding continued payment of
this bond by the Guardian personally.
WHEREFORE, Petitioners respectfully request this Honorable Court to enter an Order
releasing the bond in the above-captioned matter.
Respectfully submitted,
Date: 5 -/9- OJ'
Marie e F. azen, Es
Attorney ID No. 68003
HAZEN ELDER LAW
2000 Linglestown Road, Suite 202
Harrisburg, Pennsylvania 17110
(717) 540-4332
Attorney for Petitioners
VERIFICATION
I verify that the statements made in this Petition are true and correct. I understand that
false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to
unsworn falsification to authorities.
KEVI~
VERIFICATION
I verify that the statements made in this Petition are true and correct. I understand that
false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to
unsworn falsification to authorities.
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DOROTHY ELLIS \
IN RE: IN THE COURT OF COMMON PLEAS OF
EDITH MAYO CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
An alleged incapacitated ~
Person NO. 21-05-1012 ~:
IN RE: PETITION FOR APPOINTMENT OF CO-GUARDIANS OF ~~E~N
AND ESTATE OF AN ALLEGED INCAPACITATE~EJ(~C5Jt
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BEFORE OLER, J.
ORDER OF COURT
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AND NOW, this 29th day of December, 2005, U~QQ
consideration of the Petition of Kevin L. Ellis and Dorothy E~lis
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for Appointment of a Permanent Plenary Guardian of the Person and
Estate of Edith Mayo, following a hearing at which the allegedly
incapacitated person was represented by court-appointed counsel,
Michael J. Whare, Esquire, and for the reasons stated in the
accompanying opinion, Edith Mayo is adjudicated an incapacitated
person and Kevin L. Ellis and Dorothy Ellis, her nephew and sister
respectively, are appointed permanent plenary co-guardians of her
estate and person.
This appointment is conditioned upon and shall not be
effective without, the filing in this action of a bond, with
corporate surety acceptable to the Court in the amount of $100,000,
securing the proper performance of the guardians' duties and the
maintenance of said bond with surety in full force and effect
during the duration of the co-guardianship.
The co-guardians shall timely file with the Court all
reports and accounts required by statute.
Ms. Mayo and her counsel are hereby notified of her
right to petition at any time for a modification or termination of
the guardianship provisions contained in this order.
The co-guardians of the person appointed herein shall
have the power and authority jointly and/or individually to serve
Exhibit "A"
as personal representatives for all purposes of the Health
Insurance Portability and Accountability Act of 1996
(Pub.L. 104-191), 45 CFR Sections 160 through 164 ("HIPAA"). The
co-guardians shall be considered the personal representatives
jointly and/or individually for Edith Mayo's health care
disclosures under the federal HIPAA regulations and shall have full
authority to review Edith Mayo's medical records and to execute
releases of confidential information from all medical providers and
insurers or other third-party payors.
As co-guardians of the estate, Dorothy Ellis and Kevin
L. Ellis, shall have the authority jointly and/or individually to
make distributions from principal to the payment of nursing home
expenses, all medical needs, and legal fees.
By the Court,
Marielle F. Hazen, Esquire
2000 Linglestown Road
STE 202
Harrisburg, PA 17110
Attorney For the Petitioners
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Michael J. Whare, Esquire
155 South Hanover Street
Carlisle, PA 17013
Court-appointed Attorney For Edith Mayo
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PENNSYLVANIA NA TIONA~
MUTUAL CASUALTY INSURANCE COMPANY /
Harrisburg, Pennsylvania " I
I3CW 1\0. 319896 ... .......::~
In the Matter of the Estate of: Edith Mayo
KNOW ALL MEN BY THESE PRESENTS, that we,
Kevin Ellis and Dorothy Ellis
as
Guardians
of the Estate of
Edith Mayo
and Pennsylvania National Mutual Casualty Insurance Company, a Pennsylvania Corporation, of HalTisburg,
Pennsylvania, as Surety, are held and firmly bound unto the
Court of Cumberland County
in the full and just sum of
One Hundred Thousand and 00/100
DOLLARS,
($ 100,000 )
for the payment of which, well and truly to be made, we bind ourselves, our heirs, executors, ,
administrators, successors and assigns, jointly and severally, finnly by these presents.
Sealed with our seals, and dated this 18th day of Januarv, 2006.
Guardians
Kevin Ellis and Dorothy Ellis , has been, or is about to be, appointed
of the estate of Edith Mayo
WHEREAS,
, by the
Judge Dler
County.
Court of
Cumberland
NOW, THEREFORE, the condition of this obligation is such, that if the said
Guardians
shall well and truly discharge the duties of said trust according to law, then this obligation
is void, otherwise to remain in full force and effect.
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KeV.lll E 1.S ~
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Dorothy Ellis \
PENNSYLVANIA NATIONAL MUTUAL
CA UAL TY INSU N E COMPANY
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By:
Gayle K.
Exhibit "B"
FOIm 78-168
PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY
Harrisburg, Pennsylvania
POWER OF ATTORNEY
Know All Men By these Presents, That PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY, a
corporation of the Commonwealth of Pennsylvania, does hereby make, constitute and appoint
KATHLEEN M. HOOVER, GAYLE K. MORSE, TIMOTHY C. HOAGLAND, KIITY A. CASSELL, HEIDI R. GATES, JAMI
WERNER AND BRENT D. HEADLEY, ALL OF MECHANICSBURG, PENNSYLVANIA (EACH)
its true and lawful Attomey(s)-in-Fact to make, execute, seal and deliver for and on its behalf as surety as its act and deed:
ANY AND ALL BONDS AND UNDERTAKINGS PROVIDED THE AMOUNT OF NO ONE BOND OR UNDERTAKING
EXCEEDS THE SUM OF FIVE HUNDRED THOUSAND DOLLARS ($500,000.00)-----------------------------------------------------
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ALL POWER AND AUTHORITY HEREBY CONFERRED SHALL HEREBY EXPIRE AND TERMINATE WITHOUT NOTI E
AT MIDNIGHT OF THE 30TH DAY OF NOVEMBER 2009, AS RESPECTS EXECUTION SUBSEQUENT THERETO.
And the execution of such bonds in pursuance of these presents shall be as binding upon said Company as fully and amply, to all
intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the Company at its
office in Harrisburg Pennsylvania, in their own proper persons.
This appointment is made by and under the authorization of a resolution adopted by the Board of Directors of the Company on
October 24, 1973 at Harrisburg, Pennsylvania, which resolution is shown on the reverse side hereof and is now in full force and eff; t.
In Witness Whereof: PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY has caused these
presents to be signed and its corporate seal to be affixed on FEBRUARY 23, 2006
PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMP Y
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Kenneth R. Shutts, Executive Vice-President, Secretary & General Co e1
Commonwealth of Pennsylvania, County of Dauphin - ss:
On FEBRUARY 23, 2006, before me appeared Kenneth R. Shutts to me personally known, who being by me duly sworn, did say at
he resides in the Commonwealth of Pennsylvania, that he is Executive Vice-President, Secretary & General Counsel of
PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY, That he is the individual described in and w
executed the preceding instrument, and that the seal afftxed on said instrument is the corporate seal of said Company, and that said
instrument was signed and sealed on behalf of said Company by authority and direction of said Company, and the said office
acknowledged said instrument to be the free act and deed of said Company.
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Commonwealth of Pennsylvania, County of Dauphin - ss:
Notary Public
Notarial Seal
Jacqueline A. Ellis, Notary Public
City Of Harrisburg, Dauphin County
My Commission Expires Dec. 19, 2009
Member. Pennsylvania Association of Notaries
[, Michael F. Greer, Vice President, Surety & Fidelity of the PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANC
COMPANY, a corporation of the Commonwealth of Pennsylvania, do hereby certify that the above and foregoing is a true and corre
::opy of a Power of Attorney, executed by the said Company, which is still in full force and effect.
IMPORTANT NOTICE: This border must be RED in color. If it is not
ary 18, 2006
[n Witness Whereof, I have hereunto set my hand and afftxed the corporate
78-190 (Rev 05/02)
RESOLUTION
. adopted by the Board of Directors of
. ,Pe,~nsylvania National Mutual Casualty Insurance Company
, on October 24, 1973
RESOLVED, that (1) the President, any Vice President, the Secretary, or
any Department Secretary shall have power to appoint, and to revoke the
appointments of, Attorneys-in-Fact or agents with power and authority as
defined, or limited in their respective powers of attorney, and to execute
on behalf of the Company, and affix the Company's seal thereto, bonds,
undertakings, recognizances, contracts of indemnity and other written
obligations in the nature thereof or related thereto; and (2) any of such Of-
ficers of the Company may appoint and revoke the appointments of joint-
control custodians, agents for acceptance of process, and Attorneys-in-Fact
with authority to execute waivers and consents on behalf of the Company;
and (3) the signature of any such Officer or of any Assistant Secretary or
Department Assistant Secretary and the Company seal may be affixed by
facsimile to any power of attorney or certification given for the execution
of any bond, undertaking, recognizance, contract of indemnity or other writ-
ten obligation in the nature thereof or related thereto, such signature and
seal when so used whether heretofore or hereafter, being hereby adopted
by the Company as the original signature of such Officer and the original
seal of the Company, to be valid and binding upon the Company with the
same force and effect as though manually affixed.
IN RE: EDITH MAYO
: IN THE COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY,
: PENNSYLVANIA
: ORPHANS' COURT DIVISION
An incapacitated person
: NO. 21-05-1012
On the Petition of KEVIN L. ELLIS and DOROTHY ELLIS
CERTIFICATE OF SERVICE
I, Marielle F. Hazen, Esquire, certify that on S /it! / OJ
, I
, I served a true and
correct copy of the within Petition to Release Bond on the parties named below, by depositing
same in the United States mail, certified mail, postage prepaid as follows:
Mrs. Dorothy Ellis
4097 H Farm Drive
Harrisburg, P A 17112
Mr. Kevin Ellis
1505 Nittany Lane
Harrisburg, PAl 71 09
Mrs. Laura Lennon
4428 44th Street
S. Minneapolis, MN 54406
Mrs. Brenda Selby
26454 Forill Avenue N.
Wyoming, MN 55092
Mrs. Beverly McClure
30 Second Avenue
Bay Shore, NY 11706
West Shore Health & Rehabilitation Cntr
770 Poplar Church Road,
Camp Hill, Pennsylvania 17011
Michael J. Whare, Esq.
Rominger, Bayley & Whare
Attorneys at Law
155 S. Hanover Street
Carlisle, P A 17013
s/r7/o~
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Date
Mariel F. Ha e , Esq.
P A I.D. No. 68003
HAZEN ELDER LAW
2000 Linglestown Road, Suite 202
Harrisburg, PAl 711 0
(717) 540-4332