HomeMy WebLinkAbout04-22-13 IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
SIERRA ROY, an ORPHANS COU T DIVISION
• 0--Alleged incapacitated person NO. 2 1 '—
GUARDIANSHIP-INCAPACITATED PERSON
PETITION FOR APPOINTMENT OF GUARDIAN
NOW comes petitioners, Joanna R. Miller, Beverly A. Martin and Megan A. Miller, by
their attorney, Karl E. Rominger, esquire, and presents this Petition for appointment of guardian
of the person of Sierra Roy, representing as follows:
1. Petitioners are Joanna R. Miller, an adult individual residing at 5 East Marble
Street, Apartment 1, Mechanicsburg, Pennsylvania, Beverly A. Martin, an adult individual
residing at P.O. Box 12, Plainfield, Pennsylvania, and Megan A. Miller, an adult individual
residing at 130 East Main Street, Apartment 1, Shiremanstown, Pennsylvania.
2. Petitioners are the natural mother, grandmother and sister, respectively, of Sierra
Roy, the alleged incapacitated person, born on April 30, 1995, who resides with her mother,
Joanna R. Miller.
3. The alleged incapacitated person was born Cerebral Palsy and a mild form of
Autisium which left her with serious medical conditions making her mentally unable to
handle her own financial affairs. See Competency Affidavit executed by Dr. Todd Barron,
M.D., incorporated herein by reference and attached hereto as Exhibit"A".
4. The alleged incapacitated person is in daily and immediate needs of medical care
and the assistance by Petitioners, Joanna R. Miller, Beverly A. Main and MMan Av Miller,
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to handle her medical care and to handle her financial decisions an ima Bow heF—Fnwdical
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care and financial circumstances will be seriously impaired if reli]g isinnm gra ted, o that
she will no longer be a minor on April 30, 2013. c c
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5. The alleged incapacitated person's natural father, M. Todd Roy, is agreeable with
appointing Petitioners, Joanna R. Miller, Beverly A. Martin and Megan A. Miller, as,
guardians of the person Sierra Roy and appointing Joanna R. Miller, Beverly A. Martin and
Megan A. Miller as guardian of the estate of Sierra Roy. An affidavit signed by M. Todd Roy
is attached hereto as Exhibit"B".
6. Petitioner Joanna R. Miller, Beverly A. Martin and Megan A. Miller, are qualified
to make medical decisions and financial decisions.
7. Petitioners have no knowledge of any other Court within the Commonwealth
which has appointed a guardian for the alleged incapacitated person.
8. Petitioners have no interest adverse to the alleged incapacitated person and have
agreed to have Joanna R. Miller, Beverly A. Martin and Megan A. Miller, act as guardian of
the person and act as guardian of the estate if this Honorable Court shall so appoint.
WHEREFORE, Petitioners respectfully requests this Honorable Court appoint Joanna R.
Miller, Beverly A. Martin and Megan A. Miller, as guardians of the person and as guardian of
the estate of Sierra Roy pending further order and to schedule a hearing in which this matter may
be heard and the guardianship made permanent.
Respectfully Submitted,
Rominger& Associates
Date: April 15, 2013
K . Rominger, Esquire
155 South Hanover Street
Carlisle, Pennsylvania 17013
(717) 241-6070
Supreme Court ID#81924
Attorney for Petitioner
IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
SIERRA ROY, an ORPHANS COURT DIVISION
Alleged incapacitated person NO.
GUARDIANSHIP-INCAPACITATED PERSON
VERIFICATION
We, Joanna R. Miller, Beverly A. Martin and Megan A. Miller, Petitioners in this matter,
do hereby depose and state that the facts contained in the foregoing Petition are true and correct
to the best of our knowledge, information and belief. We understand that false statements made
herein are subject to the penalties of 18 Pa.C.S.A. Section 4094, relating to unsworn falsification
p'
to authorities.
Date:
Jo" a R. Miller, Petitioner
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Beverly A Martin, P titioner
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Date: rc
Meg A. Miller, Petitione
IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
SIERRA ROY, an ORPHANS COURT DIVISION
Alleged incapacitated person NO.
GUARDIANSHIP-INCAPACITATED PERSON
COMPETENCY AFFIDAVIT
I, Todd 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 Health. I
have examined the alleged incapacitated person, Sierra Roy, 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: 41
D.
Witness Signature Witness Sign to e
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Witness Printed Name Witness Printed Name
EXHIBIT
IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
SIERRA ROY, an ORPHANS COURT DIVISION
Alleged incapacitated person NO.
GUARDIANSHIP-INCAPACITATED PERSON
AFFIDAVIT
I, M. Todd Roy, Natural Father of Sierra Roy, and ask the Court to approve the
Guardianship Petition provided by Attorney Karl E. Rominger, Esquire, which I am in favor of.
I waive my right to be present at any hearing. I verify that the statements made in this affidavit
are true and correct, I understand that false statements herein are made subject to the penalties of
18 Pa. Cons. Stat. § 4904 relating to unsworn falsification to authorities.
Date.
M. odd Roy,Natural Fat
of Sierra Roy
COMMONWEALTH OF PENNSYLVANIA )
SS:
COUNTY OF01 I )
On this,the 0�-N)L, day of o , 2013, before me a notary public,the
undersigned officer, personally appear d M. Todd Roy, known to me (or satisfactorily proven)
to be the person whose name is subscribed to the within instrument, and acknowledged that he
executed the same for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
Notary ubli "j OF NvANIA
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Assoca�noM o�i oIANEs
EXHIBIT "B"
IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
SIERRA ROY, an ORPHANS COURT DIVISION
Alleged incapacitated person NO.
GUARDIANSHIP-INCAPACITATED PERSON
CONSENT OF PROPOSED GUARDIAN
1, Joanna R. Miller, do hereby certify that I am willing to act as the guardian of the person
of Sierra Roy, if the Court shall so appoint me.
Further, I do hereby certify that I am not a fiduciary of any estate in which the alleged
incapacitated person has an interest, nor have I any interest adverse to him.
The facts and opinions contained herein are true and correct to the best of my knowledge,
information and belief. /
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Date: ,
Joanna R. Miller, Petitioner
COMMONWEALTH OF PENNSYLVANIA )
SS:
COUNTY OF )
On this, the _Rtday of , 2013, before me a notary public, the
undersigned officer, personally appeaA Joanna R. Miller, known to me (or satisfactorily
proven) 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 hereunto set my hand and official seal.
Notary ublic
of KNNSnvANra
anal Seal
CW'We�,Guyer, Wb t
MEMBER,ppy A 12015
7ION OF N ARtPS
IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
SIERRA ROY, an ORPHANS COURT DIVISION
Alleged incapacitated person NO.
GUARDIANSHIP-INCAPACITATED PERSON
CONSENT OF PROPOSED GUARDIAN
1, Beverly A. Martin, do hereby certify that I am willing to act as the guardian of the
person of Sierra Roy, if the Court shall so appoint me.
Further, I do hereby certify that I am not a fiduciary of any estate in which the alleged
incapacitated person has an interest, nor have I any interest adverse to him.
The facts and opinions contained herein are true and correct to the best of my knowledge,
information and belief.
Date: D 3
Beverly A. artin, Petitioner
COMMONWEALTH OF PENNSYLVANIA )
SS:
COUNTY OF )
On this, the day o , 2013, before me a notary public, the
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undersigned officer, personally appear Beverly A. Martin, known to me (or satisfactorily
proven) 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 hereunto set my hand and official seal.
Notary'7Pubfic
M_"'w" .'r'OF PENNSYLVANIA
Susan K
Publt
L 4 2025
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IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
SIERRA ROY, an ORPHANS COURT DIVISION
Alleged incapacitated person NO,
GUARDIANSHIP-INCAPACITATED PERSON
CONSENT OF PROPOSED GUARDIAN
I, Megan A. Miller, do hereby certify that I am willing to act as the guardian of the
person of Sierra Roy, if the Court shall so appoint me.
Further, I do hereby certify that I am not a fiduciary of any estate in which the alleged
incapacitated person has an interest, nor have I any interest adverse to him.
The facts and opinions contained herein are true and correct to the best of my knowledge,
information and belief.
Date: 190
MegaX A. Miller, Petitioner
COMMONWEALTH OF PENNSYLVANIA )
SS:
COUNTY OF )
4
On this, the day of , 2013, before me a notary public, the
undersigned officer, personally appeare Megan A. Miller, known to me (or satisfactorily
proven) 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 hereunto set my hand and official seal.
Notary Public
COM—MN—WEALTFI OF pENN SYLVANIA
NotaNal Seal
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