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Home My WebLink About11-01-05 In re: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYL VANIA : ORPHAN'S COURT DIVISION Kelsey N. Martin and Courtney L. Martin : PETITION FOR APPROVAL OF : STANDBY GUARDIAN DESIGNATION : NO.~/-OS;-_ CA b')' 1<> -(..,.-:) 1_...-';') -:.)""1 ~-) ro-",.::' , PETITION FOR APPRO V AL OF STANDBY GUARDIAN DESIGNATION PURSUANT TO 23 Pa.C.S. ~5612(e) , \ Now comes, Thomas Webster Martin, sole-surviving parent ofthe minor children, Courtney Lynn Martin and Kelsey Nichole Martin, and petitions the Court to approve his designation of said children's aunt and uncle, Ronald James Crone, II, and Heather Renee Crone, as the children's standby guardians, without a hearing as provided by 23 Pa.C.S. s5612(e), and avers in support thereof as follows: 1. Designator, Thomas Webster Martin, desires court approval of the designation of Ronald James Crone, II, and Heather Renee Crone, as the standby guardians of his two minor children. 2. Designator is the sole-surviving parent of Courtney Lynn Martin, born September 5, 1991, and Kelsey Nichole Martin, born September 22, 1994. 3. The children's mother, the designator's wife, Shelly Martin, died on September 9,2005. 4. Designator, Thomas Webster Martin, resides at 113 West Shady Lane, Apartment L, Enola, Cumberland County, P A 17025. 5. Designees, Ronald James Crone, II, and Heather Renee Crone, aunt and uncle of the subject children, reside at 40 Asbury Court, Mount Wolf, York County, P A 17347. ~ <") .. 0'\ 6. Attached as exhibits are the Standby Guardianship Agreement, as provided by 23 Pa.C.S. S5611(c), the birth certificates of the designator's minor children, and the death certificate of the minor children's mother. 7. All consents to the proposed designation required by 23 Pa. C.S. S5611 are attached as exhibits. WHEREFORE, designator, believing and alleging that the welfare of the minor children will be promoted by the designation, prays that your Honorable Court enter without a hearing, a Decree of Standby Guardianship Designation designating Ronald James Crone, II, and Heather Renee Crone as standby guardians for Courtney Lynn Martin and Kelsey Nichole Martin. Respectfully submitted, Date: ~2,t)O{ ~a+<-1Cr~ Alexandra N. Corcoran Certified Legal Intern w.~~ Robert E. Rains Supervising Attorney DISABILITY LAW CLINIC 45 S. Pitt St. Carlisle, P A 17013 (717) 243-3696 STANDBY GUARDIANSHIP AGREEMENT I, Thomas Webster Martin, of 113 West Shady Lane, Apartment L, Enola, Cumberland County, P A 17025, (717) 732-5497, do hereby appoint my brother-in-law, Ronald James Crone, II, and my sister-in-law, Heather Renee Crone, of 40 Asbury Court, Mount W olf, York County, P A, 17347, (717) 268-0564, as the standby guardians of Courtney Nichole Martin and Kdscy Nichole Martin, to take effect upon the occurrence of the following triggering event or events: My death A determination of my incapacity A determination of my debilitation I hereby revoke all former wills and codicils to the extent that there is a conflict between those formerly executed documents and this, my duly executed standby guardian designation. I am the sole-surviving parent of Courtney Lynn Martin, date of birth September 9, 1991, and Kelsey Nicole Martin, date of birth September 22, 1994. The children's mother, my wife, Shelly Martin, died on September 5, 2005. By this designation, I am granting Ronald James Crone, II, and Heather Renee Crone, the authority to act for sixty (60) days following the occurrence of the triggering event as co- guardians with me, or in the event of my death, as guardians of my minor children. If I have indicated more than one triggering event, it is my intent that the triggering event which occurs first shall take precedence. If I have indicated "my death" as the triggering event, it is my intent that the persons named in the designation to be standby guardians for my minor children in the event of my death shall be appointed as guardians of my minor children when I die. It is my intention to retain full parental rights to the extent consistent with my condition and to retain the authority to revoke the standby guardianship if I so choose. This designation is made after careful reflection, while I am of sound mind. C;\--)9-o~ Date ~J-~~ Witness's Signature ~5 E &fh;,,{)y€ ~f: Witness's Number and Street Address 6}:~'n~~~. l{i "}?7 ()<'l~-' Designator's Signature ~I ~~tC~ WItness's SIgnature .:l.nS ~ ~)., S;.j.. Witness's Nu er and Street Address 17CJ/J &l2...1 :<,,1" I PA l"'MI ~ Witness's City, State, and Zip Code I, Ronald James Crone, II, maternal uncle of the children, hereby accept my nomination as standby guardian of Courtney Lynn Martin and Kelsey Nichole Martin. I understand that my rights and responsibilities toward the minor children named above will become effective upon the occurrence of the above-stated triggering event or events. I further understand that in order to continue caring for the children, I must file a petition with the court within sixty (60) days of the occurrence of the triggering event. Date: 7 !Ie; (0.<; -~ ....~ / j /"'7 __~--'"~'.",'-' ,,/'"..." /.,/;7"ft" "..-<.----- ~~;2,~"'6/ / ~ <f ]l~' /L Ronald James / rone,~ I HEREBY CERTIFY that on this Iql~ day of September, 2005, before me and the subscriber, a Notary Public and for the Commonwealth of Pennsylvania, personally appeared RONALD JAMES CRONE, II, and acknowledged the foregoing Standby Guardianship Agreement to be his act. NOTARIAL SEAL LINDA M. CARVER, NOTARY PUBLIC . CARLISLE BORO. CUMBERLAND COUNTY AS WITNESS my hand and Notonal S~ af.W COMMISSION EXPIRES DEC. 5 2006 /mh (ll~ I [SEAL] I, Heather Renee Crone, maternal uncle of the children, hereby accept my nomination as standby guardian of Courtney Lynn Martin and Kelsey Nichole Martin. I understand that my rights and responsibilities toward the minor children named above will become effective upon the occurrence of the above-stated triggering event or events. I further understand that in order to continue caring for the children, I must file a petition with the court within sixty (60) days of the OCClliTenc of the triggering event. ql JS 0-5 Widit4 0)W{~ Heather Renee Crone Date: I HEREBY CERTIFY that on this 20 Y::!.. day of September, 2005, before me and the subscriber, a Notary Public and for the Commonwealth of Pennsylvania, personally appeared HEATHER RENEE CRONE, and acknowledged the foregoing Standby Guardianship Agreement to be her act. AS WITNESS my hand and Notorial Seal t COMMONWEAlTH OFPENNSYLVANlA. NolariaI SMI Brenda J. WISe. NotaIy NlIIc MallChester Boro. York COUnty My CommIssion ExpIres Au;. 28, 2007 Member. Pennsylvania Association Of Notal; .. HUI","'(\'::: fJ!"V This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. P llf;SS691 Nn. ",\1,,~~(1\(oF7;1;'---____ ,l\~~4'J);~ ~~/_ M~" \~;. J~/_ -~~ - \~\ ~ ~I . "'" I~~ ~~ - {~~." /~~ \*\~LC "~~.' .~. .,;*~ ;. .::2 .~_.. /~ ~ ~~~ A~\l "'-"'-_}?lMENl ~\ ~~,,'I"\ "-"-"'-"""f/"UII11JJ"fl ~f1?~ Local Registrar Fee for this certificate, $6.00 SEP 0 9 2005 Date . 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH NAME OF OECEOENT 1F-';ST, Mldc:lle~--~~'------'----------'--~---~ SEX ,. Shelley M. Martin LFemale STATE Fllf NUMBER SOCIAl. SECURITY NUMBER AGE (Last BlfthOay) UNDeR 1 YEAR MOtIIf\e Days UNDER I 0"- Houn MW'wtee 3. 209 - 60 8197 DATE OF DEATH IMcn!h, 0..,. '(eall 9/9/05 4. OECEOENl'S USUAL OCCUPATION (Give Iund d work done dunng I'TlClSI 01 working Me; do not use rellred ) MS DECEDENT eVER IN u.s. ARMED FORCES? .... 0 NoXl g,:"Y' 0 40 y" 81RTHPLACE !C,1y arod PlACE OF DERH (Cl'>eck Q(1ly Ol"e -;ee 'f'lSIIUCI,oos on Olhel '31<Hl) Stale 01 Fcregn COIJnfry) HOSPITAL Yo r k , P a 1_."", 0 ERIOuIooti... 0 7. ... FACn.ITY NAME (If not ,nsNIJlron. gIVE! Slree! and number I ,. COUNTY OF OEi<TH Cumberland E. Ie. 313L Shady Enola,Pa .... ".. CNA "0. Heal th C re DECEDENT'S MAILING AOORESS (Slfee1. CitylTown. Stale. ZoCodel DECEDENT'S ACTUAL RESIDENCE (See InSlruclllJF\S on Olher side) MARITAL STATUS - Married N8vel' ~n'ied. WMiowed. O-lSeecdyJ Married 14. Thomas W. East Pennsbolio _. 313L Shady 1.. Enola, Pa FRHER'S NAME (First Mlljdle. LJ$l) 11.. Slale Pennsylvania (J;d -.. MIfU Cumber land -.....' 17..0 :j,~':':::oI MOTHER'S NAME (F"lI"st. MIddle. Marden Surname} 17.XXv..._......in Lane 17025 17b. Coo cnvlboro ... INFORMANT'S NAME (T ypelPrinll -. UETHOO OF DISPOSITION 8uri81 0 Cremahon ~ OonotionO 01"'1(_' 21.. SIGNATURE Ronald J. Thomas W. Crone Martin _ Vir inia L. Hoff INFORMANT'S MAIUNG AOOAESS tStfee\. ayl1own. State, ZJp Code) 2Gb) 1 3L Shady Lane., Enola Pa PlACE OF OISPOSnlON. Name at C8ITWIICNy. CremalOfY lOCRION. Citytrown. State. Zip CocIt or Other P1ace RemovaIlrom 51al. 0 2005 21.. Leola Pa "...,. 24.26 mua be completed by ~ who pronounces de.th IMMEDIATE CAUSE (Final dISeaSe 01 condition resuling tn 06aIh~____ Sf rz il. V<( 28. I Approximat. : interval behween I onset and dnlh , i DUE 10 COR AS A CONSEQUENCE Of), Stquential)y list conditJons if *'Y. kIIldlng to immediate cauee. Enter UNDERLYINQ CAUSE (Disease or rnp.ny lhaf initiaCed events resulbng Ir1 deeth) LAST DUE 10 (OR AS A CONSEOUENCE Of)' DUE 10 lOR AS A CONSEOUENCE OF), w-.s AN AUTOPSY PERFORMED? . WERE AUlOPSY FINDINGS AVAILABLE PRIOR TO COMPLETION OF CAUSE OF DEATH? MANNER OF OE.ATH OATE OF INJURY (Month. Day. 'mar) TIME OF INJURY INJURY AT WORK? DESCRIBE HON INJURY OCCVARED. Natural ....a- D o HomJtid8 o o o ~.CE OF INJURY. AI home. fa~.C:;eet. factory. olfic:::. buikfino, e1C. ISpecllvl 300. Yes 0 NoD ~Cidenl Pending Invesli9ation Could not be dBUIRnlned M. 3Oc. 30d LOCATtON (Su.. CitV/Town. State) _0 No.J:d'" y.. 0 NoV SlIicide 2811. 21b. carflFlEA fCheck only onel -CERTIFYING PHYSICIAN fPhyslClan Cefhfytn,QC3use r::J death wher'l ano\h81 phVSIC..an has pronounced dealh and COOlpleled llem 231 "To Ihe ~I Of my knowledge, death oceurr.-d due 10 lh. cauM'{s) and manner a. IIlaled. 29. 33. ~~4<.1...t-,?- h(1/ r::<t/I/ I 3.. DATE FILED (Monlh. Day. Year) ~ .:) 6ieI'l\lE CENTER Of Marysvilie Routes '11 '&. 15 e Road Marysville. PA 1705 ;) 00 S- -PRONOUNCING AND CERTIFYING PHYSICIAN IPhysoan borl'1 ;,lfonounclng dealh and Ce11rlytng 10 cause 01 deathl To the bftIt of my knawJedgfl, death occurred at the time. date. .and plac., and due to the cause(a} and m.nner.. 'stated ....EDICAL EXAMINER/CORONER On the b.sis of examination andJor investigation, In my opinion, death occurred III the time. date, and'place, and due to the cause(s) and m.nner a. 'tated.. . . . . .. ......................................................................................... 31.. REGISTRAR'S SIGN o 34. ~ 9 ../ I' I" " COMMONWEALTH OF PENNSYL ,ANIA' DEPARTMENT OF HEALTH VITAL flECORDS 0{j({ertifiratlon of 18irtb~ 1963817 , AFFIDA VIT Thomas Webster Martin, being sworn according to law, deposes and says that he is the petition~r in the foregoing matter, and that the facts set forth in the foregoing Petition for Approval of Standby Guardian Designation are true and correct, partly upon personal knowledge and the remainder upon information and belief. Date: 0'- / q , d L] ~/ . /-~. z::::- ( / ---k---w'0 !~j/~A.e~i". .!j ~ 4rt. " Thomas Webster Martin I HEREBY CERTIFY that on this / f f/z. day of September, 2005, before me and the subscriber, a Notary Public and for the Commonwealth of Pennsylvania, personally appeared THOMAS WEBSTER MARTIN and acknowledged the foregoing Petition for Approval of Standby Guardian Designation to be his act. AS WITNESS my hand and Notorial Seal NOTARIAL SEAL lINOA M. CARVER, NOTARY PUBllC CARLISLE BORO~{ CUMBERLAND COUNTY MY COMMISSIOn EXPIRES DEC. ~. 2006 , ../ [SEAL] {;:7J ~~ /71 ~