HomeMy WebLinkAbout08-15-13 IN RE: SAMANTHA J. GRIES, a minor : IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,PENNSYLVANIA
ORPHAN'S COURT DIVII.SS ON
NO. c21r 12,_ S c/ t
PETITION FOR APPOINTMENT OF
GUARDIANS FOR A MINOR
The petitioners, CHRISTOPHER S. COLLARS and COURTNEY A. COLLARE, by and
through their attorneys, Irwin& McKnight, P.C., respectfully represent the following:
1. Petitioners Christopher S. Collate and Courtney A. Collate are adult individuals \
residing at 19 Kengrey Drive, Carlisle, Cumberland County,Pennsylvania 17013.
2. The minor child is Samantha J. Gries, born October 1, 2001, and currently age
eleven (11). A true and correct copy of the minor child's birth certificate and Social Security
card are attached hereto and incorporated herein as Exhibit"A."
3. This Orphan's Court has exclusive jurisdiction over the appointment of guardians
for the minor pursuant to 20 Pa.C.S.A. §711(6).
4. As set forth on the birth certificate attached hereto as Exhibit "A," the mother of
the minor child is Wendy I. Gries, an adult individual currently residing at 2312 Hoffer Avenue,
Apt. 2, Reading, Pennsylvania 19605. c t M
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5. As also set forth on the birth certificate attached hereto as E'ti bip,A,,the ather
of the minor child is John Charles Gries.
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6. The minor child's father, John Charles Gries, passed away on February 9, 2011,
in Reading, Pennsylvania. An original Certificate of Death for John Charles Gries is attached
hereto and incorporated herein as Exhibit`B."
7. To the best of Petitioners' knowledge, information, and belief, the only living
next-of-kin of the minor child are as follows:
a. Wendy L Gries (mother) of Reading, Pennsylvania;
b. Two (2) unknown other minor children of mother that do not reside with
mother or Petitioners and would be either siblings or half-siblings of the
minor child; and
C. Linda A. Waggoner,the sister of the minor child's deceased father.
8. Petitioners are currently the temporary guardians of the minor child pursuant to
the consent of the natural mother and various documents entitled "Appointment of Temporary
Guardian for Minor Child and Durable Healthcare Power of Attorney" and signed by the natural
mother. True and correct copies of such forms signed by the natural mother and dated December
9, 2011, May 25, 2012, and November 21, 2012, are attached hereto and incorporated herein as
Exhibit"C."
9. The forms signed by the natural mother and attached hereto as Exhibit "C," also
name Edward A. Waggoner and Linda K. Waggoner, the minor child's uncle and aunt, as joint
temporary guardians, but only Petitioners have been serving in that role since at least December
9, 2011.
10. The minor child was born in Montgomery County, Pennsylvania on October 1,
2001.
11. The natural mother lost custody of the minor child after the intervention of$erks
County Children & Youth Services.
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12. Custody of the minor child was ultimately transferred to Petitioners with the
knowledge and approval of Berks County Children & Youth Services, and the agency closed its
case with regard to the minor child. A true and correct copy of correspondence from Kathy
Lashinsky, M.A. of Berks County Children & Youth Services dated July 26, 2012, confirming
the agreement for placement of the minor child with Petitioners is attached hereto and
incorporated herein as Exhibit"D"
13. The transfer of custody of the minor child to Petitioners was also done with the
knowledge of minor child's mother, aunt, and uncle named above.
14. Petitioners,have been primarily responsible for raising, caring for, and supporting
the minor child since December 9, 2011.
15. Petitioners have also been the sole source of financial support for the minor child
since December 9, 2011.
16. More recently, the parties have discussed establishing a more formal arrangement
with regard to the Petitioners and the minor child.
17. The natural mother is in agreement to the grant of permanent Guardianship status
to the Petitioners and on or about May 11, 2013, signed a document entitled"Affidavit by Parent
Consenting to Petition for Appointment of Guardians for Minor." The original Affidavit signed
by the natural mother is attached hereto and incorporated herein as Exhibit"E."
18. As a result of the death of the natural father, no other consents are necessary in
this matter other than that of the natural mother as attached hereto.
19. There is no interest of the Petitioners that is adverse to that of the minor child.
20. Other than monthly social security payments issued on behalf of the minor child
as a result of the death of her father for which the social security administration maintains review
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and oversight, there is no estate in which the minor is interested, and no interest of the minor in
which Petitioners are fiduciaries, sureties, or employees of any such fiduciary or surety.
21. Other than the monthly social security payments as outlined above, there is
presently no estate or assets of the minor child, and no additional such estate or assets are
currently anticipated.
22. No other petition has been filed for the appointment of a guardian for the minor
child in this or any other jurisdiction.
23. Upon information and belief, the minor child's father was a veteran, but because
he is deceased no notice is proposed to be given to the United States Veteran Administration.
24. Petitioners request that this Court waive the requirement for official searches of
the proper offices of Cumberland County, where the minor child resides, on the grounds that the
subject of this petition is a minor and that there are no judgments, decrees, or any other like
documents of record against the minor child.
25. "The best interests and permanent welfare of the child requires that the Court grant
the Petitioners' requests as set forth above.
WHEREFORE, Petitioners respectfully request that this Honorable Court:
a. Enter a decree granting guardianship of the person and estate of the minor
child to Petitioners along with corresponding temporary legal and physical custody of the
minor child in accordance with the affidavit and consent signed by the natural mother and
attached hereto as Exhibit"E"; or
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b. In the alternative, fix a date for hearing this Petition and direct that notice
of this Petition be given to the natural mother at her last known address.
Respectfully Submitted,
IRWIN& McKNIGHT, P.C.
Do glas . Miller, Esquire
Suprem Court I.D. No. 83776
60 West Pomfret Street
Carlisle, PA 17013
(717) 249-2353
Date: d , 2013 Attorney for Petitioners
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I
VERIFICATION
The foregoing document is based upon information which has been gathered by our
counsel and ourselves in the preparation of this action. We have read the statements made in this
document and they are true and correct to the best of our knowledge, information and belief. We
understand that false statements herein made are subject to the penalties of 18 Pa.C.S.A. Section
4904,relating to unworn falsification to authorities.
CMUSTOPHE jR'S.�COLLARE
COURTMV A. COLLARE
Date: 8 12 1
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H145.
APPOINTMENT OF TEMPORARY GUARDIAN FOR MINOR CHILD AND DURABLE
HEALTHCARE POWER OF ATTORNEY
I'Wendy I. Gries, mother of Samantha J. Gries, of Seeks County, Pennsylvania, appoint temporary
guardianship and durable power of attorney for healthcare and finances of Samantha J. Gries, born 1 October
2001, to Christopher S. Collare and Courtney A. Collare of 19 Kengrey Drive Carlisle, Cumberland County,
Pennsylvania with telephone 717 243 2230, having the following relationship to Samantha J. Gries as friends,
and jointly or severally Edward A.Waggoner and Linda K.Waggoner of 231 Webster St. Carlisle, Cumberland
County, Pennsylvania, with telephone 711 243 4966, having the following relationship to me as brother-in-law
and sister-in-law.
Will become effective immediately and will terminate upon the earlier to occur of(a)the revocation in writing of
any parenttguardian, (b) as required by applicable law or(c) if I (mother)obtain adequate housing before
15 June 2012.
To the maximum extent permissible under applicable law, the temporary guardian(s)will have the same
authority as I would have with respect to the custody and care of Samantha J. Gries as I have specified below,
including the following acts and the following decisions:
To make all emergency and non-emergency healthcare decisions and execute all related documents including
insurance and waiver claims and forms, including the right to approve or decline medical,dental, eye care, or
psychiatric treatment, diagnostic tests, hospitalization, healthcare and personal care, in any situation in which,
as the result of illness, disease, absence, injury, or death I am incapable of making or communicating a
decision with regard to Samantha J. Gries'medical or dental care, provided that such decisions are made
following consultation with one or more licensed physicians or other licensed medical practitioners. I further
delegate the power to my short term guardian(s)to seierA, employ, and discharge healthcare personnel,
including dentists and eye care professionals for Samantha J. Gries'benefit and to contract in my name and on
my behalf for all health care services, including emergency and non-emergency medical, dental, vision and
psychiatric care services and related goods.
To make all decisions, execute all documents, and grant permission regarding Samantha J. Gries' education,
including but not limited to school enrollment, school and extracurricular activities, school trips and school
conferences.
IN WITNESS WHEREOF,the parties hereto have executed this agreement on this day ofblPlu(Poll 1.
Signed in the presence of:
Witness
Witness
Parent
i
Guardian
Guardian C�
Guardian rg
Guardian 17
Va
Commonwealth of Pennsylvania Sworn to and atxbacribed before me COMMONWEALTH or PENNSYLVAIN
i20t( ero�ro .NOT
County of�� this _day of__ ( HEATHER a.MEARS.NOTARY S COUNTY
.�li WEST READING BOROUGH, BERKS COUNTY
MY COMMISSION EXPIRE F A:GUST 26,2014
APPOINTMENT OF TEMPORARY GUARDIAN FOR MINOR CHILD AND DURABLE
HEALTHCARE POWER OF ATTORNEY
I Wendy 1. Gries, mother of Samantha J.Gries, of Barks County, Pennsylvania, appoint temporary
guardianship and durable power of attorney for healthcare and finances of Samantha J.Gries, bom 1 October
2001, to Christopher S. Collare and Courtney A.Collare of 19 Kengrey Drive Carlisle, Cumberland County,
Pennsylvania with telephone 717 243 2230, having the following relationship to Samantha J. Gries as friends,
and jointly or severally Edward A. Waggoner and Linda K.Waggoner of 231 Webster St. Carlisle, Cumberland
County, Pennsylvania,with telephone 717 243 4966, having the following relationship to me as brother-in-law
and sister-in-law.
Will become effective immediately and will terminate upon the earlier to occur of(a)the revocation in writing of
any parent/guardian, (b)as required by applicable law or(c) if I (mother)obtain adequate housing before
25 November 2012.
To the maximum extent permissible under applicable law, the temporary guardians),Mll have the same
authority as I would have with respect to the custody and care of Samantha J. Gries as I have specified below,
including the following acts and the following decisions:
To make all emergency and non-emergency healthcare decisions and execute all related documents including
insurance and waiver claims and forts, including the right to approve or decline medical, dental, eye care, or
psychiatric treatment, diagnostic tests, hospitalization, healthcare and personal pre, in any situation in which,
as the result of illness, disease, absence, injury, or death I am incapable of making or communicating a
decision with regard to Samantha J.Gries'medical or dental care, provided that such decisions are made
following consultation with one or more licensed physicians or other licensed medical practitioners. I further
delegate the power to my temporary guardian(s)to select, employ, and discharge healthcare personnel,
including dentists and eye care professionals for Samantha J. Gries' benefit and to contract in my name and on
my behalf for all health care services, including emergency and non-emergency medical, dental, vision and
psychiatric cane services and related goods.
To make all decisions,execute all documents, and grant permission regarding Samantha J. Gries'education,
including but not limited to school enrollment, school and extracurricular activities, school trips and school
conferences.
IN WITNESS WHEREOF,the parties hereto have executed this agreement on thisZL3 day of W 2012.
Signed in the presence of:
Parent J �
Guardian Ap
Guardian 1
Guardian
Guardian OLd4t � (laa� ra�e
NOTARIAL SEAL
DENISE YAiI'L
NotuIf P1 li k
ARLISLE BOROUGH,CUMBERLAND COUNTY
MY Cammisslon Expires,Aprr66,2015
INDIVIDUAL ACKNOWLEDGMENT
State/Commonweafth of S Gj ✓�
County of / 11�f��i°�/Q •-y�t� r/
On this the day of /�� _ r%r�/dam before-me,
Day onth / Year
se_ ✓���c J the undersigned Notary Public,
Name of Notary Public
personally appeared ��/ l7di'�S
Name(s)of Signer(s)
❑personally known to me—OR—
❑proved to me on the basis of satisfactory
NOTARIAL Ai.SEAL evidence
ONotar V utilic to be the person(s)whose name(s)is/are subscribed
Notary Pubtic
CARLISLE t uMeERtgruo couNry to the within instrument, and acknowledged to me
My C°m safcrt Expires Apr 6. 2015 that he/she/they executed the same for the purposes
therein stated.
WITNESS my hand and official sealer
Signature of Notary Public
Any Other Required Information
Place Notary Seal/Stamp Above (Printed Name of Notary,Expiration Date,etc.)
OP77ONAL
Not required by taw, this information can be useful to those relying on the document
and prevent fraud. • a
Top of thumb here Top of thumb here
Description of Any Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s) Other Than Named Above:
0 2010 National Notary Association -NationalNotary.org • 1-800-US NOTARY(1-800-876-&827) Item#15936
I Wendy 1. Gries, of Barks.County Pennsylvania, mother of Samantha J. Gries, born 1 October
2001 grant permission to Christopher S. Collare and Courtney A. Collare of 19 Kengrey Drive
Carlisle, Cumberland County, Pennsylvania with telephone 717 243 2230, having the following
relationship to Samantha J. Gries as friends, and Edward A.Waggoner and Linda K.Waggoner
of 231 Webster St. Carlisle, Cumberland County, Pennsylvania,with telephone 717 243 4966,
having the following relationship to me as brother-in-law and sister-in-law to take Samantha on
vacation from the Commonwealth of Pennsylvania.
Parent twr ( , Zb , (Z
APPOINTMENT OF TEMPORARY GUARDIAN FOR MINOR CHILD AND DURABLE
HEALTHCARE POWER OF ATTORNEY
I Wendy 1. Gries, mother of Samantha J. Gries, of Barks County, Pennsylvania, appoint temporary
guardianship and durable power of attorney for healthcare and finances of Samantha J.Gries, born 1 October
2001,to Christopher S.Collars and Courtney A. Collars of 19 Kengrey Drive Carlisle, Cumberland County,
Pennsylvania with telephone 717 243 2230, having the following relationship to Samantha J. Gries as friends,
and jointly or severally Edward A. Waggoner and Linda K.Waggoner of 231 Webster St. Carlisle, Cumberland
County, Pennsylvania, with telephone 717 243 4968, having the following relationship to me as brother-in-law
and sister-in-law.
Will become effective immediately and will terminate upon the earlier to occur of(a)the revocation in writing of
any parenttguardian, (b) as required by applicable law or(c) if I (mother)obtain adequate housing before
18 May 2013.
To the maximum extent permissible under applicable law, the temporary guardian(s)will have the same
authority as 1 would have with respect to the custody and care of Samantha J. Gries as 1 have specified glow,
including the following acts and the following decisions:
To make all emergency and non-emergency healthcare decisions and execute all related documents including
insurance and waiver claims and forms, including the right to approve or decline medical, dental, eye care, or
psychiatric treatment, diagnostic tests, hospitalization, healthcare and personal care, in any situation in which,
as the result of illness, disease, absence, injury, or death t am incapable of making or communicating a
decision with regard to Samantha J. Gries'medical or dental care, provided that such decisions are made
following consultation with one or more licensed physicians or other licensed medical practitioners. I further
delegate the power to my temporary guardian(s)to select, employ, and discharge healthcare personnel,
including dentists and eye care professionals for Samantha J. Gries' benefit and to contract in my name and on
my behalf for all health care services, including emergency and non-emergency medical, dental, vision and
psychiatric care services and related goods.
To make all decisions, execute all documents, and grant permission regarding Samantha J. Gries'education,
including but not limited to school enrollment, school and extracurricular activities, school trips and school
conferences.
IN WITNESS WHEREOF,the parties hereto have executed this agreement on this / day of. aft 12012,
Signed in the presence of:
Parent
i
Guardian
Guardian )
Guardian - C L/? c
tu
Guardian nr�s
INDIVIDUAL ACKNOWLEDGMENT
State/Commonwealth of l&r,�,�</lJl'/�k
ss.
County of
On this the 4ell day of ///GZ/?rJ?d' fa� before me,
Day Month Year
the undersigned Notary Public,
Name of Notary Public
personally appeared
Name(s)of Signers)
O personally known to me-OR-
❑proved to me on the basis of satisfactory
evidence
to be the person(s)whose name(s) is/are subscribed
to the within instrument, and acknowledged to me
that helshe/they executed the same for the purposes
therein stated.
WITNESS my hand and official seat.
NOTARIAL SEAL
DENISE WNITZEL Signature of Notary Public
Notary Public
CARLISLE BOROUGH,CUMBERLAND COUNTY
My Commission Expkes Apr ti,2015
Any Other Required Information
Place Notary SeallStamp Above (Printed Name of Notary, Expiration Date, etc.)
OP17ONAL
Not required by law, this information can be useful to those retying on the document
and prevent fraud. �!op 7thumb rumb
Description of Any Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s) Other Than Named Above:
0-2-0-1-0-National Notary Association-NationalNotary.org• 1-800-US NOTARY(1.800-876.6827) item#16986
COUNTY OF BERKS� PMSYLVANL4,
�atcVLTYy Children & Youth Services
WServices Centm,I1th Floor Phone:810.478.6700
E, 633 Gawk asset Toll Free;868.7774490
R06 ft PA 1 01-4323 Fax:610.478.6799
Christian Y.LaInbach,Chair George m.Kovade.Executive Director
Kevin S.SarrhsrA Commissioner
Mark C.80A Esq.,owed
July 26,2012
Re: Samantha Gries 10/01/01
CHIP Insurance
Dear Provider:
Subject: Samantha Gries
This letter is to verify that Christopher&Courtney Coliere are currently the caring for Samantha Gries.
This is an inibrmal agreement between the family members and the agency does not have an open rase as
Samantha is remaining in their care. Please feel fired to call with any questions 610.478-6700 ex: 6778.
Thank you for your assistance with this matter.
Sincerely, f
Al /44-!
Kathy Lashinsky,M.A.
Caseworker
Dedicated to public service With intagrity,virtue&exceaenca
rM1N=w,nne SmMpelcrklnlhxeplkrrTlrJ1ve11-(:Imul-ImeTnriedmri �s,ga.us
IN RE: SAMANTHA I GRIES : IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY,PENNSYLVANIA
ORPHAN'S COURT DIVISION
NO.
AFFIDAVIT BY PARENT CONSENTING TO PETITION
FOR APPOINTMENT OF GUARDIANS FOR bIINOR
I,Wendy L Gries,being duly sworn according to law,do depose and state:
1. That I am a competent dult witbL a current mailing address of
a3 Q Hoiie� Fide
2. That I am the natural mother of Samatha J. Gries, for whom a Petition for Appointment of
Guardians is to be filed by Christopher S.Collare and Courtney A.Collare;
3. That I previously agreed to the placement of my daughter with Christopher S. Collare and
Courtney A.Collare;
4. That the father of the minor child,John Charles Gries, is deceased,having passed away on
February 9,2011.
5. That my daughter's date of birth is October 1,2001 (currently age 11).
6. That I have knowledge of and approve the petition of Christopher S.Collare and Courtney
A.Collare for their appointment as guardian of the person and estate of my minor child;
7. That I voluntarily consent to appointment of Christopher S. Collare and Courtney A.
Collare as guardians for my daughter, Samantha J.Gries;
8. That I have not in any manner been coerced into signing this Affidavit or in agreeing to the
appointment of Christopher S. Collare and Courtney A. Collare as guardians of my minor
child.
I verify that the statements made in this affidavit are true and correct. I understand that false
statements herein made are subject to the penalties of 18 Pa.C.S. Section 4904, relating to unworn
falsification to authorities.
Date: I 11 13 By:
W"DY 1.GRIES
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