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Home My WebLink About11-17-05 IN RE: EDITH MAYO : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, : PENNSYL VANIA : ORPHANS' COURT DIVISION An alleged incapacitated person : NO. /) I -. (J 5 j 0 J d On the Petition of KEVIN L. ELLIS and DOROTHY ELLIS PETITION FOR APPOINTMENT OF CO-GUARDIANS OF THE ' PERSON AND ESTATE OF AN ALLEGED INCAPACITATED PERSON TO THE HONORABLE PRESIDENT JUDGE OF SAID COURT: NOW COME Petitioners, KEVIN L. ELLIS and DOROTHY ELLIS, by and through their attorney, Marielle F. Hazen, Esquire, and file the within Petition for the Appointment of Co- Guardians of the Person and Estate of an Alleged Incapacitated Person, and in support hereof, aver as follows: 1. EDITH MAYO, the alleged incapacitated person, currently resides at West Shore Health and Rehabilitation Center, 770 Poplar Church Road, Camp Hill, Pennsylvania 17011, a skilled nursing facility. She is seventy-two (72) years old, her date of birth being May 2, 1933. 2. EDITH MAYO's husband died in 1995 and she has no children. 3. EDITH MAYO is not a patient in a mental hospital. 4. The Petitioners are EDITH MAYO's nephew, KEVIN L. ELLLIS, of 1505 Nittany Lane, Harrisburg, Pennsylvania, 17109; and EDITH MAYO's sister, DOROTHY ELLIS, of 4128 Tamrack Square, Harrisburg Pennsylvania 17112. V' 5. The names and addresses of those persons who would be the intestate heirs (or next of kin) of EDITH MAYO are her four( 4) sisters as follows: Dorothy Ellis, Petitioner, 4128 Tamrack Square, Harrisburg, Pennsylvania 17112; Laura Lennon, 4428 44th Street, South Minneapolis, Minnesota 54406; Brenda Selby 26454 Forill Avenue North, Wyoming, Minnesota 55092; and Beverly McClure 30 2nd Avenue, Bayshore, New York 11706. 6. The name and address of the person or institution providing residential services to EDITH MAYO are as follows: West Shore Health and Rehabilitation Center, 770 Poplar Church Road, Camp Hill, Pennsylvania 17011; (717) 763-7070. 7. The names and addresses of other service providers are as follows: None. 8. EDITH MAYO's primary physician is: Nita Rastogi, M.D., 4810 Jonestown Road, Harrisburg, Pennsylvania 17109; (717) 540-1920. 9. EDITH MAYO was not a member of the Armed Services ofthe United States nor is she receiving benefits from the United States Veterans Administration. 10. The Petitioners ask that they, KEVIN L. ELLIS and DOROTHY ELLIS, be appointed as Co-Guardians, acting j ointly and/or individually, of the person and estate of EDITH MAYO. The proposed Co-Guardians are the nephew and sister of EDITH MAYO. 11. The proposed Co-Guardians have no interests that are adverse to the interests of EDITH MAYO. 12. Petitioners believe, and therefore aver, that no Court has ever assumed jurisdiction in a proceeding to determine whether EDITH MAYO is incapacitated. 13. Petitioners believe, and therefore aver, that EDITH MAYO has not previously had a guardian appointed, nor is a guardianship hearing pending in any other jurisdiction. 14. The reasons why this guardianship is being sought are as follows: EDITH MAYO is unable to manage her financial affairs or to make decisions regarding health care/medical decisions, due to advanced dementia. 15. The functional limitations and physical and mental condition of EDITH MAYO are: EDITH MA YO is not able to manage her financial affairs, nor is she able to make competent decisions as far as her welfare is concerned. EDITH MA YO requires total assistance with all of her activities of daily living. 16. The following steps have been taken, in order to find less restrictive alternative to the appointment of a guardian: EDITH MA YO is not competent to execute a power of attorney. No less restrictive alternatives are available to adequately provide for the physical and financial care of EDITH MAYO. 17. The Petitioners request that the Co-Guardians be granted powers to act for EDITH MAYO in the following specific areas: financial management, and medical and health care affairs including care and placement decisions, access to all medical records, including psychiatric records, and the power to make all decisions regarding medical treatment and life support. 18. Petitioners also request that they, in their capacity as plenary Co-Guardians (jointly and/or individually) of the Person and Estate of EDITH MAYO, have the power and authority to serve as personal representatives for EDITH MAYO for all purposes of the Health Insurance Portability and Accountability Act of 1996, (Pub.L.104-191), 45 CFR Sections 160 through 164, including but not limited to full authority to review her medical records and to execute releases of confidential information from medical providers and insurers or other third party payors. 19. The proposed Co-Guardians have the following qualifications: The proposed Co- Guardians are the nephew and sister of EDITH MAYO. The proposed Co-Guardians love and care for EDITH MA YO. 20. EDITH MAYO currently has no assets but she is anticipating receipt of an inheritance that may be approximately $100,000.00. 21. EDITH MAYO's net income from all sources totals approximately One Thousand Sixty ($1,060) Dollars from Social Security. Petitioners respectfully request that the Court, under Section 5511 ofthe Probate, Estates and Fiduciaries Code, issue a Citation to EDITH MAYO, EDITH MAYO's next of kin, and to such other persons as the Court directs, to show cause why EDITH MAYO should not be adjudged to be an incapacitated person and plenary Co-Guardians of her person and estate be appointed. Respectfully submitted, Date: II! ~ ts , ~}J&;~ - By: M lelle F. azen, EsqUIre Attorney for Petitioner P A J.D. No. 68003 2000 Linglestown Road, Suite 202 Harrisburg, Pennsylvania 17110 (717)540-4332 IN RE: EDITH MAYO : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, : PENNSYL VANIA : ORPHANS' COURT DIVISION An alleged incapacitated person : NO. On the Petition of KEVIN L. ELLIS and DOROTHY ELLIS VERIFICATION I verify that the statements made in this Petition are true and correct. I understand that false statements herein are made subject to the penalties of 18 P A.C.S. ~ 4904, relating to unsworn falsification to authorities. /\)(Jf) ( KEVIN~'E~ VERIFICA nON I verify that the statements made in this Petition are true and correct. I understand that false statements herein are made subject to the penalties of 18 PA.C.S. ~ 4904, relating to unsworn falsification to authorities. ~€QQ~ DOROTHY. ELLIS \ COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN On this, the J S"'tiL day of JOJt:AA tX:.f.2-. ,2005, before me, the undersigned officer, personally appeared KEVIN L. ELLIS, who, being duly sworn according to law, does depose and say that the facts set forth in the foregoing Petition are true and correct to the best of his knowledge, information and belief. IN WITNESS WHEREOF, I hereunder set my hand and official seal. ~ KEVIN L. ELLIS SWORN to and subscribed before me this /SrL day of JaJe.u..&f2...- ,2005. CCiVliviUr"WEALTH OF PENNSYLVANIA ~ Notarial Seal Marielle F. Hazen. Notary Public Susquehanna Twp.. Dauphin County My Commission Expires Sept. 23. 2006 .~~ ~-{ . . ko arytftblic i ..--- COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN On this, the 15~ day of J6J~J..-t ~ (l- ,2005, before me, the undersigned officer, personally appeared DOROTHY ELLIS, who, being duly sworn according to law, does depose and say that the facts set forth in the foregoing Petition are true and correct to the best of her knowledge, information and belief. IN WITNESS WHEREOF, I hereunder set my hand and official seal. ~'"it-~. ~ DOROTHY ELLIS \ SWORN to and subscribed before me this /~ day of Jdl.I'e'J.-tJ::xg1Z.- ,2005. COMMONWEALTH OF PENNSYLVANIA Notarial Seal Marielle F. Hazen. Notary Public Susquehanna Twp.. Dauphin County My Commission Expires Sept. 23. 2006 tdflaA){~ otary Public .-/ IN RE: EDITH MAYO : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, : PENNSYL VANIA : ORPHANS' COURT DIVISION An alleged incapacitated person : NO. On the Petition of KEVIN L. ELLIS and DOROTHY ELLIS CONSENT TO APPOINTMENT AS GUARDIAN 1. The name of the proposed Co-Guardian of the person of EDITH MAYO is DOROTHY ELLLIS. 2. The name of the proposed Co-Guardian of the estate of EDITH MAYO IS DOROTHY ELLIS. 3. The proposed Co-Guardian speaks, reads and writes the English language. 4. The proposed Co-Guardian does not have an interest adverse to the alleged incapacitated person. 5. The proposed Co-Guardian is retired. 6. The proposed Co-Guardian is not a fiduciary, or officer or employee of a corporate fiduciary of an estate in which the alleged incapacitated person has an interest; and is not the surety, or officer or employee of a corporate surety of such fiduciary. Dated: J J - \ 5 .:. 0 .5 ~~ DOROTHY ELLIS" IN RE: EDITH MAYO : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, : PENNSYLVANIA : ORPHANS' COURT DIVISION An alleged incapacitated person : NO. On the Petition of KEVIN L. ELLIS and DOROTHY ELLIS CONSENT TO APPOINTMENT AS GUARDIAN l. ELLIS The name of the proposed Co-Guardian of the person of EDITH MAYO is KEVIN L. 2. ELLIS. The name of the proposed Co-Guardian of the estate of EDITH MA YO is KEVIN L. 3. The proposed Co-Guardian speaks, reads and writes the English language. 4. The proposed Co-Guardian does not have an interest adverse to the alleged incapacitated person. 5. The proposed Co-Guardian is currently self-employed in the field of Real Estate. 6. The proposed Co-Guardian is not a fiduciary, or officer or employee of a corporate fiduciary of an estate in which the alleged incapacitated person has an interest; and is not the surety, or officer or employee of a corporate surety of such fiduciary. Dated: ///;s-k I ~~ KEVIN L. ELLIS "7 . PRAECIPE/REQUEST In The Court of Common Pleas To be filed with the Clerk of the FOR ASSIGNMENT Cumberland County Pennsylvania Orphans' Court INRE: EDITH MAYO, an alleged incapacitated person DOCKET # Estimated Hearing/Conference Time: 1 Day(s) 1 Hour(s) .. --,- SPECIFIC MATTER TO BE ASSIGNED (Check Only One Category) Assignment Proceedings and Conferences Adoptions Compel Accounting Sale of Real Estate InvoluntaryNoluntary Termination Objections to Account Attorneys Fees X Guardian of Incapacitated Person Proceedings Against Fiduciaries Status Conference Discharge Guardian Will Contest Argument Guardian of Minor Inheritance Tax Appeal Other (describe) Minor Settlement Terminate Trust Wrongful Death/Survival Dissolution of Corporation/Charity Name(s) and Judge(s) of related case(s) Docket number(s) of related case(s) ~ 6 Date: Attorney for Peti ioner X Respondent NAMES, ADDRESSES, E-MAILS & TELEPHONE NUMBERS OF ALL COUNSEL INVOLVED (use back of form for additional names and addresses) For the Petitioner(s): Telephone No. Marielle F. Hazen, Esq. 717 -540-4332 For the Respondent(s): Telephone No. v-