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CONNECTIONS: Health * Wellness' AdvocacyREQUEST/AUTHORIZATION TO DISCLOSE INFORIl4ATIONO

authorize CONNECTIONS to (check all that apply):

^.I f)tU1 i n (Z^n^ 1 a lon to/ frS

born on o2 l1 ^J V1(Date of Birth)

disclose, ® receives r[^ verbally exchL J

a?ge my individually identifiable health inform t•

Authorized Indroldual/Organzatto andfull address J, f•R4Ovk ch

Purpose of Disclosure•, g er assessment informationgoing treatment 0 t o d ^ for treatment planning^ to gather information forcoor mate benefits and entftlements

Type of Information to be DI 1 d L^J other purposes (specify): a ( t,^sc ose :1.) information on mental illness and/or treat

q tr t t I ^ ent, specifically 6 psychiatric notes,ea men p ans, progress notes (other infor,mation s ee' ^lab results,

2.) Information on druolalcohottreatment, specificall ( p ^) i^ 1 n h^o^( ^ ^ 6^SY^I Progress notes, QClqf, (]progress in treatment,Olab results, Durine testing, Qattendance, []HIV/AIDS testing or status , Oprenatalcare, Qdiagnosis Qother information (specify) 0Pregnancy testing,

3•) Qother information (specify):

Type of Information Requested:1.) q information on mental illness

and/or treatment, specifically Q psychiatric notes, []lab results,q treatment plans, ^]progress notes [I other information

(specify)2.) q information on drug/alcohol treatment, specifically 0 progress notes, QCIAI, Oprogress in treatment,Olab results, Qurine testing, ^]attendance, E]HIVLAIDStesting or status, (]pregnancy testing,^prenatal care,

[]diagnosis Dother information (spc°^;fy)3.) Dother information ls^ecif„).„•

Speciffc Dates or Amount of Information to be Disclosed: p n ^

This authorization to Disclose/Receive or Verbally Exchange confidential informionwill u omatically expire one hundred

eighty (180) days after the date of authorization unless I ationan earlier condition, date, or event.

Condition, date or event of expiration earlier than 180 days:1t . I

rJ

or p one number.

q to coordinate treatment 0 to ath

aAj_j_M10,6T1-cv.

Date and.lgnature of Client orOther Person Authorized to Permit Disclosure Date a d Signature of wi ne s

If this authorization has been signed by anyone other than client, parent of minor child, or minor chfld (see 42 CFR 2.14b),documents must be submitted to show authority to request information on the client. If this authorization has been signedby anyone other than client or parent of minor child, please print name and indicate relationship

My refusal to sign this authorization will not affect my ability to obtain treatment, payment, enrollment oreligibility.

q This release has been revoked effective:(authorizing signature on reverse side of this form)

Please return requested i fn ormation to the following location:Connections-The Office Placeq Connections- Rockefeller Pointe^\ 24200 Chagrin Blvd. 2490 Lee Bfvd., 3uite 103 El Connections

Beachwood, Ohio 44122-5429 3104 West 250, 2nd floorFax (216) 766-6084 Cleveland Hits., Ohio 44118

Fax (216) 371-5312 Cleveland, Ohio 44109Fax (218) 737-0440

Original - chart Copy - receiver/requestor ,copy-

No. I I - srlq®

IN THE

U.S. POSTHO

CLEVELRF^O.OH49I05

^w^rosrerez OCT 17, II

ioas $5=65

SUPREME COURT OF THE UNITED STATES

--',®AU for Re.hef4c ► 113

^qr^! ltilELZo10 ® PETITIONER(Your Name)

VS.

&-PT%lo r ANtzr42yAs C L- RESPONDENT(S)

PROOF OF SERVICE

&Orrk! n'" L--Tb/d , do swear or declare that on this date,(5 til 117 , 20-Li, as required by Supreme Court Rule 29 I have

served the enclosed MOTION FOR LEAVE TO PROCEED IN FORMA PAUPERISand PETITION FOR A WRIT OF CERTIORARI on each party to the above proceedingor that party's counsel, and onevery other person required to be served, by depositingan envelope containing the above.documents in the United States mail properly addressedto each of them and with firstclass postage prepaid, or by delivery to a third-partycommercial carrier for delivery within 3 calendar days.

The names and addresses of those served are as follows:

At/ ^-n l-# AA.LC c-) n l ` a,`3 C4(,<2, s] c/ n lAC2, 5-1-•2 3R6

Cle<<P,I4jur1 0 14r'n qL6//3

I declare under penalty of perjury that the foregoing is true and correct.

Executed on ^-1(14"" ti , 20ii

RECEIVE

OC'f 2 q 2011OFFICE OF T71E G(:ERK3UPREME COURr US:

Supr®ITO Courf

No& .1i®_5.7q®

SuPPOEi"1C C-®URr

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OCT 1 T 2®11^FFieEO_^

^Cli"^i n ^A Assoc°AfQ

Mr^oP,n G.RobethS

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G

WAIVER

Gary Melton

SUPREME COURT OF THE UNITED STATES

Supreme Court Case No. 11-5740

(Petitioner)

v GER Taylor Gardens LLC

(Respondent)

RECEIVED

SEP 13 2011OFFICE OF Tl^IE CLEi1KSJPREME COURT, U.B.

I DO NOT INTEND TO FILE A RESPONSE to the petition for a writ of certiorari unless one is requestedby the Court.

Please check one of the following boxes:

0 Please enter my appearance as Counsel of Record for all respondents.

q There are multiple respondents, and I do not represent all respondents. Please enter myappearance as Counsel of Record for the following respondent(s):

I certify that I am a member of the Bar of the Supreme Court of the United States (Please explain ifyour name has changed since your admission):

S 0-'--

(Type or print) Name Jay S. Hanson

m Mr. q Ms. 13 Mrs. q Miss

Firm Staff Counsel, American Family Insurance Company

Address 323 Lakeside Place, Suite 380

City & State Cleveland, OH Zip 44113

Phone (216) 912-4070

A COPY OF THIS FORM MUST BE SENT TO PETITIONER'S COUNSEL OR TO PETITIONERIF PRO SE. PLEASE INDICATE BELOW THE NAME(S) OF THE RECIPIENT(S) OF A COPYOF THIS FORM. NO ADDITIONAL CERTIFICATE OF SERVICE IS REQUIRED.

SEE REVERSE FOR INFORMATION CONCERNING THE STATUS OF A CASE ON THEDOCKET.

CC: Gary Melton

No.

1L-5 74 o,IN THE

SUPREME COURT OF THE UNITED STATES

C;-Ak M t3LTOour Name)

vs.

- PETITIONER

t9P.r ^A^ l Ic11^ 19A1tdef'1S - RESPONDENT(S)

ON PETITION FOR A WRIT OF CERTIORARI TO

Oh;OsUprertie - Cor..rt,+ CIdSts Ki U a0lo-a 9-9 O^L-(NAME OF COU T THAT LAST RULED ON MERITS OF YOUR CASE)

PETITION FOR WRIT OF CERTIORARI

G fr^ 1`^^LTo r^(Your Name)

Ca29l:3 ferris AyL=

(Address)

(^Jev%e-l6tiJ oh^^ 451os(City, State, Zip Code)

6a uD J 3aa-Cf a3s(Phone Number)

C

STATEMENT OF THE CASE

C>n ^^v^rc^ 3traao$ G, rneW=DKa^ wr^5 Pv ^.,^r

^. ^^bne^ S ¢ du+j ^'vTres,^ors p4+he Fo^BSt TAY lor° Rora^ ^'p.S-^-

Cle,rel p,^ o ^' cea`Fra,J

^'l°r< Gwrr1e,^r

^l^lua, ^pt- Yay,iresIde^-f

Sal^er APt Yby,^/^^ I 1 zf"Is.t^r^,eh Ga,-rr^el^@ cu,^s(e^in

^^.I +' c"(,t ^^ ^^+e Per^r Srk;r 3 Edao^^/^l/<rvtc^ ^(aw^ "s 0-p4hC' Ap,3r,^^ri

. e"-^ 6 t1` lc^t^ .^a^^^,^ ^©+^he m^9^1 - S+A`^s l,e s+ ^ +he `/r^+

r`^c Fhe ^CAseQ,A s4y<^ . h^ (sT^loc^k

^ he SsI^, o^ e s Fa/,s ^^ retN^p 1,y ^^Ec^

Jar^ °^' -fl,e ow^/he4d o'4 ^ r1 ^^ ^he ^^ ^Zoe2 ^'iA'd^` S ^q yyz$ o c^ ^hQ^^

^ p ^ 54 ^v n^ ^^ 7`^,^ ^ps ;. - ^

^A 1 I /^ Iso ^" $ i/ ^o fiec j4

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t^ry ^ el "S^s^tp ^ S a ^ri ss t^ 7G^e,x^^ y 'xJ

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CIPveI^r.^( C(lA,,' °^0 8.A^ c^e^e ja^a(C

REASONS FOR GRANTING THE PETITION

To °t'I-ve F-IonorArlole U,u4-eJ S+A+e,s ChpeS,Sus+°ce. auJ Jus-f^ceg

ixJ -F-h-e Low^^ Courz ^-^oo„i 3urjge Pt^^-r^^ k r<e,cty 4 tj D+ Ie.+ eg^rr► el^o,t^ Pc^ur^ Cv°cJenee ^tuc^ [3uat^^n^C f^ot^sln t/ro;oAr {0lpen^o^e^X,hr(^,•-^--^p ^^2J^

^OSKo om^}^FF^ ^rv3 beea^rqe pro^„br-^s c^rsr^rr+-^^

r^ud i I S^r ^e ( A . w pro4e41to n4o pe rsons w1,o pre el°s K4biee! .u; A^ep^a`im^airmenlr 4ha^ReJ,v^^7 S ubsfck,-^'r'ally in,^-F-s Oh2 z^r,,,ore,-rn^a-^oF tSiae

es` Zvdye AA-1-riek h^e(ly Jicln^4- provicfe CprYmero 1fon f^^s9^^Lr r9 }^^S ^-^ea-{-io n. Gp er6Yj Sa ^"[ ^el^on ^Ove A menfNl rrnpn;rrnenE-^;ga6^li^'Ad

(ILhQ-{- 4-,As.

^otn 7 Aclm"" O'Slra !-tpan,Aud Ga2Y mai-Fo-n9 ^'1 ^ n--F-h,^Caurv^-r Unejer^^+^na^^^^1 ^el-Ebn r:s oo m ^-h,^-k- be-cr+r^e. ^.nc.csr,^^e-Fence,^^Jp^eC^ ^gCr+ n-1-sFf <

_jCovr-1 A40US a:

^mer ^^ ^,r^i`^yjnsuraNCe (2or,r'/447<^ en^ n

ti6n^sconar»,'C ^or^ `^ ^ Y C^t}r rnek^on C(qr`m or, Tnsv-^eIt F^^(3ad ^a , F^^ on eonsa?r.^ ci 4rf-n herf^.er,C^ e^ S Insur-,.n

A Cf' o A-^+opr^ ^^a l^wu^M n ^ `l seilAbuseo^ Pr^oCess O..P Den^

Pro per ^7 +rr^ '^ U^^',rSe^Flemeri-1;Au ; ni-F-be ^v r4roay,., 3ra

^"h'q 1^,e s^ ^^ r,^ / jy©^ S^,ow y Nanson 4Acc1ON J

aoC/Ca ury^tis t3r^hc^:`4-ipn

lqS IUO^ rnr.^ke, 44o

1,^^So+h^^e^^ndn ^edWy `s ^0 c^`6'7" bel^euel,-F-^h ''4S }

^'^=Cvbyh YJj ,t(17'#.I',g P--t•' -^he

^xe 9 ^^^^^ sytrrUreS"^"'

,4^ 1 ^'^S -rev+e

O 4.071^v5e sa ,^^a-f

^vY-e Lia Sn°d-ere^r ^ OA-WYAJe.S'r:

+^ e O r Tn ^^kroel ^ ^c^ meri`^° ^u ^S s eJ 6,,, '•}-44-ome-q ^ fi'-ve• -

C-K $'^e 14mcsurv+ c3f Cej(j4rC)vers^

PrMer Avh oUY4 1,15 j000 rn eS c. +a-r-^-,

CONCLUSION

The petition for a writ of certiorari should be granted.

R^spectfully submitted,

^^ ^ ' • ^^•-^ ,

Date: 6IJqUS4-5 .,a21.)1l

TABLE OF AUTHORITIES CITED

CASES Cd/-oq> rjo593 I PAGENUMBER

CN^t4C L"GoAl ws - C, LR TAVIor C,a-kcJff-xlS

X,s"GME8 :^ud6e. i•I^A4-r^C,k Kellc^^^sig)Jrnen-f°

STATUTES AND RULES -Jt, rors -i r^ ^ Ik^ o'-i ^a `71ao1o = o^1/a$ faata

Jurq re1-urns Am unAn°mouS ve,-^^c E-`Fo

Yhe6-Iroau lb'ec,AUs2 0^ E^e f^re^oncaLSr^^oe o^-^-he I:v+°ie.nc,e_°nXtavoF\- o+-N.e. be-Feoc3kl4* A u4 / 5A-ins4 +he ptnYS n4-"-'P-R^

^t^qmen 1- en+e.rec^ ^or t^^'e^K^ ►^iu^4-^E^c?^ °C^y^or (^Yq-rrjewsj Anic{ A90,'nS$

'We-tDtA`P^{^19`^ ije!$ry 11^e^11^ T Y(lL^'1

OTHER i -T0^ C0 L)^T^OOYV1

C^Y\f^4 Ve. ^'14M ^5

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D44

Q^oy ^^:t ptiJ -

V7e^r^^^iru^ P^PerFy-l-^r} S c^lArna^e8^^e^Y,t ^ GseszY^r^e^+-C u,^,dc^^o^h

S Ebe+^E^ ^^SAL+^ -^Lw;weC6(.^ i k/,1f55.j ^ ^

CONSTITUTIONAL AND STATUTORY PROVISIONS INVOLVED\fPo I^,'C °®,^i

'r64e 4-'®ur4eer1-^h Am-end m-e,n`r

Un^^ecj S#-A^fes C®ns^^-^vl-r®n®

p'P-n7e 8 *^,-e. r-^,+ +-o h-,we (,+^s eq t Pho-Fee-l-l6n e,J-AVse Aw M-4,o^

rtpresen-l- (',Rry M-t-7^ C4-o-dA-+- +cr-M AgA`in s+ 7ay 4Af4a,0AJs ^

Kere-Fo('e GarY MEL re„4j ^clas c^enN c : k°s C°6er-tv i^mj proPe`r-ty1-3 45 w4hau++ke r`,Fs 4rrg

pr6ce.85CiArrge lA^l e9 uhr^ ^^Sec-F;b,j Fi,e ^y^4► A mendrne44 _V, 4e o'n

u c^ PkeJectsron no-F -#-o Aflow G^ry Mel^oAI

Cen^n ous +v o6tR^^^ P

Mr'. ME 1^o^!^5 1) Coonsa/ -^o

represer,l !,- m^^-r^ a1 de,n,? ^

PLrsua,u c.lµuse o+ -F-he /clws, p,g se-E -F0r44^o s^C-^;o^ ( ►^ oF +-he fyYU^men^men-^ ^ ^

'oflS'^i^-v^;o ^[ ti e- Vn4ecl S4p4BS

geC4-;an(s) -rbkL:- Congre"'s 5"I! have ower k,! rg[^s^rs^! â enPorce,6y A^PP^#^riA-+e`z3 ^4ke provrs^olls a-f +h;s ^rF^'ele.

OuJ ^^uemery-l- - AMendmeN-4 dtl'- gl,4 s I n ci V^l cA ses

TABLE OF AUTIiORIT1ES CITED

CASES PAGE NUMBER

C t^c^/^ ^v c^ ^ e om¢n®,zL PLcAs Ca v-CT Lo uramC,® e9-a'ZT .rewtl

Appemcs€ oc,.Fc5 L^:6k4'h b;^ I

su're`qe, Gouc^t ^ ^ f^^o ^ec^S^a^

STATUTES AND RULES

-,^vdje PP4-rdclC KGlc` jJn-^ re,-1- 09Pq('S/rr)e 14'o.v 9e-(- 1e'3A-( Covse l^'rm^

R^ cm^y Us1-f67,fs A t-1-t-4-^-preces o^ ev:d^r,c^ r^^d A-tsa I^td ^r^ ►^/^^,r

f D f!3 Ke 4°F,^^^a e^ ae ^o{GA^ a^ ^^ Frorn rFe'P+ A44a ne^ T7ky *06^

5rr i 's1<, ! 4-6 w4'w `my Case, Fn-^'h^ Covr-lrr^ ►.^:.^,u^-Fh2^ury!s ^^'-A e°P,

CP.P-t rv^ 461"j tz^ "beaAvse ^,^3u^^'s dh^n'-^ see ^^ ^e^FvGi^ff}^Nll^e, S^s

PP.tra-r ^Cs^enota^w f S. 06+q! A4 1-h2 C6ur-k-cs{'App5w(^"y ►^ ^ t^ ^„p^r

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^ ^(V a ^ h e^ r Fe^ ^eer^c^s e- o P

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OTHER r^TwP^1^a.1 C,t^B^ ^ve^v^ ^a ^lve Qar^6r^en.^e(3ocx^CF-P 0 6Fo p-KLd "eyd&,r,e°sseo^

'^^P^--4a prto ae ^S Cems4 ^^ hr^^^r ^I t^^^ ^s i crr^s+^P-

v o i ta^_^ c>neleK

QUESTION(S) PRESENTED

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rn m C-{`^' ^ ^j '^J(JN 0&1 4-ti e

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4-he d!d P ro kmi4 e P ra peY^PfAdj^

ted^e^n"c3^^l ^lY^,r^(4^ iNVi4 -^'i'9^e s4/^rrcc.^se ft-)!O( {^,V F^ I^T

G fbf „1 ^, ^ "'V r ^!(/'(+1 f+_tS

e- pr75r^^^ erm^e A,

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Qr^t^s h p raPeP L ^^ s reS o ^ h e^rt't'er

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b^ ^erhv^,^^'ra,^ / rnef^°" w^ne^S'^ psk N^^defe,,d^^s ^°P"r L

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ID,W^ONd,4r_r3s

Supreme Court of the United StatesOffice of the Clerk

Washington, DC 20543-0001

August 9, 2011

ClerkCourt of Appeals of Ohio, Cuyahoga CountyCuyahoga County Courthouse1200 Ontario StreetCleveland, OH 44113

Re: Gary Meltonv. LLC Ger Taylor GardensNo. 11-5740(Your No. 95010)

Dear Clerk:

William K. SuterClerk of the Court(202) 479-3011

The petition for a writ of certiorari in the above entitled case was filed on June16, 2011 and placed on the docket August 9, 2011 as No. 11-5740.

Sincerely,

William K. Suter, Clerk

by

Ruth JonesCase Analyst

SUPREME COURT OF THE UNITED STATES

OFFICE OF THE CLERKWASHINGTON, DC 20543-0001

June 21, 2011

Gary MeltonP. 0. Box 605186Cleveland, OH 44105-0186

RE: Gary Melton v. Ger Taylor Gardens, LLC

Dear Mr. Melton:

The above-entitled petition for writ of certiorari was postmarked June 16, 2011 andreceived June 21, 2011. The papers are returned for the following reason(s):

The notarized affidavit or declaration of indigency does not comply with Rule 39 inthat all of the questions have not been answered.

The petition fails to comply with the content requirements of Rule 14, in that thepetition does not contain:

The questions presented for review. Rule 14.1(a).

The appendix to the petition does not contain the following documents required byRule 14.1(i):

The lower court opinion(s) must be appended in its entirety.

The order denying rehearing`must be appended. Rule 14. 1 (i)(iii).

lt is impossible to determine thetimeliness ui t'fie petition without the lower eoi:."t

opinions.

The aforementioned documents must be contained in anappendix immediatelyfollowing the petition.

Please correct and resubmit as soon as possible. Unless the petition is submitted tothis Office in corrected form within 60 days of the date of this letter, the petition willnot be filed. Rule 14.5.

A copy of the corrected petition must be served on opposing counsel.

When making the required corrections to a petition, no change to the substance of thepetition may be made.

Sincerely,William K. Suter, ClerkBy:

Ruth Jones(202) 479-3022

Enclosures

57901879

GARY MELTONPlaintiff

IN THE COURT OF COMMON PLEASCUYAHOGA COUNTY, OHIO

I Case No: CV-08-670947

Judge: JOSE' A VILLANUEVA

GER TAYLOR GARDENS LLCDefendant

JOURNAL ENTRY

87 DIS. W/O PREJ - FINAL

PLAINTIFF HAVING FILED A NOTICE OF DISMISSAL, CASE DISMISSED WTTHOUT PREJUDICE.

FINAL

O.S.J.

COURT COST ASSESSED TO THE PLAINTIFF(S).

Judge Signature Date

VROCESSED

,JUid ^ 5 2G"v9

GERFtt Q E E.Im^g1GG QEFP,R

- 8706/09/2009

Page 1 of 1

Jay S. Hanson, Attorneii, Law

323 Lakeside Place, Suite 3801Cleveland, OH 44113(216) 912-40701 Ext. 43836 1 Fax: (877) 888-1537jhanson@amfam.com

September 2, 2011

Supreme Court of the United States1 First Street, NEWashington, DC 20543

RE: Melton, Gary v. Ger Taylor Gardens LlCClient: Ger Taylor Gardens LLCClaim No.: 00-221-127821Date of Loss: January 31, 2008Case No.: CV09705931

Dear Sir:

Licensed in Ohio

Enclosed please find an original and one copy of my Waiver. Please file the originaland return a time-stamped copy to me in the enclosed, self-addressed stamped envelope. Ithank you for your assistance in this matter.

If you have any questions, please do not hesitate to contact me.

Very truly yours,

Jay S. Hanson

JSH/kleEnc.

RECEIVEDSEP 13 2011

OMOc ° ^^e T^u s

The above-named attorney is a full , time employee ofAmerican Family Insurance Company.

ORI61NAlNo.

11 -5740IN THE

SUPREME COURT OF THE UNITED STATES

M.-,-L'TD rj - PETITIONER(Your Name)

' VS.

00 LSiZ- TAb Id IZ Afir e S` RESPONDENT(S)

MOTION FOR LEAVE TO PROCEED.IN FORMA PAUPERIS

The petitioner asks leave to file the attached petition for a writ of certiorariwithout prepayment of costs and to proceed in forma pauperis.

[] Petitioner has previously been granted leave to proceed in forma pauperisin the following court(s):

I-E-4] Petitioner has not previously been granted leave to proceed in formapauperis in any other court.

Petitioner's affidavit or declaration in support of this motion is attached hereto.

(Signature)

Gary MeltonP.O. Box 605186Cleveland, OH 44105