HomeMy WebLinkAbout07-19-13 130 Dorwood Dr
Carlisle, PA 17413
July 1$, 2013
Register of Wills
One Courthouse Square
�arlisle, PR 17D i 3-3387
Re: File Number 21-13-0452
As the surviving spouse of Wiiliam D. Nenry, deceased an April b, 2013, I eiect
#o take against the wi11. As the decedenfi (eft me nothing under fihe will, !
chodse fio receive instead what the surviving spQUSe is entitled to under
Pennsylvania state law.
As I am in a nursing home, please confiact Carol L. Henry, P(JA, at 13CI
Qorwood Dr, Carlisle, PA, (717� 701-3099 with ar�y questians.
Thanks for your cansiderafiion.
Sincerely,
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Fairlyn C. Henry � �.:.=: =
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3 En�fosures � . � _ ,�
Power c�f At#orney � . �' �
Nofiice of Estate Adminis#ratian `' � �
Check ($20 Filing Fee) n ' rti,
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�c: Griffie & Assaciates, P.C.
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PUWER QF ATTORNEY
NUTiCE
THE PURPQSE OF THIS PCIWER OF ATTORNEY IS TO GIVE THE
PERS(JN Y4U DESIGNATE (YOUR "AGENT") BRQAD PUWERS TO HANDLE
YOUR PRUPERTY, WHICH MAY INCLUDE POWERS T{� SELL OR OTHERWISE
DISPQSE OF ANY REAL OR PERSONAL PROPERTY 'I�VITHt�UT ADVANCE
NOTTCE TO Y4U OR APPRUVAL BY YOU.
THIS PC�WER (�F ATTORNEY DQES NOT IMPOSE A DUTY ON YOUR
AGENT TO EXERCISE �'RA�ITED P4WERS, BUT WHEN P{)WERS ARE
EXERCISED, YOUR AGENT MUST USE Dt1E CARE TO ACT FOR YUUR
BENEFIT AND IN ACCQRDANCE WITH THIS POWER OF ATTc�RNEY.
YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE
THR(�UGHOUT Yt�UR LIFETIME, EVEN AFTER YOU BECQME
INCAPACITATED, UNLESS YOU EXPRESSLY LIMIT THE AURATION 4F
THESE POWERS OR Yt7U REVOKE THESE POWER5 4R A CCtURT ACTING QN
YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY.
YOUR AGENT MUST KEEP YC7UI2 FUNDS SEPARATE FRC►M YOUR
AGENT'S FUNDS.
A CC3URT CAN TAKE AWAY THE POVVERS QF YC)UR AGENT IF IT
FINDS YOUR AGENT IS NOT ACTING PROPERLY.
THE P4WERS AND DUTIES OF AN AGENT UNDER A PC�WER OF
ATTORNEY ARE EXPLAINED M4RE FULLY TN 20 PA. C.A. CH. 56.
IF THERE IS ANYTHING �BOUT THIS FORM THAT Y4U D4 NOT
UNI7ERSTAND, YOU SHOULD ASK A LAWYER 4F Y4UR OWN CHOOSING T4
EXPLAIN IT TO YQU.
I HAVE READ OR HAD EXPLAINED TC! ME THIS NIJTICE AND I
UNDERSTAND ITS C{�NTENTS.
..,.�--
", �. _ ���--�%-� �`� G��?�?
FAIRLYN '. HENRY �����a (Da e)
I, FAIRLYN C. HEI�TRY of So�tth Middfeton �'ownsi�ip {�nailing address: 822
Forge Raad, Carlisle, PA 17015),. Cumberland Caunty, Pennsylvania, do hereby
naminate, constitute, and appoint my husband. WILLIAII�I �}. HENRY, residing with me
at 822 Forge Road, Carlisle, Cumberiand County, Pennsylvania 17015, as and for my
true and lawful attarney-in-fact, and as my agent (referred to herein as either my
"attorney-in-fact" or my "agant"), far me and in my name, place and stead, and for my
use and benefit ta transact all my bt�siness and ta manage all my property and medical
and health affairs as I might do if personally present, and competent, as hereinafter set
farth. If my husband, William D. Henry, is unable or unwilling to serve, ar once having
quaiified, is unable or unwilling to serve, I appoint my daaghter, CAR4L L. HENRY,
residing at 130 Dorwood Drive, North Middleton Township, GarIisIe, Cumberland
County, Per�nsylvania, as and far my true and lawfu! attorney-in-fact, and as my agent
(referred to herein as either my "attorney-in-fact" or my "agent"), for me and in my
name, place and stead, and for my use and benefit ta transact a!1 my business and to
manage ail my progerty and medical and health affairs as I might do if personally present,
and campetent, as hereinafter set forth:
Power of Attorney,for Fairlyn C.Nenry Page I of 7
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l. Effective Immediately, Durable. This power of attorney �hall be effective
immediately. This power of attorney shall not be affected by my subseq��ent disability or
incapacity.
2. Statutory powers. My attorney-in-fact shall have the foll��wing powers as
those powers are defined by Section 5603 of the Probate, Estates and f�iduciaries Code
(20 Pa.C.S.A. § 5603):
a. To make limited gifts.
b. To create a trust for my benefit.
c. To make additions to an existing trust for my benefit.
d. To claim an etective share of the estate of my deceased spc�use
e. To disclaim any interest in property.
f. To renounce fiduciary positions.
g. To withdraw and receive the income or corpus of a trust.
h. To authorize my admission to a medical, nursing, residential or similar
facility and to enter into agreements for my care.
i. To authorize medical and surgical procedures.
j. To engage in real property transactions.
k. To engage in stock, bond, and other securities transactions
l. To engage in banking and financia( transactions.
m. To borrow money.
n. To enter safe deposit boxes.
o. To engage in insurance transactions.
p. To engage in retirement plan transactions.
q. To handle interests in estates and trusts.
r. To pursue c(aims and litigation.
s. To receive government benefits.
t. To pursue tax matters.
3. General Powers. In addition to the above-enumerated pc wers as defined
by statute, my attorney-in-fact shall have the following powers:
a. Giving and granting unto my attorney-in-fact full power and authority
to do and perform every act necessary, requisite, or proper to be done i�l exercising this
power of attorney as fully as I might or could do if personally present, w th full power of
substitution and revocation, hereby ratifying and confirming all that my attorney shall
lawfully do or cause to be done by virtue hereof.
b. I direct that my attorney shall not sell any of my t,ousehold goods
or furnishings unless it shall be necessary in order to provide adequate ��unds to pay for
my reasonable living and medical expenses. I direct that my attorney shafl retain all such
household goods and furnishings as my attorney believes I may currendv need or need in
the future. In the event my attorney deems it necessary to dispose oi any househ���
goods or furnishings not needed to be sold to raise money for my care and not deemed to
be needed by me currently or in the future, then I direct that all such hous��hold goods and
furnishings be given to the person or persons to whom I have provide�i that they pass
either specifically or as part of the residue of my estate in my most recent y executed Last
Will and Testament and that none be sold.
c. If my mental condition shall have deteriorated so that I am no
longer able to give gifts to persons to whom I have customarily given F;ifts, then to the
extent that my attorney deems the assets of my estate, both principal anci income, are in
excess of the amounts reasonably anticipated to be required for my proper support and
maintenance, then I direct my attorney to make gifts and transfers as a ��irt of estate and
asset protection planning.
4. Access to my medical and other personal information. To request, review,
and receive any information, verbal or written, regarding my personal affairs or my
physical or mental health, including medical and hospital records, and to execute any
releases or other documents that may be required in order to obtain this ir��ormation.
Power of Attorney for Fairlyn C.Henry Page 2 of 7
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5. Employ and discharge others. To employ and discharge physicians,
psychiatrists, dentists, nurses, therapists and ather prafessionals as my agent deems
necessary for nny physical, mental, and emotional well-being; and to pay them, or any of
them, reasonabie cornpensation.
b. Consent, ar refiase consent, to my medical care. Ta give or withhold
consent to my medical care surgery or any other medical procedures or tests; to arrange
for my hospitalization, convaIescent care or home care; and to revoke, withdraw, madify
ar change cansent ta my rnedical care, surgery, or any other medical procedures or tests,
hospitalization, convalescent care, or home care which I or my agent, may have
previously allowed ar consent implied due to ernergency conditions. I ask my agent to be
guided in making such decisions by the personal preferences I have expressed regardiz�g
such, including those preferences as stated in my Living Wi11, if any, and I direct my
attorney-in-fact to foilaw the provisions of said Living Will, using the version which is
most recent to the time when my attarney-in-fact may be making any such decision, and
to defer to the wishes of the surrogate named in said Living Will, if that individual is
different from my attorney-in-fact, when rnaking healthcare decisions. Based on those
same preferences, my agent may also summon paramedics or other emergency rnedical
personnet and seek emergency treatment for me, or choose not to do so, as my agent
deems appropriate given rny wishes and my medical status at the time of the decisian.
� My agent is authorized, when dealing with hospitals and physicians, to sign dacuments
titIed or purporting to be a "Refusal to Fermit Treatment" and "Leaving Hospital Against
MedicaI Advise" as well as any necessary waivers of or releases from liability required
by the hospitals or physicians to implement my wishes regarding medical treatment or
nontreatment.
7. Consent, or refuse consent, ta my psychiatric care. Upon the executian of
a certificate by two (2) independent psychiatrists who have exarnined me, and in whose
apinion T am in immediate need of hospitalization because of inental disorders,
alcohalism or drug abuse, to arrange for my voluntary admission to an appropriate
hospital ar institution for ireatment of the diagnosed problem ar disarder; to arrange for
private psychiatric and psychological treatment far me; ta refuse consent for any such
hospitalization, institutionalizatian, and private psychiatric and psycholagica! care; and ta
revoke, modify, withdraw ar change consent to such hospitalizatian, ttlS�Itl1tIOTt1IiZ�t1C}I7
and private treatment which I or my agent may have given at an earlier time.
$. Provide reCief from pain. Ta consent to and arrange far th� administration
of pain-relieving drugs af any type, or other surgical or medical procedures calcalated to
relieve rny pain even though their use may lead ta permanent physieal damage, addietian
or even hasten the moment af, but nat intentionalty eause, my death.
9. Pratect rights o�f privacy. To exercise my right of privacy to make
decisions regarding my medical treatment and my right to be left alor►e even though the
exercise af my right might hasten death or be against canventional medical advice. My
agent may take apprapriate legal actian, if necessary to enforce my right in this regard.
10. Third party reliance. For the purposes of inducing any physician,
hospital, or ather party ta act in accordance with the powers granted in this document, I
hereby rapresent, warrant and agree that: .
a. If this document is revaked or amended for any reason, I. my estate, my
heirs, successors, and assigns will hold such party or parties harmtess from any lass
suffered, or iiability incurred, by such party or parties in acting in aceordance with this
document prior ta that party's receipt of written r�otice of any such termination ar
amendment or that pacty's actual notice of my death.
b. The pawers canferred on my agent by this document may be exercised
by my agent alone and my agent's signature ar act under the autharity granted in this
dacurnent may be accepted by third parties as fully authorized by me and with the same
farce ancf effect as if I were personalty present, competent, and acting on my awn behalf.
Power of Attorney for Fairlyn C.Nenry Page 3 of 7
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c. No persan wha acts in reliance upon any representatians my agent may
make regarding the scope of autharity granted under this document �hall incur any
liability to me, my estate, my heirs; successors or assigns for permittir g my agent to
exercise any such power.
d. Alt third parties from wham my agent may reque�st infarmatian
regarding my health or personal aff'airs are hereby authorized and dire{:ted to pravide
such informatian without limitation and are released from any Iegal liabi[ity whatsoever
to me, my estate, my heirs, successors ar assigns for comglying with my a�ent's requests.
With specific reference to medicai information, including information at�out my mental
candition, I am hereby authorizing in advance all Qhysicians and psycl�iatrists who have
trea+.ed me, and all other providers of health care, including hospitals, tc� retease to my
agent alI information and photocopies of any records which may be requested, Atl
physicians, haspitals, and other health care providers are hereby authori�ed to treat my
agent's request as that of a legal representative of an incompetent patieltt and to honor
such request on that basis. I hereby waive all privileges which may be ap�licable to such
infarmatian and records or, applicable tfl any comrnunicatian pertaining Ec� me and made
in the course of a lawyer-client, physician-patient, psychiatrist-patient, cle-gyman-patient,
or sexual assault victim-coanselor relationship.
e. My agent shali have the right to seek court or�lers mandating
apprapriate acts if a third party refuses to comply with actions taken by �ny agent which
are authari�ed by this dt�cument, or enjoining acts by third garties whicn my agent has
not authorized.
11. Anatomical Gifts. To rnake anatomical gifts of body parts ��r argans for
use by other living persons, but not to make a general �ift of my body for �cienti�ic
research or other similar general gift.
OR
]1. Anatomical Gifts. To make an anatomical gift of alt or part of my body.
OR
11. Anatamical Gifts. My agent shall not have the pawer ta m,ike any
anatomica� gifts of a11 or any part of my body as I do nat wish to have an.� such gifts
made.
12. Nomina�ion of Gr�ardian. I hereby naminate, my husband, WILLIAM I7.
HENRY as guardian of my estate or persan in accordance with 2pPa. Con. Stat.
§5604{c}{2} and any successor section which authorizes me to nominate a gaardian af my
estate or persan if incompetency proceedings af my estate ar person are h�►eby
commenced. if my husband WilliamD. Henry, is unabte ar unwilling to a.t�t or to continue
to act, I nominate my daughter, CAROL L. HENRY as guardian of my estate or person.
13. General reliance on Power. This power may be accepted and relied upon
by anyone to wfiom it is presented until such persan either reeeives s��ritten natice of
revocation by me ar a guardian or similar fiduciary of m� estate or has a�tual knawledge
of my death.
IN V�ITNESS WHEREOF, I have hereunto signed my narrta and seal this
2-�-'�' day of��' �����-�" , 2006.
�1
Witnes �
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FAIRL�N HENFtY `
Power of Attarrtey for Fairlyn C.Herzry Page 4 of 7
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COMMONWEALTH OF PENNSYLVANIA
� ss
C(:�UNTY OF CUMBER.LAND
On this the �
�.._ day af ����.?���t,2l�, 2046, before me, the
undersigned officer, persanally appeared FAIRLYN C. HENRY known to me to be the
persan vcvhase name is subscribed to the within instrutnent, and acknowtedged that she
executed the same far the purposes therein contained.
IN WITNESS WHEREOF, I hereunta set zny hand and affciat seal.
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NOTARIAL SEAL
RQBERT G FREY NpTARY PUBIIG
Borougb pt Cariisie Cumbe�land Gounry PA
My CAmmiss�on Expires June 4 2Qi0
Power af Attorney far Fairtyn C.Heetry Page S of 7
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ACKNOWLEDGMENT EXECUTED BY AGEN�'
AN AGENT SHALL HAVE NO AUTHC?RITY TO ACT A;� AGENT UNDER
THE POWER OF ATTC?RNEY UNLESS THE AGENT HAS FIRS'I' EXECLITED AND
AFFIXED TO THE POWER OF ATTORNEY AN ACKNOSYLEDGMENT IN
SUBSTANTIALLY THE F4LLOWING FURM:
I, WILLIAM D. HENRY, HAVE READ THE ATTACI-iED P(3WER OF
ATTORNEY AND AM THE PERSQN IDENTIFIED AS THE �.GENT FUR THE
PRINCIPAL. I HEREBY ACKN(JWLEDGE THAT IN THE �BSENCE (JF A
SPECIFIC PROVISIQN TO THE CONTRARY IN THE PC}WER Q1� ATTORNEY t}R
IN 24 PA.C.S, WHEN I ACT AS AGENT:
I �HALL EXERCISE THL� �'C)��RS F{�R THE BEi�iEFiT 4F THE
PRINCIPAL.
I SHALL KEEP THE ASSETS OF THE PRINCIPAL SEPA.2ATE FR4M MY
ASSETS.
I SHALL EXERCISE REASCINABLE CAUTIC}N AND PRU:[�ENCE.
I SHALL KEEP A FULL AND ACCURATE RECORD C}� ALL ACTIONS,
RECEIPTS AND DISBURSEMENTS ON BEHALF OF THE PRINCI PAL.
�����'� .�..fcrc...�_ c�i�?.��SL¢ �� .�'c���
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WILLIAM D. HENR (Date}
COMMONWEALTH t7F PEl`�NSYLVANIA
J�" ss
Ct�UNTY OF CUMBERLAND
h a
(3n this the �� day of ��' ����*�, 2006, befare me, the ur:dersigned afficer,
persona#ly appeared WILLIAM D. �NI2Y, known to me to be the per�on whose name
is subscribed to the within instrument, and acknowledged that he execur_sd the same for
the purposes therein cantained.
IN WITNESS WHEREOF, I hereunta set my hand and officia( seal.
NOTARIA�.SEAI �--�.J, �r
' / (SEAL)
R08ERT G FREY NOTARY PUBIiG -�..-
Borough of Garbsle Gum6edand County PA
My Commission Expires June 4 20t0
Power of Attorney for Fairtyn C.Nenry Page 6 of 7
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+ ACI�N4WLEDGMENT E�fECUTED BY AGENT
AN AGENT SHALL HAVE NGl AUTHt�RITY TO ACT AS AGENT UNI7ER
THE POWER QF ATT(JRNEY UNLESS THE AGENT HAS FIRST EXECUTED AND
AFFIXED T4 THE POWER QF ATTORNEY AN ACKNOVI�LEDGMENT IN
SUBSTANTIALLY THE FOLLOWING FORM:
I, CARCfL L. HEN�Y, HAVE READ THE ATTACHED POWER UF
ATTdRNEY AND AM THE PERSON IDENTIFIED AS THE AGENT FOR THE
PRINCIPAL. i HEREBY ACKNOWLEDGE THAT IN THE ABSENCE OF A
SPECIFIC PRt7VISION TO THE Ct7NTRARY IN THE POWER OF ATTORNEY UR
IN 20 �A.C.S. WHEN I ACT AS A�ENT:
I SHALL EXERCISE THE PQ�4�ERS FOR THE BENEFIT O� THE
PRINCIPAL.
I SHALL ICEEP THE ASSETS OF THE PRINCIFAL SEPARATE FRC}M MY
ASSETS.
I SHALL EXERCISE REASi�NABLE CAUTIQN AND PRUDENCE.
I SHALL KEEF A FULL AND ACCURATE RECQRD OF ALL ACTIt�NS,
RECEIPTS AND DTSBURSEMENTS QN BEHALF OF THE PRINCIPAL.
. ��
CAROL L. HENRY (Date}
CQMMONWEALTH (�F PENNSYLVANIA
� ss
CQUNTY QF CUMBERLAND
.�,2>
Qn this the �5 day af ���• , 2006, before me, the undersigned afficer,
personally appeared CAROL L. HENRY, known ta nne ta be the person whose name is
subscribed to the within instrument, and acknowledged that she executed the same for the
purposes therein cantained.
IN WITNESS WHEItEtJF, I hereunta set my hand and official seaI.
� �S� / r• {SEAL)
.....��..
N47ARlAL SEAI.
TRiSNA A.UESS,Notary Publi�
Borou�h of Ca�iiste,Cumb.County,pq
My Cammission Expires May 20,2014
Power af Attorney for Farrtyn C.Henry Page 7 of 7