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Adam R. Deluca, Esquire C,? ' =1 (Z'
Allied Attorneys of Central Pennsylvania, LLC
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PA Supreme Court ID# 311738 4:_.> Cz
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61 West Louther Street -, -+ m
Carlisle, PA 17013 '' -C Lo o
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(717)249-1177
(717)249-4514 (fax)
adelucaa,alliedattorneysllc.com
Attorney for the Petitioners
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,PENNSYLVANIA
IN THE MATTER OF ORPHANS' COURT DIVISION
MARIE A. JARUSEWSKI r
An Alleged Incapacitated Person No. a =� gS
EMERGENCY PETITION FOR ADJUDICATION OF INCAPACITY
AND APPOINTMENT OF A GUARDIAN
AND NOW, come Petitioners, Maureen E. Clay and Scott D. Jarusewski, by and through
their attorneys, Allied Attorneys of Central Pennsylvania, L.L.C.,by Adam R. Deluca, Esquire,
and hereby petitions for an adjudication of incapacity and appointment of guardians under 20
Pa.C.S. § 5511, and in support thereof represents as follows:
1. The name of the alleged incapacitated person is Marie A. Jarusewski, hereinafter
referred to as Ms. Jarusewski.
2. Petitioners are Maureen E. Clay, daughter of Ms. Jarusewski, and Scott D.
Jarusewski, son of Ms. Jarusewski, residing at 8 West Mulberry Hill Road, Carlisle,
Pennsylvania 17013 and 425 Pine Grove Road, Gardners, Pennsylvania, 17324 respectively.
3. Ms. Jarusewski is an adult individual, widowed, Eighty-four(84) years of age,
having been born on April 3, 1931, currently residing at 1339 Georgetown Circle, Carlisle,
Pennsylvania 17013. She is not a patient in a mental hospital.
�i
4. To the best of Petitioners' knowledge, information and belief, the following
individuals are entitled to the alleged incapacitated person's estate if she died intestate at this
time; the name, address and relationship to the alleged incapacitated person are as follows:
Maureen E. Clay (daughter) Scott D. Jarusewski (son)
8 West Mulberry Hill Road 425 Pine Grove Road
Carlisle, PA 17013 Gardners, PA 17324
Pamela M. Rajtik(daughter) Alan J. Jarusewski (son)
3293 Muirfield Drive 2455 Bellavista Street
Chambersburg, PA 17202 Castle Rock, CO 80109
5. The name and address of Ms. Jarusewski's primary physician is as follows:
Amy Maley, D.O.
Graham Medical Clinic
100 South High Street
Newville, PA 17241
6. The names and addresses of the persons/institutions who provide caregiver
services for Ms. Jarusewski at her residence are as follows:None
7. Maureen E. Clay and Scott D. Jarusewski are the proposed Emergency Guardians
of Ms. Jarusewski; they currently reside at 8 West Mulberry Hill Road, Carlisle, Pennsylvania
17013 and 425 Pine Grove Road, Gardners, Pennsylvania, 17324 respectively. Each hopes to
obtain permanent Co-Guardianship upon further hearing.
8. Upon information and belief, Ms. Jarusewski's Gross Estate consists of:
a) Real Estate in Cumberland County with a County Assessed value of
$216,500.00
b) Orrstown Bank account approximately $40,000.00
9. The total of the foregoing non-real estate assets are $40,000.00.
10. Upon information and belief, Ms. Jarusewski currently receives a Social Security
check and Veteran's benefits from her deceased spouse in the amount of approximately
$2,400.00 per month, which is her total monthly income.
11. The alleged incapacitated person was never a member of the Armed Services of
the United States and does receive benefits from the United States Veterans Administration or its
successor on behalf of her deceased spouse. This amount is included in the above stated income.
12. Ms. Jarusewski suffers from dementia, major depression, and diffuse cerebral
atrophy.
13. Due to Ms. Jarusewski suffering from dementia, major depression, and diffuse
cerebral atrophy, she is not capable of making medical or financial decisions.
14. The attending physician named above will be available to provide testimony via
telephone as to Ms. Jarusewski's incapacity.
15. Due to her condition, Ms. Jarusewski is:
a. Unable to manage her financial affairs;
b. Unable to make and communicate responsible decisions relating to her financial
affairs;
C. Unable to make responsible decisions concerning her person, health, welfare, and
safety;
d. Unable to communicate her needs concerning her health, welfare, and safety;
e. Unable to reside alone;
f. Unable to provide for her personal safety;
g. Unable to keep herself properly nourished and hydrated;
h. Unable to tend to her personal hygiene;
i. Unable to medicate herself;
j. Unable to make responsible decisions with regard to her medical care, including,
but not limited to, obtaining health care services and entering herself into a
hospital, convalescent home, skilled care facility, residential care facility, or
similar institution.
16. This proposed guardianship is in the best interest of Ms. Jarusewski for the
purpose of medical decisions and management of her financial resources.
17. Due to Ms. Jarusewski's medical condition, no less restrictive alternative to a
guardianship is feasible. Ms. Jarusewski has executed multiple Powers of Attorney, and has
revoked each of them at different times. Most recently, Petitioner Maureen E. Clay received a
notice of revocation of the current Power of Attorney this week.
18. The following steps have been taken to find a less restrictive alternative to that of
a Guardianship: Ms. Jarusewski has executed multiple durable Powers of Attorney, but each of
them has been revoked. While still acting as Power of Attorney, the Petitioners had tried to, in
conjunction with Ms. Jarusewski's family physician, explore options at personal care facilities,
but this has been met with hostility from Ms. Jarusewski. Petitioners are currently very
concerned for their mother's well being as she has ceased taking medication, closed her bank
accounts, including those that all bills were being paid from, and is being aided in these
endeavors by members of her Church who are unaware of the severity of Ms. Jarusewski's
condition.
19. The proposed guardians, Maureen E. Clay and Scott D. Jarusewski, have no
interest adverse to Ms. Jarusewski.
20. No court has ever assumed jurisdiction in any proceeding to determine
competency of the alleged incapacitated person.
21. No court has previously appointed a guardian for Ms. Jarusewski.
22. The type of guardianship sought is plenary of Ms. Jarusewski's person and estate.
WHEREFORE the Petitioners, Maureen E. Clay and Scott D. Jarusewski, pray the
Court to direct the attached citation to the alleged incapacitated person, with notice thereof to her
next of kin and to such other persons as the Court may direct, to show cause why she should not
be adjudicated an incapacitated person and Maureen E. Clay and Scott D. Jarusewski not be
appointed guardians, either being able to act individually, of her person and estate. Petitioners
pray this Honorable Court to issue an order granting Emergency Guardianship of Marie A.
Jarusewski to Maureen E. Clay and Scott D. Jarusewski in order to keep Ms. Jarusewski safe and
not allow her to continue her current course of action which is detrimental to both her health and
financial wellbeing.
Respectfully Submitted,
Date Adam R. Deluca, Esquire
Allied Attorneys of Central Pennsylvania, LLC
PA Supreme Court ID 9 311738
61 West Louther Street
Carlisle, PA 17013
(717) 249-1177
(717)249-4514 (fax)
adeluca o,alliedattorneysllc.com
Attorney for the Petitioners
VERIFICATION
I, MAUREEN E. CLAY AND SCOTT D. JARUSEWSKI, hereby acknowledge that we have
read the foregoing petition and verify that the facts stated therein are true and correct to the best
of my knowledge, information and belief. I understand that false statements made herein are
subject to the penalties of 18 Pa. C.S. §4904, relating to unsworn falsification to authorities.
5 ` .5 By:
jVJWA
Date Maureen E. Clay
By:
D eScott arusewski
,
fit GRAHAM MEDICAL CLINIC, P.C.
Name:Marie A Jarusowski DOB:04/03/1$31 Sox:F Aoe:84 yrs AactN; 116021
CC; Pt here for breast exam and mammo script,
DBttl:07/09/2018
Waa the patient queried about smoking behavior? VI Yes I I No
Does the patient currently smoke? Smoking:Patient has never smoked,
t
"
St4}ijSGtl.V@
CC;Patient presents for general physical exam-well woman check
HPI:Physical exam,Patient Is feeling well,
ROS:
I Const:Denies chills,fever and night sweats.
i CV:Dentes chest pain and shortness of breath,
i GI:Denies abdominal pain,change in bowel habits and bloody stools.
GU:Denies urinary symptoms.
Musculo;Denies muscuioskelatal symptoms,
Skin;Denies skin,hair and nail symptoms.
1 Nouro:Denies neurologic symptoms,
Psych:Denies psychiatric symptoms.
I
Current Meds Prior to Visit: Namenda.XR 7 mg,Vitamin B-12 ER 1044 mcg:Mirtpzapine 7.6 mg, d
Hydrochlorothiazide 12.5 mg,Aricept 10 mg,Calcium 011rato*,Vitamin D-1600 Maxlmurrl$trepgth 1000
E Unit,Methimazole 5 mg,Venlafaxine HCL 8R 75 mg,$Imvastatin 20 mg.
Allergies; Sulfa Antibiotics
PMH:
+ Problem List:Osteoporosts,Sclatioa Disorder of thyroid gland,Mixed hype rilpld*Mls,History pf p�►lyp-pf
I colon,Thyrotoxicosle from ectopia thyrold,nodulo with no crisis,Benign essential hypertensit3n,f►fit#IrttaA(
4 cognitive impairment,Mild recurrent major depression,Vltamlh D deficiency,Madefote recur rstAJpt_
I depression
Health Maintenance: -
Mammogram-(1/1112011): fz t f`
F s
Pneumovax-(2005)
Pneumovax-(2010) x a 1 t t
Zostavax-{2007)
Mammogram-(413/2012) , ^ ,
p 1+ y
I Colonoscopy-M1912013}
Dexa Scan-(4/"29/2014)'
Mammogram-(dt2912014) 4 ' � ' e
$UrglCe{H%: �.
Total Hysterectomy,Septoplasty,Tonsillectomy,laoo lift „�
081Gyn Hx:Gravldity:(4)P.rtty:Full terrn'(4}
Reviewed and updated, 4 F.
FH;
Father;Deceaseif due is 0111"cancer Jell, d
Mother.DaCctas ad +¢tnOr+datiC enmitl 4i} fi{ rt y t x
� z
Page#2
A JWuse"Ji DOB 04AW188i
Brother 1:Decoased due 10 Kkk V. Disease-age 2-
Sister
Sister 1:
A llve And Neil.
Ravowed,no C►ta+x M
M.
Lives 1Ntth:Atone-Daughter Maureert lives dose by
Personal Habits: Smoking:Pa(iont has never smoked.Cigaratte Use:Never Smoked Clgarettes.Aleohoi:
Nevsfr used alcohoLExerctsrType:Exercises regularly.
Reviewedi no changes.
Objective
1313:12270 Pulso:84 T:88.1 Ht:90.5"5'0.50'Wt:1321b Wt Prior.1351b as of 08/01/16 Wt Dif:4b
BMI:25.4
Exam:
Const•Appears well.No signs of acute distress present.
HsmNF=w Atraumatic on Inspection.
Eyes%Con undivae dear.Pupils equal,round and reactive to light.
ENb T.Sictemal ears WNL.Auditory canals normal.Tympanic membranes translucent,with good
ianMrarks bilaterally.Nasah turbinates are normal In color and size.Dentition Is normal for age.
Orophwyruc Appears rtormal.Posterior pharynx is normal.
i Nock:Normal to inspection.Thyroid is normal to palpation.No JVD.Carotids:no brults bilaterally,
I Itespr Respiration rate is normal.No wheezing.Lungs are dear bilaterally
IIr CV:Rate is regular.Rhythm it regular.S1 is normal,S2 is normal.No extra sounds.No heart
murmur appreciated.Extremltt"t No edema of the lower limbs bilaterally.
f Breasts:Exam was done with a!emote chaperone present.Breasts normal on inspection.There are no
skin changes.No masses noted
Abdomen:PasiUve bowel sounds In all quadrants.Normal to percussion.Abdomen Is soft,nontender,
and neral sterded.No abdominal masses palpable.No palpable hapatosplenomewly.
Lymph:No palpable or visible regional tymphadenopethy.
Musculo:Upper Extremities:Normal to lnspectgn and palpation.Lower Extremities:Normal to Inspection
NO palpation.
Sktnr Skin wart and dry with no evidence of unusual rashes or suspletovs lesions.
Neuro:Alert and oriented Achilles and patellar DTRs are brisk and symmetrical.
Cranial Nerves:Crenlat nerves Ib-XII grossly intact.
Psych:Mood/Affect:Mood Is normal.Affect Is normal,
Lsh Aogulred:04r23116
Test Home Result H/L Referenoe Range Units
CBC(INCLUDES DIFFIPLT) -Profile-
WHITE BLOOD CELL COUNT 8.7 N 3.8-10.8 Th
RED BLOOD CELL COUNT us
4.81 N 3.80-5,10 Milli
oo
HEMOGLOBIN 13.8 N
HEMATOGRff 14.7-15,5 g/dL
42.4 N 35.0-46.0
MCV 82.2 N B0 0 100.0
MCH 30.0 N 27:0330 fL
MCHC 32.5 N 32.0-39.0. Pg
RDW 13.7 N 11.0-15.0 hItlL
PLATELET COUNT e�
ABSOLUTE NEUTROPHILS 5Wri38 N '140-400 Thous
ABSOLUTE LYMPHOCYTES 2292 N 1500-7800 cello
I ABSOLUTE MONOCYTES 687 N 850 3800 cells
m ABSOLUTE EOSINOPHILS B1 N 200-950 Calle
N 1"OO cells
11"31: 13 ti31 Page Ala
t
53 N 0,200 cells
N %
5
79 N `K
ar :5 017 N %
06 N
94 �_ N 85.99 mg/dL
19 N 7-25 mg/dL
0.73 N 0.60-0.88 mg/dL
S _ s.,---tiff- pVr-Sh�for peWe
°4': •remit Au IEFZ:CM 76 N >OR=60 mUml
Pa'*z2 :�*:.a52>�►�t ss N >OR=60 mUml
' _ $_�► ,OT1', ftkra NOT APPLICABLE 6-22 (Calc
= 142 N 135-146 mmoll
PC"4 37 N 3.55.3 mmol/
100 N 98-110 mmov
vw C'1TY:iZE 24 N 1930 mmol/
L! 9.3 N 8.6-10.4 mg/dL?LQTrixTOM 6.9 N &1-81 g/dL
4.3 N 3.85.1 g/dL
2-6 N 1.9-3.7 g/dL
�=C'i uLOS Z LK RAi40 1.7 N 1.0-2.5 (Calc
L�—RLZS,X TOTAL 0.8 N 0.2-12 mg/dL
A4-'A NT PHUSPi4A1TASE 61 N 33-130 UA.
AST 18 N 1035 U/L
':-T 93 N 6-29 UIL
C1 -'PDI:ii-ZPW NE 937,W- SEE IMAGE
fto"=...c 4"! 391.43 t:;d Cog%Z"bnP--MMA so Stated
C— Sha vs m fie=s'dd:a of a work up w;:h neurology regard'umg memory loss. She Is very
' =x m arry t$em d4d owe tis a_proh m, She,however,is vary high tunctioning
t`c:5 t=there hive been no m-"safety Issues or concoms, the conies to today
I>rr good f,%=A!ht tmw rng;nies her to most of hot
for"= apptd i revtc d y(th
1)H"L-*W mViested be rM.*wlh me and gut I W-1 of courte need rMeate In
wd r b be cW&b do Uwl
74 Her rS:ptgq vcumtn d d MX for some records. She ImmetWely twmmo nnatr
Sh*w=veryupsct. she z r�C.rtety w-tted 10 confirm th.K we haw not gtven her
Z Y raced= Sun rt t d that€ho(>n Lik^n off th+Ntppa endle, yd food
t~' bbep4d.+tryz xx
Of ncy N +�;b',rr�tR, syc p to Gumtm*+d CtmEw gs today w;th hrr fft nd 10
9,a of mavinq 1IY*o wth wit"«crl,z eon 0101
vie r-J-;ne-a so—.,cl: _ He ,+c*,rhe k"'4•nn timet mawrern Ida hcv th,1t
Made A jkirusmvskf DOB 0470371931 Page 94
Maureen called CG and told them she was insane"and they shouldn't take-her. Per
Made,Maureen called to Marie to specifically tell her this. Marie says"Maureen Is
trying to commit me. When I expressed that it was my understanding that Maureerys
goal was to have her move somewhere where she could have more help end have more
supervision and that t didn't think that made sense Marie just said`she doesn't want
me to be anywhere but committed'.1 disagreed with this and expressed to Marie that I
believe a personal care or asslstediivtng would be a perfect environment for Marie,
Care Pian:
Med Current Aricept io mg 1 tab by mouth every at bedtime
Follow up 0 months for follow up
Retbommendelions: Follow with Dr.Ismail as scheduled for next week.
Assessment tl2: V76-10 Screening For Malignant Neoplasm Breast
Caro Plan:
Xray Mammography,Bilateral
Plan Other.
Med Current : Namende Xft 7 mg 1 by mouth every day
Vitamin 8-12 ER 1000 mcg 1 tab by mouth daily
Minazapine 1.5 mg 1 tab by mouth every al bedtime
Hydrochlorothiazide 12.5 mg 1 by-.mouth every day
Calcium Citrate+600mg by mouth twica a day
Vitamin 0-1000 Maximum Strength 1000,Unit 1 by mouth everyday
Melhimazote 5 mg Take 1.P0 daily
Verildwine HCL ER 75 mg take 1 capsule daily.
Simvastatin 20 mg 1 by mouth every day
Amy Matey,00
Seen by: Electronically signed by Amy Malay,D.O,on 07(09/2015
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830 Walnut flatfoot Road,Corllslf.PA 17011 1114,110101 004110ft'Nhilif
Phone: 717-145-0011 Vw 717.246,0100 4'J)%jMtf1 1)1 1111(X011-1i I'll I .
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Report Details
Patient Narric. 3ARU8EWSKI,MAR19 11forodwra DOW: I/a/A015
Date of Birth: 4/3/1931 Age 84 Accennion; 412127
Patient ID, L2504 Referring Phyaliclant tarnall, Mohammed
Procedure: CT Head Unenhanced 70450 Procedure ID! 22x61
Report Text
CT OF BRAIN, WITHOUT CONTRAST
History: organic brain syndrome
The CT examination of the brain Is Parrormad without contrant. Thero 1,,i mild diffu,.t, vrobf al
atrophy. There 1r;no Intracranial mann,mar,!;affect or c1dema, The ventricli-, r11id ,1-,tu,ji-, rtw
normal in appearance. There 1,;no extra-axlal collection, The brdln 'Awn and(owfutilkint mv
unremarkable.
IMPRESSION:
Mild diffute cert brat atrophy.
Keith S. Pumroy, M,D,
KSP/tijM T: 07/06/15
Thank You for referring your patitnt W Walnut Bottom p dl()Ioqy.
tfi
Signed by: Pumroy'Keith
DAM fillinedi
i tat,
32M Val- 7,fjn 1SP1i7Ci io:to
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,PENNSYLVANIA
IN THE MATTER OF ORPHANS' COURT DIVISION
MARIE A. JARUSEWSKI
An Alleged Incapacitated Person No.
CONSENT OF PROPOSED GUARDIAN
Maureen E. Clay and Scott D. Jarusewski do hereby certify that they are willing to act as
guardians of the person and guardians of the estate of Marie A. Jarusewski, an alleged
incapacitated person, if the Court shall so appoint.
Date: By-
a een A. Clay
Date: j By:
Scott
A0ase'W"ski