HomeMy WebLinkAbout03-14-13IN THE INTEREST OF:
NICOLE L. ZOMOK
An Alleged Incapacitated Person
IN THE COURT OF COMMOIxPLEAS
OF CUMBERLANT~'OUNTI'~A ~ m
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)N OF INCAPACITY Ai'~D `' r '. rn
A PLENARY GUARf'fIAN F-' ~- '~'
OF THE PERSON AND ESTATE
TO THE HONORABLE JUDGES OF SAID COURT:
AND NOW, this ~( day of , 2013, comes the Petitioners,
Raymond P. Zomok, and Christine G. Zomok, by and through their counsel, Vincent M.
Monfredo, and files the following in support of this Petitioner for Adjudication of Incapacity and
for the Appointment of a Plenary Guardian of the Person and the Estate.
1. Petitioners, Raymond P. Zomok and Christine G. Zomok are the married natural parents
of the alleged incapacitated person, currently residing at 88 Millers Gap Rd. Enola, PA,
17025.
2. The alleged incapacitated person, Nicole L. Zomok, is an adult individual twenty-four
(24) years of age, having been born on May 13, 1988; she is single with no heirs,
brothers, or sisters.
3. The Petitioners are the alleged incapacitated person's next of kin as they are her parents.
4. To the best knowledge, information and belief of Petitioners, the Estate of the alleged
incapacitated person and their assets consists of:
a. A savings account with PSECU to receive SSI payments
i. Petitioner Raymond Zomok is the representative payee;
ii. The account is managed not to exceed $1,000;
iii. The alleged incapacitated person receives direct deposits of $710 SSI
benefits monthly;
iv. She further receives approximately $25 per month from the state;
v. This monthly income is used to pay for expenses such as rent, food,
utilities, etc...
b. The alleged incapacitated person does not own any real property, home, vehicle,
stocks, bonds, investments or any other assets.
5. To the best knowledge, information and belief of Petitioners, the income from all sources
of the alleged incapacitated person is listed above.
6. The alleged incapacitated person's monthly income is believed to be approximately $735
from SSI.
7. The alleged incapacitated person was never a member of the Armed Services of the
United States and is not receiving benefits from the United States Veteran
Administration.
8. The appointment of a guardian is sought because the alleged incapacitated person's
ability to receive and evaluate information effectively and communicate decisions is
impaired to such a significant extent that she is totally unable to manage her care and
affairs.
9. The alleged incapacitated person suffers from severe mental retardation and intractable
epilepsy; is anon-verbal, incontinent and suffers from seizures on a regular basis; and she
has 22q deletion, a genetic syndrome that has resulted in a missing pulmonary artery
serving her left lung.
10. The Petitioners, and natural parents of the alleged incapacitated person, are the proposed
guardians of the person and estate.
11. The proposed guardians have no interest adverse to that of the alleged incapacitated
person.
12. No court has ever. assumed jurisdiction in any proceeding to determine the competency of
the alleged incapacitated person.
13. The alleged incapacitated person does not already have a guardian appointed.
i 4. A guazdi is sought over the following specific areas of incapacity: Plenary Guardian of
the Person and Estate.
15. The alleged incapacitated person does not have a relationship with an attorney at law who
is expected to represent her in this matter, and given her condition, is unlikely to be able
to engage an attorney on her own.
WHEREFORE, Petitioners pray this Honorable Court issue a Citation directed to the alleged
incapacitated person, with notice to any person as the court may direct, to show cause why she
should not be adjudged an incapacitated person and a Guardian for her person and estate
appointed.
Date: ~ - ~ -( ~'
Respectfully Submitted,
Rominger & Associates
intent M. Monfredo, Esquire
155 South Hanover Street
Carlisle, Pennsylvania 17013
(717)241-6070
Supreme Court ID#206671
Attorney for Petitioners
CONSENT OF THE PROPOSED GUARDIANS
• The undersigned hereby consents to the appointment of a Guardian for the alleged
incapacitated person, Nicole L. Zomok.
• The address of the undersigned is 88 Millers Gap Rd. Enola, PA, 17025.
• The occupation of Petitioner Raymond Zomok is C/yE ~- ~~1/f~~il/s~~
• The occupation of Petitioner Christine Zomok is ~~~(.~l ~~ .
• The undersigned both speak, read and write the English language.
• The undersigned parties do not have any interest adverse to the alleged incapacitated
person.
• The undersigned parties are not a fiduciary, or officers or employees of a corporate
fiduciary, of an estate in which the alleged incapacitated person has an interest; and is not
the surety, or an officer or employee of a corporate surety of such a fiduciary.
Date ~`' /~ ~~ ~
Date z~19 ~°{ 3
VERIFICATION
I verify that I am the petitioner and that the statements made in the foregoing Petition are
true and correct. I understand that false statements herein are made subject to the penalties of 18
Pa. C. S. § 4904, relating to unsworn falsification to authorities.
Date: ~' ~ `~ X0/3
R
VERIFICATION
I verify that I am the petitioner and that the statements made in the foregoing Petition are
true and correct. I understand that false statements herein are made subject to the penalties of 18
Pa. C. S. § 4904, relating to unsworn falsification to authorities.
Date: ~ /y ?~~ ~ ~_
Christine Zom titioner
~From:Aominger & Associates 7172416878 02/25/2013 12:10 #473 P.002l002
IN THE INTEREST OF:
NICOLE L. ZOMOK
An Alleged Incapacitated Person
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PA
ORPHANS' COURT DIVISION
NO.
GUARDIANSHIP
COMPETENCY AFFIDAVIT
I, Todd F. Barron, M.D., being duly sworn according to law, depose and state that I am a
licensed physician in the Commonwealth of Pennsylvania employed by Well Span
Neurosciences in York, PA. I have examined the alleged incapacitated person, Nicole L. Zomok,
with care and diligence. Based upon said examination and observation, I am of the opinion that
she is incompetent to manage her own affairs and there is no expectation of her recovery within a
reasonable medical certainty.
Date: ~J 113
~~~-~~/or~~
Witness Signature
/~L• C : Tay log; /~~1
Witness Printed Name
Todd F. Barron, M.D.
_ c.J~1.c.C-..ev
s Si e
Witness Printdi Name
r.
IN THE INTEREST OF: IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,. PA
NICOLE L. ZOMOK
ORPHANS' COURT DIVISION
An Alleged Incapacitated Person NO.
:GUARDIANSHIP
CERTIFICATE OF SERVICE
I, Vincent M. Monfredo, Esquire, do hereby certify that I served a copy of the Petition
upon the following by depositing same in the United States mail, postage prepaid, at Carlisle,
Pennsylvania, addressed as follows:
Ray and Christine Zomok
88 Millers Gap Rd.
Enola, PA 17025
Dated: ~~^
Nicole Zomok
88 Millers Gap Rd.
Enola, PA 17025
Rspectfully submitted,
ROMINGER & ASSOCIATES
Vincent M. Monfredo, Esquire
155 South Hanover Street
Cazlisle, PA 17013
(717)241-6070
Supreme Court ID # 206671
Attorney for Plaintiff