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HomeMy WebLinkAbout02-0966COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: : NO. a ~ .. ~~ ~ q APPOINTMENT OF A GUARDIAN OF THE ESTATE AND PERSON OF MARK DAVIS, A/K/A MARK G. DAVIS an alleged incapacitated person PETITION FOR APPOINTMENT OF A GUARDIAN OF THE ESTATE AND THE PERSON IN ACCORDANCE WITH 20 PA C.S.A. § 5511 TO THE HONORABLE, THE JUDGES OF SAID COURT: 1. The Petitioner is Jeffrey Davis, the brother of Mark Davis, a/k/a Mark G. Davis, the alleged incapacitated person. The Petitioner resides at 406 Ethan Allen Dr., New Cumberland, PA 17070. 2. The alleged incapacitated person has no power of attorney and there have been no previous Petitions for appointment of a guardian of the person or guardian of the estate. 3. The alleged incapacitated person is age 45 years, having a date of birth of December 1, 1956 and the alleged incapacitated person's Social Security Number is currently residing at Health South, 175 Lancaster Blvd., Mechanicsburg, PA 17055, having a last address as 4172 Annelope Lane, Apt. 103, Mechanicsburg, PA 17050, and a former of address of 1927 Queenswood Dr., Apt. J-101, York, PA 17403. 4. The following persons are the alleged incapacitated person's only living next of kin: a. Jeffrey Davis, an adult individual, his brother, 406 Ethan Allen Dr., New Cumberland, PA 17070 b. Carl A. Davis and Jane N. Davis, husband and wife, adult individuals, his parents, at 227 N. 21 S' St., Camp Hill, PA 17011 5. The assets of the alleged incapacitated person are valued at approximately $2,000 - $3,000 before the consideration of debt. The debt of the alleged incapacitated person is believed to greatly exceed his assets. 6. The alleged incapacitated person had also owned an automobile, a 1999 Mustang, but due to the alleged incapacitated person's condition and the payments still owing against the Mustang, the Mustang was allowed by his parents to be returned to the lender. There is believed to have been no value in the alleged incapacitated person's motor vehicle. 7. The alleged incapacitated person's monthly income as a driver for Roadway Express had been approximately $3,000 per month estimated, which has now stopped by reason of the alleged incapacitated person's disability. The Petitioner and his parents are applying for Social Security benefits for Mark Davis, the alleged incapacitated person. 8. The alleged incapacitated person was not and is not a member of the Armed Services of the United States and is not receiving benefits from the United States Veterans' Administration at this point. 9. The alleged incapacitated person is suffering from the consequences and symptoms of a severe stroke which has paralyzed his entire right side and disabled him mentally from functioning in a cognitive way, he cannot make intelligent decisions and lacks the ability to fully understand the consequences of his actions. As an example, he can talk a little bit and he can sign part of his name but he has no understanding of why he would be signing his name. 10. The proposed Guardian of the Estate and Person of the alleged incapacitated person is the Petitioner, Jeffrey Davis, the alleged incapacitated person's brother. There is no known Will for the incapacitated person. 11. The Petitioner has no personal adverse interests to the alleged incapacitated person. 12. The Petitioner has assisted his parents in seeing that the alleged incapacitated person obtains the best medical and health care. 13. The Petitioner will continue to cooperate with his parents to provide full and adequate measures for the care, needs and protection of his brother, the alleged incapacitated person. 14. Attached here and incorporated herein by reference are the Doctor's Report for Social Security Application to the Social Security Disability Benefits Application (Exhibit A) and the caseworker's report (Exhibit B) on the condition of Mark Davis, the alleged incapacitated person, and incorporated herein as if set forth at length. 2 15. By reason of the current diagnosis and prognosis of that is a likely permanent condition for Mark Davis, it appears that the Petitioner will have to assist his brother in obtaining some sort of Assisted Living Care, the level of which is not known at this point and that the Petitioner will continue to provide those measures which are for the benefit, care and protection of the alleged incapacitated person, as follows: a. The alleged incapacitated person has suffered disability to his memory and his ability to process information and therefore cannot assist himself in his own care and medication. b. The alleged incapacitated person by reason of the physical paralysis and mental disability, cannot take care of his proper nutritional nor hygiene needs. c. The alleged incapacitated person by reason of his physical and mental disability cannot drive whatsoever and all items for his care and nutrition must be obtained for him. d. The alleged incapacitated person has suffered a severe mental disability by reason of said stroke according to his attending doctor, Dr. Do. e. The alleged incapacitated person does not nor cannot recognize his own needs. f. The alleged incapacitated person is in Health South with full caretakers and until he can recover somewhat physically, he will need full caretakers. 16. Dr. Do in his physical and mental evaluation of Mark Davis has recommended that a Guardian be sought to take care Mark Davis' activities of daily living as well as manage his financial assets and/or affairs. 17. No other Court has ever assumed jurisdiction at any proceeding to determine the capacity of the alleged incapacitated person. 18. The consent of Jeffrey Davis to act as the Guardian of the Estate and the Guardian of the Person of Mark Davis, is marked as Exhibit C, attached hereto and incorporated herein by reference. 19. Mark Davis' parents consent to have their son, Jeffrey Davis, act as the Guardian of the Estate and Guardian of the Person of Mark Davis, their son. 20. Failure to appoint a Guardian of the Estate and the Person of Mark Davis, the alleged incapacitated person, will result in irreparable harm to his person and affairs. 21. Your Petitioner seeks Guardian of the Estate and Person for his brother, the alleged incapacitated person, in order to be able to fully provide for his care, protection and needs. WHEREFORE, the Petitioner respectfully requests this Honorable Court to award a Citation directed to Mark Davis, the alleged incapacitated person, with Notice thereof to be given to immediate next-of-kin, his parents, who are not Petitioners, but have consented to this Petition, to show cause why Mark Davis should not be judged an incapacitated person and Jeffrey Davis be appointed of his Estate and Person. RESPECTFULLY SUBMITTED, RUPP Richard . Cupp, Eire Sup. ourt I. D. No. 34832 355 N. 215' St., Suite 205 Camp Hill, PA 17011 (717) 761-3459 Attorneys for Petitioner 4 r^ ac ~ ~ ~~ 4 z• ~~ M~ ~- CENTkAL PENNSYLVANIA TEAMSTERS HEALTH AND WELFARE FUND Application for Benefits Name of Participant K G. Dt~y15 IMPORTANT-This form to be filled out by the participant, doctor and employer immediately after the commencement of disability and forwarded to Central PA Teamsters H&W Fund, P.O.Box 15224, Reading, PA 19612-5224 NOTE: All claims must be submitted within one year from the date of service for processing. Social Security No. ~~ ~-~-.;~•Zl j ~Z27 Ncrth 2/~~~t ~+1P lti~t. T A ~ 17~f1 - City state Zip Code Phone (7/ 737 - (~~ (~'~ Sex Age Participant of Local Union No. Employer S ~, ~ lob Classi5cation ~ ~ Tf Do you have any other Group Health Ins.? Yes Q No Carrier If yes, give name of carrier ~ Phone No. ( ) Dces yow spouse have any other Group Health Ins.? Yes 0 No ~ ~~~ Cartier If yes, give name of carrier Phone No. ( ) L10 you or yow family have any other Non-Group Health Insurance Yes ~ No Is Dependent Employed? IJSo, Name & Employer Address oJEmployer Telephone No. ( ) STATEMENT OF SICKNESS OR ACCIDENT fT0 BE COMPi.Ii.TF.n Rv psu~rrr-rvsrrr nnrr v~ 1. Date Sickness be an or Accident occwred ---~---~~~~ ~- ~.-a-a~vu a-u~a VI~Ll .~ pZ 2. If Accident how did it ha ? 3. Where did Accident ha ? On the Job ? 4. Name of Sickness or Natwe of In~ E l ~~ 5. Date of first medical treatment for this disability jp ~ l i d•L Where ? ~L`~ ~ ~~c~l~~ 6. Name of Doctor ~i 2 C;owrvf~C- v ATTENDING PHYSICIAN'S STATEMENT (MU.41' RF ((1MPi.TTF11 Rv vuvc>rrrwwr ntvr v. 1. Name of Patient G_ ~~~ 2. Date Sickness be or Accident occurred ~ ~ 1 f 2opz 3. Natwe of Sickness or In' - Office 4. Dates of all Medical Treatments Home Ho ital 1~l a r / Z.oo _t 7v o~~-r-~ Where ? I-! ~ ~- y SP ;' l? i ~ ( ~ C' S Pr' i Ai-- fA-w,A +-~; w , bvncr.~~w9>tiv~ 5. If atient was ho italized From: _ j -- To: - / - c Z 6. If an o ation was ormed What ? T1tS"ot,t.Tb~ /Lt~.aB ih.Seca-. 7. When in yow opinion will the pati~t be le,_y_,~Z .y p~~~- able to work ? \ ~-e-wl-r,?,,,w~ ~ u~~,,,,,,,a.., Physician's Signatwe ' Address: /75 Lam e~f.~~ ~~v _ lolt~/ zoo L. ~-lecfi a~ ics bud. pA ~ s,' N,,.-• o~ , Mb RELEASE': The >tatemmu ne true trod oottea b the ben of my belief 16eteby authaiae ny provider of sr+vioes b famish any ioformatioa tequerted 1 abo hetdry aurhoriae my Ha1t6 trod Welfare Fund Administrator b mltase or obtain from troy organintron ar person inbrmatim whie6 may be nmwsary b daernooe bemfits payable ruder troy IIa116 and Wdfine Plan. A Dopy of this a shdi be considered as eSeetive and vdid u the eriaiod. SIGNEDC~~~~~n~ ~~j DATE: O -- ,3= c3; (MUST BE SIGNED BY PATIENT/GUARDIAN) ASSIGNMENT OF I~AI.TH AND WELFARE BENEFI'r'3:16aeby auabame paymat dheetly tithe hwpital aodror doctor d1 medial. arrgial trod buspiW bme&s mtrtled me m areoum Druid diubil[y. 1 urrdaataod 1 am 5rraodally raparsibN b the and/ordoasr for dtatga na eovaad by r6s - ~~~~~ SIGNED ~CLn,.f.h • t~}rL, „~ DATE: j c --l 9 ' ~ i.- USi BE SICIVlD BY lARTIQlANT ONLY) EMPLOYER'S STATEMENT (MUST BE COMPLETED BY EMPLOYER ONLY) 1. Date of first full working day lost because of Sickness or Accident Date resumed work 2. Was claimant regularly employed and working for you when disability began ? Date employed 3. Is this beins reported under Worker's Compensation Employer's Signature: Employer DATE: Official Position: Telephone No. ( ) Non Corp. S.S. #_ Corp. Federal I.D. # DA o (/~-/ 2ac'L- i0/25/200~ 10:07 '1^-~•~=1 -a_1 _ HEHLTHSOUTH Ch•1 P~iaE 1 SECTION 9 -REMARKS Use this section for any added inform~tian you did nat show in earlier parts of the form. When you are done with tt-is section for if you don't have anything to add), be sure to go to the next page and complete the signature bloc[c. /d • 07~ ' U ~ ~~~~ ~~ C?ifl7Cer~7 -~--- __. !1//~ /IGG~S ~.SCL lUl /lGrs/~ ~ ~S ~ __ ~C ~ G~6 716- G2- ~4J /,~"/ ~C~SG- Cv4r,E e ~ -` ~- ads C~~ ~ i -- - _ _ ~~ Cv/^ FORM SSA-3365-BK (7 1 -?001' FF X08 ZG~?' The ' 2 ~ 993 edi?ion may be used unt~i ext~euated P4GE 9 GUARDIAN'S CONSENT I, Jeffrey Davis, consent to be the Guardian of the Estate and the Guardian of the Person for Mark Davis, my brother, the alleged incapacitated person. t Date: f~ ~ ~~~ ~- O ~~Je rey vis VERIFICATION I, Jeffrey Davis, verify that the facts set forth in the foregoing Petition are true and correct to the best of my knowledge, information and belief. The undersigned understands that false statements herein are made subject to the penalties of 18 Pa. C.S.A. 4904 relating to unsworn falsification to authorities. Date: l~~f Z~~~~ ~~ ff y Dav COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: No. ~ ~tt. APPOINTMENT OF A GUARDIAN ~.,~~ OF THE ESTATE AND PERSON OF MARK DAVIS, A/K/A MARK G. DAVIS an alleged incapacitated person ORDER OF COURT AND NOW, this ~~of !ta , 2002, upon consideration of the Petition for appointment of a Guardian of the Estate and Person of Mark Davis, IT IS HEREBY ORDERED AND DECREED: • A Citation is awarded, directed to Mark Davis, a/k/a Mark G. Davis, to show cause why Jeffrey Davis should not be appointed Guardian of his Estate and Person for the purposed of benefitting and protecting Mark Davis. • At least 20 days notice of the hearing shall be given to Mark Davis, the alleged incapacitated person, by personal service of a copy of the Petition and the Citation, upon the following persons by personal service or by certified or registered mail: A. Jeffrey Davis, 406 Ethan Allen Drive, New Cumberland, PA 17070 B. Carl Davis, 227 N. 21 S' St., Camp Hill, PA 17011 C. Jane Davis, 227 N. 21 S' ., Camp Hill, A 17011 J. COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: No. APPOINTMENT OF A GUARDIAN ~" ~~ -- ~`pCp OF THE ESTATE AND PERSON OF MARK DAVIS, A/K/A MARK G. DAVIS U~~~«~ ~ ~ oL~,~ an alleged incapacitated person TO MARK DAVIS A/K/A MARK G. DAVIS IMPORTANT NOTICE CITATION WITH NOTICE A petition I~as been filed with this Court requesting the appo~ntmer~ of an Emergency Guardian of your Estate and Person. If the Court finds you need a Guardian of your Estate and Person, your rights will be affected, including your right to manage money and property and to make decisions. A copy of the petition which has been filed by Jeffrey Davis is attached. You are hereby ordered to appear at a hearing to be held in Courtroom No. „~~ ,Hanover Street, Carlisle, Pennsylvania, on ~/Q ~/ /~ • tat /~ •,3~,Q.M. to tell the Court why it should not app/o~int a Guardian of the Estate and Person to act on your behalf. Cu ~y~~,~ ~ /~q~ Ll! 'vt/ c~ n7~I~ ~d u~~;7~iott~S f At the hearing, y u have the right to appear, to be represented by an attorney, and to request a jury trial. If you do not have an attorney, you have the right to request the Court to appoint an attorney to represent you and to have the attorney's fees paid for you if you cannot afford to pay them yourself. You also have the right to request that the Court order that an independent evaluation be conducted as to your alleged incapacity. If the Court decides that you are an Incapacitated Person, the Court may appoint a Guardian for you, based on the nature of any condition or disability and your capacity to make and communicate decisions. The Guardian will be of your money and other property and will have either limited or full powers to act for you. If you do not appear at the hearing (either i rso r by an attorney representing you) the Court will still hold the hearin your absent and may appoint the Guardian requested. _®,,,,,. By: IN RE: APPOINTMENT OF A GUARDIAN IN THE COURT OF COMMON PLEAS OF OF THE ESTATE AND PERSON OF :CUMBERLAND COUNTY, PENNSYLVANIA MARK DAMS, A/K/A MARK G DAMS :ORPHANS' COURT DIVISION AN ALLEGED INCAPACITATED PERSON NO. 21-02-966 IMPORTANT NOTICE CITATION WITH NOTICE A petition has been filed with the Court to have you declared an Incapacitated Person. If the Court finds you to be an Incapacitated Person, your rights will be affected, including our right to manage money and property and to make decisions. A copy of the petition which has been filed by JEFFREY DAMS is attached. You are hereby ordered to appear at a hearing to be held in Court Room No. 5, Cumberland County Courthouse, Carlisle, Pennsylvania, on NOVEMBER 18 , 2002, at 10:30 A.M. to tell the Court why is should not find you to be an incapacitated Person and appoint a Guardian to act on your behalf. To be an incapacitated Person means that you are not able to receive and effectively evaluate information and communicate decisions and that you are unable to manage your money and/or other property, or to make necessary decisions about where you will live, what medical care you will get, or how your money will be spent. At the hearing, you have the right to appear, to be represented by an attorney, and to request a jury trial. If you do not have an attorney, you have the right to request the Court to appoint an attorney to represent you and to have the attorney's fees paid for you if you cannot afford to pay them yourself. You also have the right to request that the Court order that an independent evaluation as to your alleged incapacity. If the Court decides that you are an Incapacitated person, the Court may appoint a Guardian for you, based on the nature of any condition or disability and your capacity to make and communicate decisions. The Guardian will be of your person and/or your money and other property and will have either limited of full powers to act for you. If the court finds you are totally incapacitated, your legal rights will be affected and you will not be able to make a contract or gift of your money to other property. If the court finds that you are partially incapacitated, your legal rights will also be limited as directed by the Court. If you do not appear at the hearing (either in person or by an attorney representing you) the court will still hold the hearing in your absence and may appoint the Guardian requested. By: - Clerk, Orp ns' Court Di isi ?~ ~ Cumberland County, Carlisle, PA My Commission Expires 1St Monday, January, 2006 SHERIFF'S RETURN - REGULAR CASE NO: 2002-00966 O .~/ COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND DAVIS JEFFREY VS DAVIS MARK AKA MARK G DAVIS JASON VIORAL Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within ORDER AND PETITTnN the DAVIS MARK AKA MARK G DAVIS was served upon RESPONDENT at 1550:00 HOURS, on the 30th day of October 2002 at 175 LANCASTER BLVD MECHANICSBURG, PA 17050 MARK DAVIS IN PRESENCE OF by handing to SUSAN CROUSHORE, CASE MANAGER a true and attested copy of ORDER AND PETITION together with and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing 18.00 Service 8.28 Affidavit .00 Surcharge 10.00 .00 36.28 So Answers: a' a°~ .rt:,, ;~,.~ ~,r x . 'Thomas Kline 10/31/2002 RUPP & MEIKLE Sworn and Subscribed to before By me this ~ ~,;;~_ day of ~~ ~--- '~•t~~Z ~ ~ ~ ` 1 ~ ~. ?GC ` A . D . ~_ r lerk of Orhans Court ~ i /// ,./ L_ D uty Sheriff SHERIFF'S RETURN - REGULAR CASE N0: 2002-00966 O COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND DAVIS JEFFREY VS DAVIS MARK AKA MARK G DAVIS JASON VIORAL Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within ORDER AND PETITION was served upon DAVIS MARK AKA MARK G DAVIS the RESPONDENT at 1550:00 HOURS,. on the 30th day of October 2002 at 175 LANCASTER BLVD MECHANICSBURG, PA 17050 by handing to MARK DAVIS IN PRESENCE OF SUSAN CROUSHORE, CASE MANAGER a true and attested copy of ORDER AND PETITION together with and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing 18.00 Service 8.28 Affidavit .00 Surcharge 10.00 .00 36.28 Sworn and Subscribed to before me this day of A.D. Clerk of Orhans Court So Answers: r~.. ..., R. Thomas Kline 10/31/2002 RUPP & MEIKLE By ~ ~~'-f v- D uty Sheriff • ~ Sn S COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: APPOINTMENT OF A GUARDIAN OF THE ESTATE AND PERSON OF MARK DAVIS, A/K/A MARK G. DAVIS an alleged incapacitated person . No. ~~ ~ D Z f !(O~ ~ ~~s ~ ACCEPTANCE OF SERVICE I, Jane Davis, of 227 N. 215' St., Camp Hill, PA 17011, mother of the alleged incapacitated person, Mark Davis, hereby accepts service of the Petition and Order of Court. Date: _ ~~~ ~_ p ~, Ja a Davis s~ s COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: APPOINTMENT OF A GUARDIAN OF THE ESTATE AND PERSON OF MARK DAVIS, A/K/A MARK G. DAVIS an alleged incapacitated person ACCEPTANCE OF SERVICE I, Carl Davis, of 227 N. 215} St., Camp Hill, PA 17011, father of the alleged incapacitated person, Mark Davis, hereby accepts service of the Petition and Order of Court. Date: ~` ~? Carl Davis PETITIONER'S EXHIBIT S i,? ~ COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION I N RE: APPOINTMENT OF A GUARDIAN OF THE ESTATE AND PERSON OF MARK DAVIS, A/K/A MARK G. DAVIS an alleged incapacitated person . No. (.~ z ' ! ~~ a . vn ~ ~~ S Cp v" '~ ACCEPTANCE OF SERVICE I, Jeffrey Davis, of 406 Ethan Allen Drive, New Cumberland, PA 17070, brother of the alleged incapacitated person, Mark Davis, hereby accepts service of the Petition and Order of Court. ~rl~~~~~ D Je ey av • ~ ~;~ s COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: APPOINTMENT OF A GUARDIAN OF THE ESTATE AND PERSON OF MARK DAVIS, A/K/A MARK G. DAVIS an alleged incapacitated person No. 2 ~ ~ D -z- cI ~i ~ CONSENT TO PETITION FOR GUARDIANSHIP I, Carl Davis, of 227 N. 21St St., Camp Hill, PA 17011, father of the alleged incapacitated person, Mark Davis, hereby consents to the appointment of my son, Jeffrey Davis, of New Cumberland, PA, to be the guardian of the person and guardian of the estate of my other son, Mark Davis. Date:. ~/ ~ ~ ~~Z Carl Davis PETITIONER'S EXHIBIT -~ SD 5 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: APPOINTMENT OF A GUARDIAN OF THE ESTATE AND PERSON OF MARK DAVIS, A/K/A MARK G. DAVIS an alleged incapacitated person . No. 2 ~ ~ a Z - 9(0 ~ CONSENT TO PETITION FOR GUARDIANSHIP I, Jane Davis, of 227 N. 21S' St., Camp Hill, PA 17011, mother of the alleged incapacitated person, Mark Davis, hereby consents to the appointment of my son, Jeffrey Davis, of New Cumberland, PA, to be the guardian of the person and guardian of the estate of my other son, Mark Davis. .- Jane Da s s COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ~,- ORPHANS' COURT DIVISION APPOINTMENT OF A GUARDIAN OF THE ESTATE AND PERSON OF MARK DAVIS, A/K/A MARK G. DAVIS an alleged incapacitated person FINDINGS (1) Mark Davis a/k/a Mark G. Davis, born December 1, 1956, suffers from the consequences of a stroke that has impaired his ability and his capacity to make and communicate decisions. (2) His ability to receive and evaluate information effectively and communicate decisions is impaired to such a significant extent that he is totally incapacitated and unable to manage his financial affairs and resources. (3) Both of the incapacitated person's parents have consented to the appointment of their son, Jeffrey Davis, as guardian of the person and of the estate of their son, Mark Davis. (4) By reason of his impairment and his incapacitated condition, Mark Davis is unable to handle his affairs and to take care of himself adequately. (5) A plenary guardian of the estate and of the person is necessary because of his incapacity appears to be permanent at this time. (6) The guardianship must be for an unlimited period. ORDER OF COURT AND NOW, this ~~day of November, 2002, Jeffrey Davis, brother of the incapacitated person, Mark Davis, is appointed plenary guardian of the person and of the estate of Mark Davis. By the Co , Edward E. Guido, J.