HomeMy WebLinkAbout04-25-11J. Ronaldo Legaspi, Esquire I.D. # 200240 ~_
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IN RE: IN THE COURT OF COMMON PAS `~ ~ ~:~ ~-t
OF CUMBERLAND COU]vTY, ~ ~~ ~'
PENNSYLVANIA
ELIZABETH W. WINTERS, :ORPHANS' COURT DIVISION
an Alleged Incapacitated Person
No. ~1 ~ < < - ~ 5 l'O
PETITION FOR APPOINTMENT OF GUARDIAN
OF THE PERSON AND ESTATE
AND NOW, comes Matthew L. Winters, petitioner, by and through her attorney,
J. Ronaldo Legaspi, Esquire, of Goldberg Katzman, P.C., who brings this Petition for the
determination of the incapacity of Elizabeth Winters and for the appointment of a plenary
guardian of the estate and of the person of the alleged incapacitated individual, alleging
in support thereof the following:
1. The Petitioner and proposed plenary guardian of the person and the
estate of the alleged incapacitated individual is Matthew L. Winters, who resides
at 1201 Foxfire Drive, Greensboro, NC, the son of the ~~lleged Incapacitated
Person.
2. The alleged incapacitated individual is Elizabeth W. Winters, who
is seventy-nine (79) years of age and whose domicile pis 321 Elgin Circle,
Mechanicsburg, PA 17055.
3. The alleged incapacitated is currently admitted at Forest Park
Health Center, 700 Walnut Bottom Road, Carlislf;, Pennsylvania, a
comprehensive elder-care and rehabilitation facility.
4. The alleged incapacitated person is single, widowed, and has two
adult children: Matthew L. Winters, IV, who resides at 1201 Foxfire Drive,
Greensboro, NC 27410, and Deborah A. Winters, who resides at 43 8 Kindig Road,
Waynesboro, VA 22980.
5. The presumptive adult heirs of the alleged incapacitated person are
her children, Matthew L. Winters, IV, and Deborah A. Winters.
6. The proposed guardian has no interest ad`rerse to the alleged
incapacitated person.
7. The alleged incapacitated person has n~~ guardian already
appointed.
8. No other court has ever assumed jurisdiction in any proceeding to
determine the capacity of the alleged incapacitated person.
9. The alleged incapacitated person executed a durable power of
attorney appointing her husband, Matthew L. Winters, III, deceased, and Matthew
L. Winters, IV, and Deborah A. Winters as successor agents. A true and correct
copy of the Power of Attorney instrument dated September 30, 1998, is attached
hereto as Exhibit "A."
10. The alleged incapacitated person has execute~~ a will. A true and
correct copy of the Last Will and Testament dated December 15, 2004, is attached
hereto as Exhibit "B."
11. The alleged incapacitated person has executed a living will. A true
and correct copy of the Living Will dated January 27, 2005, is attached hereto as
Exhibit "C."
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12. The reasons that guardianship is sought relate to the mental and
physical conditions of the alleged incapacitated individual and the resultant
limitations on her abilities to conduct her own affairs and make decisions about
her medical care.
13. The alleged incapacitated individual does not have the ability to
receive and evaluate information effectively and communicate decisions about her
financial affairs in a meaningful way. Medically, she has been diagnosed with
severe brain injury by her treating neurologist at Forest Park, Dr. Richard
Paczynski, in connection with an automobile accident in which she was involved
on December 21, 2010, for which institution of litigation is contemplated,
requiring the appointment of an agent for same. The alleged incapacitated
individual was diagnosed on or about January 29, 2011, by- Dr. Paczynski with
Traumatic Brain Injury (TBI) subsequent to the motor vehicle accident on
December 21, 2010. The TBI was a complex closed head injury with bilateral
frontal lobe contusions, bilateral subdural hematomas over frontal regions (small),
and right temporal lobe infarction. In aggregate, these brain injuries resulted in a
state of hypokinetic mutism (minimal spontaneous motion or speech) typical of
traumas that damage both frontal lobes of the brain. As a consequence of the
aforesaid medical condition, the alleged incapacitated individual requires
extensive assistance in her activities of daily living.
14. The Petitioner believes there are no less restrictive alternatives
than the appointment of a plenary guardian of the person and the estate.
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15. The Petitioner and Ms. Winters' other family :members believe that
the power of attorney executed on September 30, 1998, is not sufficient to allow
the Petitioner to conduct the personal and financial affairs of the alleged
incapacitated individual.
16. The proposed guardian, Matthew L. WintE;rs, IV, is a retired
professional baseball player who is now employed by Nippon Ham Fighters
Company in Sapporo,. Japan, as an international baseball scoot.
17. The gross value of the estate of the alleged :incapacitated person,
insofar as it is known to the petitioner consists of approximately $1.37 Million in
stock accounts being held with Janney Montgomery Scott and Wells Fargo
Advisers; accounts with PNC Bank totaling approximately $16,000.00; real
property located at 321 Elgin Circle, Mechanicsburg, Pennsylvania, valued at
approximately $23 8,000.00; and partnership interests in real estate in Bethany
Beach, Delaware, valued at approximately $818,000.00.
18. The net monthly income from all sources payable to the alleged
incapacitated person is $4,148.76, which consists of Social ~~ecurity benefits and
distributions from her retirement plan.
19. Due to the strong familial ties between Petitioner and the alleged
incapacitated individual, it is not anticipated that the posting of bond will be
required.
20. The proposed guardian does not intend to take a fee for his services
as plenary guardian of the alleged incapacitated individual.
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21. The alleged incapacitated has never been a rriember of the Armed
Services of the United States and is not receiving benefits from the U.S. Veterans
Administration.
22. The consent of the proposed guardian is attached hereto and made
apart hereof.
23. The alleged incapacitated is not represented by counsel, and the
Petitioner believes that appointment of counsel by the court i> not necessary.
WHEREFORE, the Petitioner respectfully requests that the Court, under Section
5511 of the Probate, Estates, and Fiduciaries Code, issue a cit~~tion to the Alleged
Incapacitated Individual, Elizabeth Winters, and to such other persons as the Court shall
direct, to show cause why the Alleged Incapacitated Person should riot be adjudged to be
an incapacitated person and the proposed plenary guardian of her estate and of her person
be appointed.
Respectfully submitted,
GOLDBERG K:ATZMAN, P.C.
By:
J. on o L squire
PA I. . No. 200:240
320 Market StreF~t
Harrisburg, PA 17101
Date: April 21, 2011 (717) 234-4161
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS.
VERIFICATION
I verify that the statements made in this Petition are true and correct to the best of
my information and belief. I understand that false statements herein are made subject to
the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsification t~~ authorities.
~ z ~:._S~
MATTHEW L. WINTERS, IV
Date: Z / ~ /
IN RE: IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS' COURT DIVISION
ELIZABETH W. WINTERS,
an Incapacitated Person
CONSENT TO APPOINTMENT
AS GUARDIAN OF THE ESTATE
1. The name of the proposed guardian of the Perso~l and Estate of the
Alleged Incapacitated Person in the above-captioned matter is Matl:hew L. Winters, IV,
(the "Proposed Guardian"). The Proposed Guardian is the son of the Alleged
Incapacitated Person.
2. The Proposed Guardian maintains a mailing address oj~ 1201 Foxfire Drive,
Greensboro, NC 27410.
3. The Proposed Guardian has no interest which is adverse to the interests of
the Alleged Incapacitated Person.
4. The Proposed Guardian consents to act as guardian for the Estate and
Person of Elizabeth Winters, an incapacitated person, if so appointed by the Orphans'
Court Division of the Court of Common Pleas of Cumberland Count~~, Pennsylvania.
Dated: y/Z /~// ~ Z G~~,,.---~
EXHIBIT 1-~
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until ~~t~~~l t-~rittet~ n{'~tcc c-at'~rac e~~ent i~ rcc~c:rtt~`~:~ h~~ such ~ersar~. In the ctier~t. ~1-n"~,~,
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EXHIBIT B
LAST WILL AND TESTAMENT
OF
ELIZABETH W. WINTERS
I, ELIZABETH W. WINTERS, of Upper Allen Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, do hereby make, publish, and declare this to be my
Last Will and Testament, hereby revoking and making null and void all prior Wills and Codicils made
by me at any time heretofore.
ITEM I. All federal, state, and other death taxes payable k~ecause of my death, with
respect to the property forming my gross estate for tax purposes, whether or not passing under this Will,
including any interest or penalty imposed thereon, shall be considered an ex~~ense of the administration
of my estate, and shall be paid from my residuary estate without apportionment or right of
reimbursement. All such taxes on present or future interests shall be paid at such time as my Executor
or my Trustee, hereinafter named, may think proper, regardless of whether such taxes are then due.
ITEM II. I give and bequeath certain items of tangible personal property that are solely
owned by me at the time of my death .and that are identified in any separate writing directing
distribution thereof after my death which is dated and is signed by me at the end thereof, to those
persons designated in such separate writing who survive me. If any item oiE tangible personal property
is identified in more than one separate writing, I direct that, unless stated to the contrary, the separate
writing bearing the last date shall govern the disposition of such item.
ITEM III. I bequeath my household and personal effects, jewelry, automobiles, and other
tangible personalty of like nature, not otherwise disposed of above, in equal shares to my children who
survive my death by thirty (30) days, namely, DEBORAH A. WINTERS, and MATTHEW L.
WINTERS, IV.
ITEM IV. I give and bequeath the following amounts to the following organizations for
their general use as determined by their governing authorities. In the event any of same are not in
existence at the time of my death, I direct that the organization's gift be distributed pro rata among the
remaining ones.
A. Lutheran World Relief - $10,000;
B. ELCA World Hunger Appeal - $10,000;
C. The Lutheran Theological Seminary at Gettysburg - $10,000;
D. Trinity Evangelical Lutheran Church, Camp :Hill, PA - $10,000;
E. Holy Trinity Evangelical Lutheran Church, L~uffalo, NY - $10,000;
F. On Eagles Wings Ministries, Inc., Glen Rock:, NJ - $10,000;
G. The National Lutheran Home, Rockville, MIS - $10,000;
H. Prospect Hill Cemetery, Washington, DC - $5,000;
I. St. Paul's Lutheran Church, Washington, DC'. - $5,000;
J. Diakon Lutheran Social Ministries, Topton, l?A - $5,000;
K. Canine Helpers for the Handicapped, Lockport, NY - $5,000; and
L. Ride with Pride, Staunton, VA - $10,000.
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ITEM V. All the rest, residue and remainder of my estate, of whatever nature and
wherever situate, shall be paid outright in equal shares to my children, DEBORAH A. WINTERS and
MATTHEW L. WINTERS, IV who are living at the time of my death; provided, however, that if
such a named child should not be so then-living, but leaves issue who are them-living, then such child's
issue shall receive, per stirpes, the share that such child would have received :had he or she so survived
me, subject, however, to the further trust provisions set forth in ITEM VI. hereof if applicable to a
particular beneficiary, who is a grandchild or great-grandchild of mine, due to his or her age. If such
a named child should not be so living and should not leave any such then-living issue, then that child's
share shall be distributed in equal shares to my other child who is then-living and to the issue of my
other child if he or she is then-deceased, per stirpes.
ITEM VI. Any property passing hereunder to a beneficiary who is a grandchild or
great-grandchild of mine and who at the time of my death is under the age of twenty-five (25) (the
"Beneficiary"), shall be held INTRUST, NEVERTHELESS, by my Trustee, hereinafter named, for the
benefit of such Beneficiary, upon the terms and for the purposes and uses, pis follows:
A. My Trustee shall hold and invest the principal of the Trust
corpus, collect the income therefrom, and expend and apply so much of the net income
(any income not so expended or applied to be accumulated and added to principal), and
so much of the principal and accumulated income, as my Trustee shell deem necessary
or advisable, in the sole and absolute discretion of my Trustee, for the support,
maintenance, medical care, and education (including college education, both graduate
3
and undergraduate) of the Beneficiary, after taking into consideration other readily
available assets and sources of income. During illness or emergency;, my Trustee may
either pay a distribution to the Beneficiary, or may make a distributic>n for the benefit
of the Beneficiary.
B. When the Beneficiary attains the age of twenty-one (21), the
entire net income of that Beneficiary's Trust shall be paid to him nor her at least as
frequently as semi-annually.
C. When the Beneficiary attains the age of twenty-five (25), the Trust
pertaining to that Beneficiary shall terminate, and my Trustee shall distribute thethen-remaining
principal and any accumulated or undistributed income to that Beneficiary, outright.
D. If the Beneficiary should die during the existf:nce of this Trust
and leave issue surviving, it shall be divided and then continued for the benefit of such
then-living issue of the Beneficiary, per stirpes, with such beneficiaries being substituted
for the Beneficiary for all purposes.
E. If the Beneficiary should die before attaining the age of twenty-
five (25) without leaving issue surviving as aforesaid, then that Trust shall terminate at
his or her deaths, and its assets shall be divided into as many equal sh~~res as are created
under Item VI. hereof for the benefit of those living children of mine:, or the issue, der
4
s ~ es, of any deceased child of mine, at the time of the death of such Beneficiary, and
then distributed to such beneficiaries; Provided, however, that if a Trust established
hereunder for any such beneficiaries exists at the time of such distribution, then such
distribution shall be made to that Trust for such beneficiary.
ITEM VII. The interest of beneficiaries hereunder shall not be subject to anticipation or to
voluntary or involuntary alienation.
ITEM VIII. I nominate and appoint PNC BANK, Camp Hill, Pennsylvania, to serve in the
capacity of Executor of this, my Last Will and Testament.
ITEM IX. I hereby appoint PNC BANK, Camp Hill, Pennsylvania, to serve as the Trustee
(the "Trustee"), of any trusts created under this Will.
ITEM X. I direct that my Executor and Trustee shall not be required to give bond or post
any other security for the faithful performance of their duties in any jurisdi~~tion.
ITEM XI. Any person who shall have died at the same time as rr-e, or in a common disaster
with me, or under such circumstances that it is difficult or impossible to detf~rmine who died first, shall
be deemed to have predeceased me.
5
/ /
ITEM XII. My Executor and Trustee shall have the following powers in addition to those
invested in them by law and by other provisions of my Will applicable to all property, whether principal
or income, exercisable without Court approval, and effective until distribution of all property:
A. To retain any investments I may have at my death so long as my
Executor or Trustee may deem it advisable to my Estate or Trust sc- to do.
B. To vary investments, when deemed desirable by my Executor
or Trustee, and to invest in such bonds, common trust funds controllf:d by my Executor
or Trustee, stocks, notes, real estate mortgages, or other securitYe~~ or in such other
property, real or personal, as my Executor or Trustee deem wi;~e, without being
restricted to so-called legal investments.
C. In order to effect a division of the principal of my Estate or
Trust or for any other purpose, including any final distribution, my Executor or Trustee
is authorized to make said divisions or distributions of the personalty and realty partly
or wholly in kind. If such division or distribution is made in kind, said assets are
required to be divided or distributed at their respective values on the date or dates of
their division or distribution.
D. To sell either at public or private sale and upon such terms and
conditions as my Executor or Trustee may deem advantageous to my Estate or Trust,
6
any or all real or personal estate or interests therein owned by m~~ Estate or Trust
severally or in conjunction with other persons or acquired after my death by my
Executor or Trustee, and to consummate said sale or sales by sufficient deeds or other
instruments to the purchaser or purchasers, conveying a fee simple title, free and clear
of all trust and without obligation or liability of the purchaser or purchasers to see to the
application of the purchase money or to make inquiry into the validity of said sale or
sales; also, to make, execute, acknowledge, and deliver any and all deeds, assignments,
options, or other writings which may be necessary or desirable, in carrying out any of
the powers conferred upon my Executor or Trustee in this paragraph or elsewhere in
my Will.
E. To mortgage real estate, and to make leases of real estate for any
period of time as is deemed reasonable by them.
F. To borrow money from any party to pay indelbtedness of mine,
or of my Estate or Trust, expenses of administration, or inheritance, legacy, estate or
other taxes.
G. To pay all costs, taxes, expenses, and charges vl connection with
the administration of my Estate or Trust. My Executor shall pay expenses of my last
illness and funeral expenses.
7
''~, .
:~
H. To vote any shares of stock which form a part of my Estate or
Trust, and to otherwise exercise all the powers incident to the ownership of such stock.
I. In the discretion of my Executor or Trustee, to unite with other
owners of similar property in carrying out any plans for the reorganization of any
corporation or company whose securities form a part of my Estate or Trust.
J. To compromise claims and to abandon any property which, in
my Executor's opinion, is of little or no value.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, consisting of eight (8) typewritten pages, this ~ day of December, 2004.
E ZABETI3 W. WINTERS
8
We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and
declared by the above-named Testatrix, ELIZABETH W. WINTERS, as and for her Last Will and
Testament, in the presence of us, who at her request and in her presence and in the presence of each
other, have hereunto set our hands and seals the day and year above written, and we certify that at the
time of the execution thereof, the said Testatrix was of sound and disposing mind and memory.
~'~' ~~-
,. n~~`~ I'~~ d~ residin at ~ l~tuY . ~~`t~
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~~, 1~~~~ residing at
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9
CO1~fMONWEALTH OF PENNSYLVANIA
COL;~NTY OF DAUPHIN
. SS.
We, the Testatrix, ELIZABETH W. WINTERS, and J~/'!-/ G(~ ~ ,and
~Q/d /~Cc~L•_r~~.-~ ,the witnesses, respectively, whose names are signed
to thf: foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that
the Testatrix signed and executed the instrument as her Last Will and that she. had signed willingly, and
that she executed it as her free and voluntary act for the purposes therein expressed, and that each of
the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best
of hip /her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and
under: no constraint or undue influence.
~.~.~ i
IZABETH W. WINTERS
---.
~.~w ~~' " ,.vim,
Witness
~~ r ~
With ss
Subscribed, sworn to and acknowledged before me by the Testatrix, ELIZABETH W.
WINTERS, and subscribed and sworn to before me by ~~'1e r' ~t and
.~CYI A ~DC l~Q,f2~'r~ctn ,witnesses, this ~ day of December, 2004.
32713. ~'
• D
v~, .
No ry Public:
(SEAL)
-~
Notarial Seal
Jennifer L. 1Baltz, Notary Public
City of Harrisburg, Dauphin County
My Cornmissior.~ Expires May 30, 2005
1111?~rohrr, P~ns~?S»i~ianf~ A,^rOC;ac;+~f?nf ~14~a!'i@S
10
EXHIBIT C
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
AND
LIVING WILL
A. DURABLE POWER OF ATTORNEY FOR HEALTH CARE
I, ELIZABETH W. WINTERS, of Upper Allen Township, Cumberland County,
Pennsylvania, being of sound mind, voluntarily create the Durable Powe;r of Attorney for Health
Care.
1. Prior Designations. I revoke any prior Durable Power of Attorney for Health Care.
2. Appointment of A ent(s) (Attorney(s)-in-Fact): In the eventthat I have been determined
to be incapable of providing informed consent for medical treatment andl surgical and diagnostic
procedures, I wish to designate as my agents for health care decisions, rriy children, DEBORAH A.
WINTERS AND MATTHEW L. WINTERS, IV.
3. Agents' Authority: My agents are authorized to act for me in all matters relating to my
health care. My agents' powers include, but are not limited to:
• Full power to consent, refuse consent, or withdraw consent tc- all medical, surgical,
hospital and related health care treatments and procedures on my behalf, according to
my wishes as stated in this document, or as stated in some other similar type document,
or as expressed to my agents by me;
• Full power to make decisions on whether to provide, withhold, or withdraw artificial
nutrition and hydration on my behalf, according to my wishes as stated in this document,
or as stated in some other similar type document, or as expressed to my agents by me;
• Full power to review and receive any information regarding my physical or mental
health, including medical and hospital records;
• Full power to sign any releases in order to obtain this information;
• Full power to sign any documents required to request, withdr~iw, or refuse treatment or
to be released or transferred to another medical facility.
My agents do not have authority to act for me for any other purpc-se unrelated to my health
care. All of my agents' actions under this power during any period when. I am unable to make or
communicate health care decisions have the same effect on my heirs, devisees and personal
representatives as if I were competent and acting for myself.
4. When Agents' Authority Becomes Effective: The designation of my agents will become
effective as soon as this document is signed and will remain in effect until my death, or until I revoke
it. This designation will not be affected by my subsequent disability or incompetence.
5. Agents' Obli ag tion: My agents will make health care decisions forme in accordance
with this document, and in accordance with any instructions I give in some other such document
(either included in this document or as a separate document), and my other wishes to the extent
_ __ - known to-my_agents._ To_the extent my_w_ fishes ar_e_unknown,_my__agents_will_make-heal-th-car-e---------_____-
decisions for me in accordance with what my agents determines to be in my best interest. In
determining my best interest, my agents will consider my personal values to the extent known to my
agents.
B. LIVING WILL
I have given instructions on my care if I have been diagnosed with the following
medical conditions: a terminal condition, irreversible coma, and persistent vegetative state.
1. Definitions: As used in this document:
a. "Attending physician" means the physician licensed by the state board of medicine,
selected by or assigned to the patient, and who has primaary responsibility for the
treatment and care of the patient.
b. "Health care provider" or "provider" means any person licensed, certified, or
otherwise authorized by law to administer health care in the ordinary course of
business or practice of a profession.
c. "Irreversible (Permanent) Coma" means a profound state of unconsciousness caused
by disease, injury, poison, or other means and for which it has been determined that
there exists no reasonable expectation of regaining consciousness.
d. "Life prolonging procedure" (or "life-sustaining procedw-e") means any medical
procedure, treatment, or intervention which sustains, restores, or supplants a
spontaneous vital function. In this document the term does, not include sustenance and
hydration administration, or the provision of medication or the performance of
medical procedure, when such medication or procedure is; deemed necessary to
provide comfort care or to alleviate pain.
e. "Persistent vegetative state" means a permanent and irreversible condition in which
there is:
i. The absence of voluntary action or cognitive behavior of any kind.
ii. An inability to communicate or interact purposefully ~~vith the environment.
f. "Terminal condition" means a condition caused by injury;, disease, or illness from
which there is no reasonable medical probability of recovery and which, without
treatment, can be expected to cause death.
2
g. "Comfort care" means treatment, including prescription medication, provided to the
patient for the sole purpose of alleviating pain. Artificially administered food and
water is not included.
h. "Artificially administered food and water" (or artificial niutrition and hydration)
means the provision of nutrients or fluids by a tube inserted in vein, under the skin in
the subcutaneous tissues, or in the stomach (gastrointestilial tract).
2. Medical Directions and End-of--Life Decisions: I direct that my health care providers and
others involved in my care provide, withhold, or withdraw treatment in ~iccordance with directions
provided by my agents for health care decisions in the event:
a. I have an incurable and irreversible (terminal) condition that will result in my death
within a relatively short time, in the opinion of two physicians:
b. I am diagnosed as being in an irreversible coma and, to a reasonable degree of
medical certainty,. I will not regain consciousness, in the opinion of two physicians:
c. I am diagnosed as being in a persistent vegetative state and, to a reasonable degree of
medical certainty, as determined by two physicians, I wily not regain consciousness.
3. Other Wishes: I understand that I may change the above-listf;d directives at any time by
revoking this declaration and writing a new one.
4. Effect of Copy: A copy of this Durable Power of Attorney fc-r Health Care and Living
Will has the same effect as the original.
5. Severability: If any part or parts of this Durable Power of Attorney for Health Care and
Living Will is found to be invalid or illegal under applicable law by a court of competent jurisdiction,
the invalidity or illegality of such part or parts shall not in any way effect the remaining parts, and
this document shall be construed as though the invalid or illegal part or parts had never been included
herein. But if the intent of this Durable Power of Attorney for Health Care and Living Will would be
substantially changed by such construction, then it shall not be so constnued.
6. Si ature: This document is made upon careful reflection. C-ptions that I have
considered and rejected are not printed above. I confirm that the health care directions contained
herein were made after careful consideration and in full awareness of other options that may have
been available to me. I declare that I am an adult in the Commonwealth of Pennsylvania, that I
understand the full import of this Durable Power of Attorney for Health (are and Living Will, and
that I am emotionally and mentally competent.
This Durable Power of Attorney for Health Care and Living Will is executed this ~ 7 day of
January, 2005.
_f..~ --~ ~, . ~ f'
EL ETFI W. WINTERS
Social Security No.: ~ ~' 7- ~6 - ~ ~ ~7,~
3
7. Statement of Witnesses: ELIZABETH W. WINTERS knowingly and voluntarily signed
this writing by_signature or mark in_my-presence._I_am at_least_eighteen-(18) years-~l~i,_and_am-not-- -- - ----
- -- --- -
the person who signed this document on behalf of and at the direction of ELIZABETH W.
WINTERS.
/? ,~
2.1~-v.~
117917.1