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ESTATE OF INEZ H. DAVIS, COURT OF COMMON PLEAS
CUMBERLAND COUNTY,
An Incapacitated Person. PENNSYLVANIA
ORPHANS' COURT DIVISION
O.C. NO. 21-07-0200
DECREE
AND NOW, this PA day of 2013, upon consideration
Of the Petition for Allowance of Distribution of Principal of an Incapacitated Person, it is hereby
ORDERED and DECREED that Gloria J. Banks, plenary guardian of the estate and person of
her mother, Inez H. Davis, is authorized to spend from the proceeds from settlement in the matter
of Gloria J. Banks, Guardian of Inez H. Davis v. GGNC Camp Hill West Shore, LP, et. al.,
docketed in the Cumberland County Court of Common Pleas at Civil Action No. 10-924, for the
benefit of the Incapacitated Person (to the extent medical insurance is not available and plus
taxes, warranties and shipping cost as necessary) as follows:
Hearing Aides
$ 9,083.00
Dentures $ 2,816.00
Cataract Surgery (unless not medically advisable) $ 4,200.00
Wheelchair—Invacare Solara
$ 6]W4'�00 w a o
Wheelchair—for Petitioner's home n
$ RtqD
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U
Iv C1
Lift chair—U1traLift (2) " o n t'rT
$gq k`� "''' PJ
Active Passive PRO LowerBody Exerciser Y
Miscellaneous Support, Rehabilitative and Therapeutic 2,436.46 o
Items -n
Clothing and accessories $ 2,000.00
Sneakers (3 pair nonskid) $ 300.00
Shoes (3 pair Orthopedic) $ 435.00
Refrigerator/Freezer $ 800.64
Television $ 1,179.97
CD/Tape Player $ 186.00
Phone $ 121.20
Burial Plot $ 3,000.00
Irrevocable Burial $10,000.00
(or as approved
by Dauphin
County Office of
Assistance)
Golden Living Nursing Home $ 1,819.21
Jevvish Home $ 55.00
Michael Davis—reimbursement for medical records $ 650.00
duplication
Care Manager fee—(Petitioner's Hearing Exhibit 2)
Janet Foreman, CRNP, SkarlatosZonarich LCC $ 900,00
It is hereby ORDERED and DECREED that Gloria J. Banks,plenary guardian of the
estate and person of her mother, Inez H. Davis, an Incapacitated Person, is authorized to
purchase a handicap accessible vehicle, for a purchase price, including tax and tags, not to
exceed $61,000.00, to be titled in the name of Inez Davis and Gloria Banks, the Incapacitated
Person's disabled daughter , as tenants in common (with no rights of survivorship). Petitioner is
authorized to purchase an extended warranty for$1,035.00 and pay the first year of insurance
coverage in an amount not to exceed $1,776.00. Gloria Banks will be otherwise responsible for
operating costs of the vehicle, including insurance, maintenance, and registration. Upon the
death of the Incapacitated Person, the Incapacitated Person's one-half interest in the vehicle will
be an asset of her estate available to satisfy the Pennsylvania Department of Public Welfare's
Estate Recovery Claim.
It is hereby ORDERED and DECREED that Gloria J. Banks, plenary guardian of the
estate and person of her mother, Inez H. Davis,an Incapacitated Person, is authorized to pay to
Gloria Banks,the Incapacitated Person's disabled daughter$18,135.00 for renovations to make
her home handicapped accessible; and $22,550.00 representing a portion of amounts Petitioner
spent for the care of the Incapacitated Person since her incapacity.
It is hereby Ordered and Decreed that term life insurance policies currently maintained
on the life of Inez Davis may be allowed to lapse, with the cash value less any taxes owed added
to her estate; provided, however, in the alternative, said policies may be sold or transferred to, or
maintained by, a third party upon payment to the estate of Inez Davis the cash value of the
policies.
IT IS FURTHER ORDERED and DECREED that Gloria J. Banks, plenary guardian of
the estate and person of her mother, Inez H. Davis, an Incapacitated Person, is authorized to pay
from principal the sum of$27,342,18.15 (inclusive of costs)to SkarlatosZonarich LLC for legal
services provided to the Incapacitated Person and $795.00 to Rhoads& Sinon, LLP.
IT IS FURTHER ORDERED and DECREED that Gloria J. Banks, plenary guardian of
the estate and person of tier mother, Inez H. Davis, an Incapacitated Person, is authorized to
distribute the Incapacitated Person's principal remaining after the above distributions have been
made, less $8,000, to Special Needs Trusts for the sole benefit of her disabled children, Elsie L.
Baker, Carolyn A. Henderson and Gloria J. Banks, said distribution to be divided twenty-five
(25%)percent in trust to Elsie L. Baker, twenty-five (25%)percent in trust to Carolyn A.
Henderson and fifty (50%) in trust to Gloria J. Banks.
IT IS FURTHER ORDERED and DECREED that Gloria J. Banks, plenary guardian of
the estate and person of her mother, Inez H. Davis, an Incapacitated Person, is authorized to
spend up to $125.00 per month from principal of the Incapacitated Person for miscellaneous
personal expenses of the Incapacitated Person.
BY THE COURT:
P �
ORPHA S' COURT DNISION J
Distribution:
Elizabeth B. Place,Esq.,SkarlatosZonarich LLC, 17 South Second Street, 6'"Floor, Harrisburg, Pa 17101
Addie A. Abelson, Esq.,Office of Chief Counsel, Department of Public Welfare, 3rd Floor West, Health & Welfare
Building, 7r"and Forster Streets, Harrisburg, PA 17120
Y
ORPHANS' COURT DIVISION
In Re: INEZ H. DAVIS COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 21-07-0200
CERTIFICATE OF SERVICE OF ORDER
ORDER DATE: 5/10/2013
JUDGE'S INITIALS: CLP
TIME STAMP DATE: 5/10/2013
IN RE: DECREE
SERVICE TO: ELIZABETH B PLACE 17 S 2ND ST FLOOR 6 HBG PA 17101
DEPT OF PUBLIC WELFARE 3RD FL W. HEALTH& BLDG 7TH&FORESTERS ST HBG 17120
DONALD RAY DAVIS 927 CABRERA AVE SAN BERNARDINO CA 92411
GLORIA J BANKS 5776 CATHERINE ST HBG PA 17112
CAROLYN A HENDERSON 16838 CERES AVE APT 106 FONTANA CA 92335
ELSI'E L BAKER 7367 CENTRAL AVE APT 152 HIGHLAND CA 92346
MICHAEL ANTHONY DAVIS 22015 CHEROKEE AVE APPLY VALLEY CA 92307
KATHERYN L ALVAREZ 1933 LENOX ST HBG PA 17104
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SERVICE TO:
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