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HomeMy WebLinkAbout234768 07/15/14 CITY OF CARMEL, INDIANA VENDOR: 368317 ® I•' ONE CIVIC SQUARE BETTY GRUBB CHECK AMOUNT: $****'**'57.27' f� �Q CARMEL, INDIANA 46032 C/O CAMPBELL KYLE PROFITT LLP CHECK NUMBER: 234768 11595 N MERIDIAN ST SUITE 701 CHECK DATE: 07/15/14 CARMEL IN 46032 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 57.27 REISSUE CK 233753 CAMPBELLKYLE PROFFITT LLP ATTORNEYS AT LAW JOHN D.PROFFITT FRANK S.CAMPBELL DEBORAH FARMER SMITH (1880-1964) WILLIAM E.WENDLING,JR. ANNE HENSLEY POINDEXTER FRANK W.CAMPBELL ANDREW M.BARKER (1916.1991) JOHN S.TERRY RODNEY T.SARKOVICS ROBERT ft CAMPBELL SCOTT P.WYATT (1946-2004) STEPHENIE K.GOOKINS N.SCOTT SMITH JOHN M.KYLE KEVIN G.KLAUSING (1927-2006) RUSSELL B.CATE MATTHEW T.LEES ALICIA A.WANKER July 11,2014 cbonty@ckplaw.com Clerk-Treasurer's Office Carmel City Hall,Third Floor One Civic Square Carmel,IN 46032 Attn: Cindy Re: Betty M. Grubb Ticket#20133970:1 D.O.S. 09/06/2013 Dear Cindy: Attorney Anne Hensley Poindexter is currently handling the affairs for Betty M. Grubb pursuant to the General Durable Power of Attorney executed by Ms. Grubb on October 27,2010, a copy of which is enclosed herewith for your records. Pursuant to Attorney Poindexter's conversation with Ann in your office today,we are returning the enclosed check#233753 so that it may be reissued to"Betty" Grubb rather than "Becky"Grubb. Please return the replacement check to our office as Mrs. Grubb no longer resides at the Mohawk Hills Drive address listed on the check. Should you have any questions regarding the enclosures or this matter,please do not hesitate to contact our office. Very truly yours, Campbell Kyle Proffitt LLP Cari W.Bonty,RP® PACE Registered Paralegal® Paralegal to Anne Hensley Poindexter Enclosures 03612-2 One Penn Mark 11595 North Meridian Street Suite 701 Carmel,Indiana 46032 (317) 846.6514 FAX(317) 843.8097 EF - r t., CITY CSE AI EL _JAMES BRAINARD, MAYOR June 16, 2014 Betty Grubb 820 Mohawk Hills Dr. Apt B Carmel, IN 46032 RE: Ticket#20133970:1 D.O.S. 09/06/2013 Dear Betty Grubb: Enclosed you will find a reimbursement check in the amount of$ 57.27. On October 29, 2013 we received your payment for $ 71.58 claim applied to your deductible. Associated Administrators reprocessed your claim paid$ 57.27 on December 9, 2013 patient responsibility amount was $ 14.31. The overpayment amount is $ 57.27. If you have any questions, please feel free to contact me at(3 17) 571-2604. Sincerely, Michelle T. Harrington Billing Administrator CARMEL FIRE DEPARTMENT STEVEN A. COUTS HEADQUARTERS T c ... ('........ TNT CN.....,... 2-1-7 9:-71 ')lnn c... 9-t" c-„ )&Ir CONFORMED COPY tt ORIGINAL LOCATED IN WILL SAF2 0r CAMPBELL KYLE PROFFITT LLP 198 SOUTH 9TH STREET, P.O. BO;"2u"�0 NOBLESVILLE, INDIANA 46060 GENERAL DURABLE POWER OF ATTORNEY of Betty M. Grubb ARTICLE I DESIGNATION OF AGENT I, Betty M. Grubb, of Hamilton County, State of Indiana, being an adult and mentally competent,do hereby designate and appoint Brian R.Grubb of Hamilton County,State of Indiana, and Anne Hensley Poindexter, of Hamilton County, State of Indiana, as my true and lawful Attorneys-in-Fact,hereinafter sometimes referred to as my Agents,giving my Agents full authority and power to make financial, asset management, and personal decisions for me in my name,place and stead,as authorized in this document. Provided,however,in all respects they shall act together not independently unless otherwise agreed by them in writing. ARTICLE II NO BENEFICIAL INTEREST IN ATTORNEY-IN-FACT .I give to my Attorneys-in-Fact the powers herein specified to be used on my behalf lam incorporating by reference herein those powers which comply with my wishes in accordance with the manner prescribed by Ind. Code § 30-5-5. The.powers given herein shall be considered limited so that my Attorneys-in-Fact shall not have any power which would cause my Attorneys- in-Fact to be treated as the owner of any interest in my property and which would cause that property to be taxed as owned by the Attorneys-in=Fact, it being my intention not to grant any beneficial interests in my estate by this instrument. General Durable Power of Attorney Page 2 ARTICLE III REVOCATION OF PRIOR POWERS I hereby revoke all powers of attorney,general and/or limited,heretofore granted by me as principal and terminate all agency relationships created under any such prior powers, including those of all successor agents named or contemplated therein, if any. g p ARTICLE IV GENERAL ASSET AND FINANCIAL POWERS My Attorneys-in-Fact is authorized,in his or her sole and absolute discretion from time to time and at any time, with respect to any and all of my property and interests in property, real, personal and mixed and matters affecting my financial interests by way of illustration and not intending any limitation, to do or perform the following: 1. Purchase,sell,mortgage,grant easements,convey and lease any interest in real estate, wherever located,of which I may be the owner or have an ownership interest,now or hereafter,and perform all activities granted under I.C. § 30-5-5-2. 2. Bargain for, contract concerning, buy, sell, encumber and in any way and manner, deal with-my personal property for my support and the support of those persons to whom I owe an obligation of support and perform all activities granted under I.C. § 30-5-5-3. E: 3. Purchase,sell,dispose of,assign and pledge notes,stocks,bonds, and securities and to exercise such voting rights as my ownership of any notes,stocks,bonds,and securities may entitle me, either in person or by proxy; and perform all activities granted under I.C. § 30-5-5-4. 4. Make, draw, and endorse promissory notes, checks, bills of exchange or other negotiable instruments to which I may be entitled under the Uniform Commercial Code and to exercise any right with regard to the same, including the right to waive, demand, presentment, protest,notice of protest, and notice of non-payment of all such instruments, as well as the right to make deposits to and withdrawals from and to invest, reinvest, or renew any of my deposited checking,savings,certificates of deposit,or other accounts of whatever nature or wherever retained or deposited;to establish new or close out existing accounts of any nature pertaining to my funds and money;to utilize and expend any of my money from any such accounts,or if necessary to utilize my assets in the event my liquid funds are depleted or not readily available for the payment of my just and lawful debts and bills,including the right to utilize my credit cards,charge accounts in a manner that will best serve my financial interests, according to the sole and absolute discretion of my said Attorney-in-Fact; and perform all activities granted under I.C. § 30-5-5-5. General Durable Power of Attorney Page 3 5. Purchase,maintain,surrender,collect or cancel:(a)life insurance or annuities of any kind on my life or the life of anyone in whom I have an insurable interest; (b) liability insurance protecting me and my estate against third party claims; (e) hospital insurance, medical insurance, Medicare supplement insurance, custodial care insurance, and disability income insurance for me or any of my dependents; and(d)casualty insurance insuring assets of mine against loss or damage due to fire, theft, or other commonly insured risk; to pay all insurance premiums, to select any options under such policies,to increase coverage under any such policy,to borrow against any such policy, to pursue all insurance claims on my behalf, to adjust insurance losses, and the foregoing powers shall apply to private and public plans,including but not limited to Medicare,Medicaid,SSI, and Worker's Compensation; and perform all activities granted under I.C. § 30-5-5-7. 6. Represent and act for me in all matters affecting a trust, a probate, an estate, a guardianship, a custodianship, an escrow or other funds out of which I am entitled or claim to be entitled as a beneficiary,and perform all activities granted under I.C. §30-5-5-8. This shall include the power to transfer all assets to a trust for my benefit and or the benefit of my spouse. 7. Represent and act for me in all ways and in all matters affecting a fund in which I am a fiduciary and apply for and procure in my name letters of administration, letters testamentary, letters of guardianship,or any other type of judicial or administrative authority to act as a fiduciary and perform all activities granted under I.C. § 30-5-5-10. 8. Institute, supervise, prosecute, defend, represent me in, intervene in, abandon, compromise, arbitrate, settle, dismiss and appeal from any and all legal, equitable, judicial, or administrative hearings, actions, suits,proceedings,attachments, arrests,decedent or guardianship estate matters, for the protection of my personal or financial interests involving me in any way, including,but not limited to,matters or proceedings with respect to claims by or against me arising out of property damages or personal injuries suffered or caused by me or under such circumstances that the loss resulting therefrom will or may be imposed on me and otherwise engage in litigation involving me,my property, or any interest of mine,including any property or interest or person for which or whom I have or may have any responsibility; and perform all activities granted under I.C. § 30-5-5-11. 9. Perform acts necessary for maintaining the customary standard of living for my spouse, children, and other persons customarily supported by me; and perform all activities under I.C. § 30-5-5-12. 10. Execute vouchers in my name for allowances and reimbursements payable by the United States, a state, or a subdivision of a state to me; and perform all actions granted under I.C. § 30-5-5-13. General Durable Power of Attorney Page 4 11. Keep records, hire and discharge accountants and attorneys, represent me in all matters of taxation involving the Federal government, the government of any State or any local governmental unit,and to prepare,sign-and file any documents or forms that may be required in any such tax matters,including my State and Federal Income Tax returns,and to receive and respond to any correspondence from these taxing agencies; and perform all actions granted under I.C. § 30-5-5-14. 12. Accept, renounce, or claim a legacy, bequest, devise, gift or other property on my behalf; establish a revocable trust for my benefit; and perform all actions granted under I.C. § 30-5-5-15. 13. Employ or contract with all types of health care providers on my behalf;to consent to or refuse health care for me in accordance with I.C. § 16-36-3 and I.C. § 16-36-4,said declaration and appointment being made as a part of this document under Article IV; and perform all actions granted under I.C. § 30-5-5-16 and I.C. § 30-5-5-17 with respect to health care powers. 14. To delegate authority to one (1) or more persons of any or all powers given my Attorneys-in-Fact in accord with the provisions of I.C. § 30-5-5-18. 15. To act as my alter ego with respect to all possible matters and affairs affecting the property owned by me that I can perform through an Attorney-in-Fact in accord with the provisions of I.C. § 30-5-5-19. All the powers granted an Attorney-in-Fact under Indiana Code Sections 30-5-5-2 through I.C.30-5-5-19 are granted to Brian R.Grubb and Anne Hensley Poindexter,my Attorneys-in-Fact under this document. ARTICLE V PROVISION APPLICABLE TO ARTICLE IV With respect to Article IV(General Asset and Financial Powers),it is to be understood that the authority I have conferred to my Attorneys-in-Fact in no way is intended to limit or restrict my own authority or decision-making capabilities covering such powers and authority as long as I remain mentally competent. r FURTHERMORE,THIS POWER OF ATTORNEY AND THE AUTHORITY I HAVE CONFERRED AND SPECIFIED UNDER ARTICLE III ABOVE SHALL REMAIN IN FULL FORCE AND EFFECT UNTIL SUCH TIME AS I MAY HEREINAFTER REVOKE THE General Durable Power of Attorney Page 5 SAME IN WRITING, PROVIDED FURTHER THAT THE SAME SHALL NOT BE AFFECTED BY MY SUBSEQUENT DISABILITY, INCOMPETENCE, OR LAPSE OF TIME. ARTICLE VI THIRD PARTY RELIANCE No person who relies in good faith upon any representations by or authority of my Attorneys- in-Fact shall be liable to me,my estate,my heirs or assigns for recognizing such representations or authority. ARTICLE VII NOMINATION OF GUARDIAN In the event a judicial proceeding is brought to establish a guardianship over my person or property,Ihereby nominate myAttorneys-in-Fact,Brian R.Grubb and Anne Hensley Poindexter, hereinabove designated and appointed,to be my Guardians. ARTICLE VIII HIPAA AUTHORIZATION I intend for my Health Care Representative to be treated as I would be with respect to my rights regarding the use and disclosure of my individually identifiable health information or other medical records. This release authority applies to any information governed by the Health Insurance Portability and Accountability Act of 1996 (a/k/a HIPAA), 42 USC 1320d and 45 CFR 160-164. I authorize: any physician,health-care professional, dentist,health plan,hospital, clinic, laboratory,pharmacy or other covered health-care provider,any insurance company and the Medical Information Bureau Inc.or other health-care clearinghouse that has provided treatment or services to me,or that has paid for or is seeking payment from me for such services,to give,disclose and release to my Health Care Representative,without restriction,all of my individually identifiable health information and medical records regarding any past, present or future medical or mental health condition, including all information relating to the diagnosis and treatment of HIV/AIDS, sexually transmitted diseases, mental illness, and drug or alcohol abuse. The authority given my Health Care Representative shall supersede any prior agreement that I may have made with my health-care providers to restrict access to or disclosure of my individually identifiable health information. The authority given my Health Care Representative has no i General Durable Power of Attorney Page 6 expiration date and shall expire only in the event that I revoke the authority in writing and deliver it to my health-care provider. ARTICLE IX MISCELLANEOUS PROVISIONS L This Durable Power of Attorney is intended to be valid and given full faith and credit in any jurisdiction or state in which it is presented. 2. My Attorneys-in-Fact shall be entitled to reasonable compensation for services performed hereunder and shall be entitled to reimbursement for all reasonable expenses incurred and paid,including transportation costs, as a result of carrying out any provisions of this instrument. 3. My Attorneys-in-Fact, including his or her heirs, legatees, successors, assigns, personal representatives, and estate, acting in good faith hereunder, is hereby released and forever discharged from any and all liability(including civil, criminal,administrative or disciplinary) and from all claims or demands of all kinds whatsoever by me or my heirs,legatee,successors,assigns, personal representatives, or estate arising out of the acts or omissions of my Attorneys-in-Fact, except for willful misconduct or gross negligence. 4. My Attorneys-in-Fact are authorized to make photocopies of this instrument as frequently and in such quantity as he or she shall deem appropriate. Each photocopy shall have the same force and effect as any original. 5. If any part or provision of this instrument shall be invalid or unenforceable,such part or provision shall be ineffective to the extent of such invalidity or unenforceability only, without affecting the remaining parts or provisions of this instrument in any way. 6. This instrument, and actions taken by my Attorneys-in-Fact properly authorized a hereunder,shall be binding upon me,myheirs,successors,assigns,legatees,guardians,andpersonal representatives. IN WITNESS WHEREOF, I have hereunto executed this Durable Power of Attorney this o� day of October, 2010. Betty M. drubb General Durable Power of Attorney Page 7 STATE OF INDIANA ) )ss: COUNTY OF HAMILTON ) Before me, the undersigned Notary Public, in and for said County and State, personally appeared Betty M. Grubb, who acknowledged the execution of the foregoing General Durable Power of Attorney this R-44� day of October, 2010. CATHLEEN E.YATES G x SP.nl. MY COMMISSION EXPIRES:02.05.2017 Notary Public MY COMMISSION NUMBER IS:601027 MY COUNTY OF RESIDENCE IS:HAMILTON This instrument prepared by: Anne Hensley Poindexter, CAMPBELL KYLE PROFFITT LLP, One Penn Mark,Ste.701, 11595 N.Meridian St.,Cannel,IN 46032,Ph:(317)846-6514,Fx: (317)843-8097