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IN THE HATTER OF
Van Philipson
CAn Alleged lncapacitated Person)
IN THE COURT OF C0l1110N PLEAS OF
Cumberland COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
491 of 1978
.
ANNuAL REPORT OF GUARDIAN
Assets at Beginning of Period:
1. Cash, CertifIcate of Deposit, Savings Account
2. Burial Fund
J.
4.
S 1,3~8 .83
1,890.17
Income from November 17,1995
TOTAL S 3,249.00
to 'November 16, 1996
1. 'Social Security for ~ months at S 361.00per month
2. Social Security for J1.. months at S 375.00per month
J. Interest added to Burial Fund
4. Interest added to Regular accountCs)
5.
$ 361. 00
4.125.00
96 . 44
72.82
bisbursements from November 17, 1995
TOTAL $ 4,655.26
to November 16, 1996:
1. Care/tfaintenance at Harrisburg State Hospital frolll
November I, 1995 to October 30, 1996
2.. Personal Spending
3. Clothin9/~hoes/l1iscellaneous
4. Room/board outside a State Facility
5.
$ 3,824.82
,)10.QO
91. 74
TOTAL $ 4,446.56
SUliHARY
Assets as of November 17, 1995
InCome frolll =November 17, 1995
Disbursements from November 17,
Balance as of November 17,
Less Burial Fund ACCount
including BuriAl Fand
- to NOvember 16, 1996
SUBTOTAL
1995 to November 16~ 1996-
1996
S 3,249.00
$ 4,655.26
S 7,904.26
S 4,446.56
S 3,457.70
1.986.61
S 1,471.09
ACTUAL CASH ON HAND
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IN THE MATTER OF
IN THE COURT OF COMMON PLEAS OF
Cumberland COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
491 of 1978
Van Philipson
&
AFFIDAVIT
I, Nancy Sunday, being duly sworn according to law do hereby depose
and say that I am the Guardian Officer of Harrisburg State Hospital and
that I have reviewed the information on the attached Annual Report of
Guardian which information I believe to be true and correct to the best of
my knowledge, information and belief.
~ rtL~~
Guar ian Of lcer '
SWORN TO AND SUBSCRIBED
BEFOR~ ~IE THIS ,jJLI, DA Y_
OF 'LflUI);l , 1994)
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NOTARY PUBLIC (
NOTARIAL SEAL
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!J 111[..'\.'-1\"1\, "1ljUt , N, Notary Public
" . Ha:rl:;ourg, PA Dauphin County
IViY Commission Expires Aug, 30, 1997
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