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HomeMy WebLinkAbout11-17-78 .:i1J ~ 7JtFI. J 7) /Cf7'8 . .. . IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION . 494 ORPHANS 1978 JoseEh A. Crouse .., An Alleged Incompetent IN RE: PETITION FOR APPOINTMENT OF GUARDIAN ORDER OF COURT AND NOW, November 17, 1978, it is hereby ordered and directed that the report and recommendation of the Special Master hereinbefore ~ppointed in the above matter, be and is hereby approved, and that Kenneth L. Dissinger, Guardian Officer of Harrisburg State Hospital, and his successors in office are hereby authorized to receive, hold, and dispose of the estate of .Tospph A _ Crouse , and to pay such debts that are presently outstanding as well as such debts that may later become due and owing. Specifically, the guardian is directed to pay to the Clerk of the Orphans' Court of Cumberland County a filing fee in the amount to Joseph P. Alexa, Esquire, Aetna Casualty and Surety, Bond No. 57S28546, is approved as suffi- cient bond. By the c.ourt, cc: Edward P. Carey, Esq. (2) Assistant Attorney General Richard W. Stewart, Esq. Special Master Joseph P. Alexa, Esq. Guardian ad litem BOOK 105 fACE 4:'7 .' .. ... . IN THE MATTER OF IN TH~ COURT OF COMMON PLEAS OF Joseph A. Crouse (name) COUNTY, PENNSYLVANIA An Alleged ~ncompetent QRPHANS' COURT D):VISION NO. 494 Orphans 1978 19 PRELIM~NARY ORPER O~ COURT AND NOW, this 13 day of Sep.tem~e:r 1978 19 , upon consider~tion of the foregoing Petition, it is Ordered that a citation be issued, directed to Joseph A. Crouse to show cause why h,~ should not be adjudged an incompetent, and a guardian of his estate appointed; and why distribution of assets and income as payment of debts listed in paragraph 11 of the within Petition should not be made. Richard W. Stewart, Esquire is hereby appointed Special Master for the purposes of conducting a hearing on said Petition at the institution at which Joseph A. Crouse resides, at a time to be fixed by said Special Master, and to submit a Report and Recommendation to this Court in a timely fashion. Joseph P. Alexa, Esquire is hereby appointed by the court to act as guardian ad litem for Joseph A. Crouse the alleged incompetent regarding this hearing. At least twenty (20) days written notice of the hearing shall be given to Joseph A. Crouse BOCK 105 p,\c: .r.},5 ., ..... I . . the alleged incompetent, by serving him personally with the, citation and a copy of the foregoing Petition; and at least twenty (20) days written notice of the Petition and hearing shall also be given to any next of kin listed in the Petition either personally or by certified mail. Joseph P. Alexa, Esquire, be and is hereby appointed to represent the Respondent. Sandra Gobrecht is assigned to take the stenographic notes of testimony. BY THE COURT: BOOK 105 ff\CE .1:,6 . . . ,"" . J ... IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF JOSEPH A. CROUSE (name) cmmE~D COUNTY, PENNSYLVANIA ORPHANS' CbURT DIVISION An Alleged Incompetent NO.494 Orphans, 1978 19 REPORT AND RECOMMENDATION OF THE SPECIAL MASTER AND ORDER OF COURT Upon hearing of the Petition and Citation for Appointment of a guardian for Joseph A. Crouse , proof of notice of the said hearing to his next of kin having been filed, and Joseph P. Alexa, Esquire appoihted as guardian ad and counsel litem,/the Special Master, appointed by this Honorable Cburt to hear said Petition, finds that the said Joseph A. Crouse is so mentally infirm that he is likely to dissipate or lose his estate and become the victim of designing persons; and that the Court further finds that the entire real and personal estate of the said Joseph A. Crouse should be handled by the Guardian designated herein. IT IS THEREFORE RECOMMENDED THAT Kenneth L. Dissinger, guardian officer, Harrisburg State Hospital and his/her successors in office be and are hereby authorized to receive, hold and dispose of the es- tate of the said Joseph A. Crouse as the duly appointed guardian under Court Decree, and to pay such debts as enumerated in said Petition, such debts having been found to be proper and in accord with law. The Master specifically ftnds that the respondent and his next' of kin received sufficient notice of the hearing of the within matter. . . . " " . . .. .. . The guardian, within three months after real or personal es- tate of the incompetent comes into his possession, shall verify by oath and file with the Clerk an inventory and appraisement of such personal estate, a statement of such real estate, and a statement of any real or personal estate which he expects to acquire thereafter. ~a:2r~ DATE: November ~. 1978 . :, m THE MA'l"IER OF m THE OOURl' OF ~ PLEAS OF CUMBERLAND cxxmY, PENNSYLVANIA : JOSEPH A. CROUSE (nane) ORPHANS' CX>URI' DIVISICN An Alleged Il"lCalpetent NO. 19 PEl'ITICN FOR APPOINlMENI' OF GUARDIAN The Petition of ,1nhnR Ing;ln)Mn , Superintendent of H;lrric:;hlJrg St;lb:l Hnc::pit;ll , respectfully represents: 1. Your Petitioner has custody of the alleged incc.rrpetent at Hilrri c;bllrg StR tF:I Hnc:: pi till 2. The alleged inoc:rcpetent was admitted to the aforesaid institution on M;lY Ill, 1 Q7f\ 3. 'Ibe alleged inoc:rcpetent is daniciled at R . D . # 1 Shippensburq, Cumberland County, Pennsylvania 4. The alleged inoc:rcpetent is ~ years of age, having been bom on December 29, 1918 5. The alleged inoarpetent' s mili ta:r:y status is: neve r a member of the Armed Forces 6. 'lhe alleged inoarpetent' s marital status is: marital status is presumed to be sinqle to the best of this petitioner's knowledqe 7. Those persons, if any, who are the alleged incnnpetent' s next of kin and their reJatialShip to same, of whan your Petitioner has knowledge are as follows: Bruce Crouse Mrs. Zelda Mooney 240 W. Kinq St.. R.D.#1 Box 302 Shippensburg, Pa. Cumberland County Fa ther Shippensburg, Pa. Cumberland County Sister 8. No other Court within this Camonwealth of which Petitioner has knCMledge has appointed a guardian for the alleged incarpetent. BOOK 105 fAI:[ 41'1 ~IR 35-E-l - 9-77 9. The alleged incx:.mpetent has incane oonsisting of: (a) Maney due fran Social Security in the amount of $ 64.90 per month (b) loDney due fran in the arrount of $ (c) per 10. The alleged inccrrpetent has assets, real and personal, of which the Petitioner is aware, in the amount of $ 3,247.84 oonsisting of: (a) Money held py the Guardian Officer of Harrisburg State Hospital in the amount of $ 2,872.47 as of August 31 ,19~. (b) "Vecchione :Refund" monies in the arrount of $ 375.37 , title to which is in dispute. (c) 11. The alleged incanpetent has debts outstanding in the amount of $ 911.54 ,as of August 31 , 19~, consisting of: (a) $ 582.40 oo.ng to the Ccmnanwealth of Pennsylvania as payment for care and maintenance received fran the period May 14 , 19~, to August 31 ,1978 , in acoordance with 50 P.S. SS 4501 and 4504 and regulations pn::mulgated theremder. (b) $ 329.14 CMing to the Ccnnonwealth of Pennsylvania as payment for care and maintenance rendered between July II, 1974, and April 4, 1975, which relates to the "Vecchione Refund", title to which is in dispute. (c) 12. The alleged incx:.mpetent is incapable of handling his financial affairs for the reasons set forth in the attached Affidavit and Carpetency :Report, prepared by V. G. del Rosario, M. D. marked as Exhibit A and made a part hereof. , -2- BOOK 105 f,\GE 472 MI/NR 35-E-2 - 9-77 13. Joyce Johnston Way , Gual:dian Officer at the aforesaid institution, and his successors in office, having no interest adverse to the alleged incarpetent, has agreed. to act as Guardian if this Honorable Court shall so appoint. The consent of the proposed Guardian to so act is attached hereto and made a part hereof as Exhihi t B. 14. If appointed as Guardian, Joyce Johnston Way is required. to act in ronpliance with regulations pranulgated under Court Order in 5 Pennsylvania Bulletin 931 et seq. (April 19, 1975). 15. In light of these provisions and in furtherance of Paragraph 7 of the aforesaid regulations, petitioner requests preference be given to a bank, trust ronpany or other individual willing to accept appointIrent as Guardian. WHl!a<t;.tURE, the Petitioner prays that a citation be issued directing Hoseph A. Crouse , and those persons, if any, listed in paragraph 7 of this Petition, to show cause, if any there be, why he should not be declared an inronpetent and a Guardian of the estate appointed, and why distribution of assets and inc:xxre as payrrent of debts listed in paragraIil 11 should not be made. Peti tioner further prays that a guardian ad Ii tern be appointed to act for the alleged incarpetent regarding such hearing. -3- MH/MR 35-E- 3 - 9-77 BOOK 105 fACE 4\/3 , . ~TH OF PENNSYLVANIA CDUNTY OF DAUPIlIIN . . John B. Logan, M.D. , Petiticner in this matter, being duly sworn acoording to law, do depose and state that lam Superintendent of Harri sburg State Hospital and that the facts set forth in the foregoing Petition are true and correct to the best of IT!Y knowledge, infcmnation and belief. SWJm 'ID .AND SUBSCRIBED BEFORE ME, 'nUS ; /) ft DAY OF .' ,,' .",.,(9 Y ...-., . '~H' ;' 0'.,.,., ; -l:'~ :: >0 ~ :. 1:1 If' ,..".rry ......t... '."(f/ ~'v,~ ", -<) . .1 tH t\ , ' .' 'y . ", ~(]'..... . .,' "'/ ~ L t r-.............. ""t"'H_".'." l-Hft'IR 35-E-4 - 9-77 BOOK 105 fACE lfi4 . I , . AF'FIDAVIT ~'lH OF PENNSYLVANIA COUNTY OF DAUPHIN : ss I, V. G. del Rosario, M.D, , being duly SWODl according to law, depose and say that I am a Psychiatric Physician in the Cal:lllL:ll:1Wealth of Permsylvania arployed at Harri sburg State Hospital , and I have examined the patient, Joseph A. Crouse , an alleged in<Xlrpetent, with care and diligence and based upon said examination and observations am of the opinion that said patient is ino::mpetent to manage his/her CMl1 affairs for the reasons set forth in the attached Carpetency Report, and that the facts and opinions contained therein are true and correct to the best of I1"!Y knCMledge, infonnation and belief. ~ {d2J' /2: ~~ --- SWJIN 'ID AND SUBSCRIBED BEFORE ME '!HIS d tJ ~ DAY OF (fb,,-- ~ ./ , 197f . .....~~tKI, Notary I'UDIIC - . MVtORl,mission Expires August \7, \98\ \. .. a'iijs~iJrg, PA Dauphin County EXHIBIT "A" r~ 35-E-5 - 9-77 .. 4 '. :REPORT OF COMPETENCY EXAMINATION - , ~~ous~, J03~PH A. h. D. 4 SHIP:"'HJSB'JRtj, f'A. 17~S7 :->~ Ih~'-';C-j;)7.~ 1:.'-:;'t-1.' It AI 1-';'0. bih ;j hA iJ::. l,j;:- .';L Lu Y ED 19"126 ')- H-76 ~91 JOSEPH CROUSE 2UI-A NAME . EXAMINER INSTITUTION HARRISBURG STATE HOSPITAL SINGLE I DATE ADDRESSOGRAPH PLATE INSTRUCTIONS: Set forth below your opinion as to whether the patient/resident meets the legal standards of incompetency Include the medical and factual basis for that opinion. If you have used a competency worksheet (state centers and MR units only) itcan serve as the factual basis for your opinion. Attach a copy to this form. Under Pennsylvania law, a person may be adjudicated incompetent if he or she, as a result of mental illness, mental retardation, or old age: (1) is unable to manage his or her property; or (2) is likely to dissipate that property; or (3) is likely to become the victim of designing persons; or (4) lacks sufficient capacity to make or communicate responsible decisions concerning the use and management of his or her entitlements. Your opinion regarding competence must make reference to at least one of these standards. Use as much space as needed and be as detailed as possible. Medical basis should refer to both diagnosis and its manifestations. Factual basis refers to questions and answers regarding the four standards above. Please sign on bottom. If additional space is required, use an attached sheet. ~. t/~~ ~-r/~4~ ~~~2h<./~ r c9 ~ ..d-eQ.. j;{, L -u. cU<,'!'4~ au ~ ~. -j- ~ d:. ~l~ ,:?J4)/ --ud~ ~ ~ty ~ A ~ "-<,,..,-7_1" +V>~ -",,' ~ -/-.<j' r~ ,& "'-" P7C>Y"'::::::" .7 ~__~..., ~. ~ .0/ ~L 4 ~4~/ / _ ~::. 'U.';,c.?-c 92-...'./ ~ ~ ::z:- ~<?~:-t' -;- /~...u~~ 4<.,.~~ a ,~' ;;~ 4~",~ CONCLUSION: (Please respond Yes or No) DYes (B Yes (kJ Yes (29 No DNo LJNo The patient/resident is capable of managing his/her financial affairs. The patient/resident is incapable of managing his/her financial affairs. (If Yes, respond to the following question.) If the patient/resident is incapable, is the patient's!resident's inc~pability to manage his/her financial affairs a product and/or manifestation of his/her mental retardation, mental illness, or old age? _ l .__)__~. D Competent Ga Incompetent \~~;;U"~"t')t/ S. .('<,y'/C::h " '----,I SIGNATURE OF REVIEWING PSYCHIATRIST,PSYCHOLOGIST COMMONWEALTH OF PENNSYLVANIA SI 533 - 8 - 77 a:NSENT OF Pr0Pa3ED GUARDIAN I, Kenneth L. Dissinger , Guardian Officer of Harrisburg State Hospital , do ~ certify that I and IW successors in office are willing to act as Guardian for the estate of Joseph A. Crouse , an alleged inc:x:npetent, if the Court shall so appoint. Further, I do hereby certify that I am not a fiducicu:y of any estate in which the alleged inc:x:npetent has an interest, nor have I any interest adverse to the alleged inc:x:npetent. '!he facts and opinions contained herein are true and correct to the best of IW knowledge, infomation and belief. ~ 19,IdJ EXHIBIT "B" MI/MR 35-E-6 - 9-77 '. . . ' IN THE MATTER OF . . IN THE ORPHANS' COURT OF JOSEPH A. CROUSE CUMBERLAND COUNTY. An Alleged Incompetent No. of 19 COMMONWEALTH OF PENNSYLVANIA, COUNTY OF CUMBERLAND ss.: V. G. del Rosario, M.D. , being duly sworn according to law, deposes and say that 1. He is a regularly licensed, practicing physician specializing in psychiatry, who is employed at the hospital or institution known as Harrisburg State Hospital at Cameron & Maclay Streets, Harrisburg, Pa. 17105 located where on September 26 , 19~, he examined a patient therein, vi z : (Name) JOSEPH A. CROUSE , (Age) 59 , (Sex) M The examination revealed that the above-named patient's condition has not changed since the examination of Apri 1 1, 1977 2. It is the opinion of the affiant that Joseph A. Crouse is still incompetent. 3. Said patient is in such physical or mental condition that he/she is capable of appearing in court and his/her presence in court will not endanger others in the court room. OR ([} Because of the physical or mental condition of said patient, his/her welfare would not be promoted by his/her presence in court, and ~/her presence might endanger others in the court room. Sworn to and subscribed _of before me this "d..7 * day ~~~ . ~ I/. $'- tf2-P /4 hr- _ . M.D. CH!\R.lES H. BROWN, No\~ry pubrlC My COI'IllI!nion ElIjlires Auousl 17. 1981 II . L po. DIlIPbin County ilrl'uUfCJ. .. - '. - IN THE MATTER OF IN THE COURT OF COMMON PLEAS JOSEPH A. CROUSE AN ALLEGED INCOMPETENT OF CUMBERLAND COUNTY, : PENNSYLVANIA : ORPHANS' COURT DIVISION NO. 19 AFFIDAVIT OF SERVICE Joseph Miller, being duly sworn according to law, deposes and says that he/she personally served the within Citation and Petition upon Joseph A. Crouse at Harrisburq State Hospital, Harrisburg, Pa. , on September 25, 1978 · at 10: 10 a.m./~J~., by reading to him/her the contents of the Citation and Petition and leaving with him/her a copy of said Citation and said Petition. ;(;,~~ ~ V' ~ . ) SWORN TO AND SUBSqq..BED BEFORE ~ THIS 01~ DAY OF 'fJ~ J.;;L , 19:1t / (~_idii ? ;;~.,4v NOTA PUBLIC~ NOTARY PUBLIC My :QmmiU;on Expire. June 25, 1979 Harr's~'rn p. D' . ...,." u. llU(:'nrn County IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOSEPH A. CROUSE ORPHANS' COURT DIVISION NO. 494 19 78 AN ALLEGED INCOMPETENT AFFIDAVIT OF NOTICE JOYCE A. HORNER , being duly sworn according to law, deposes and says that she gave notice of the hearing scheduled on October 12, 1978 on the above-captioned matter by sending by Certified Mail, Return Receipt Requested, a copy of the Court Citation and a letter of explanation from Edward P. Carey, Assistant Attorney General to all next of kin of the above-captioned person at the addresses supplied by the institution of which the alleged incompetent is a resident. A copy of the Citation and the letter(s) are attached. ?fL a. ~ Y A. HORNER Sworn to and Subscribed Before me this 13th day' of OCTOBER , 19 ~. ~I?~ Notary Public NOTARY PUBLIC MY COMMISSION EXPIRE~ MAY 13, 1982 IN THE MATTER OF IN 'l'HE COURT OF COL'-mON PLEAS OF JosephA. Crouse (name) COUNTY, PbNNSYLVANIA ORPHANS' COURT DIVISION -No. 4 q '-I [).A{2-f~ 19'78 An Alleged Incompetent CITATION .TO: Joseph A. Crouse tve command you to appear at a hearing in the Orphans' Court of Cumberland , County, to be held at Harrisburg State Hospital on October 12. 1978 , 19__, 9:30a.m. at ---.:.M., to show cause \.,hy you should not be adj udged an ;i,ncompetent, and a guardian appointed for vourestate. d and to be hear Citation Returnable/ the 12. day of . Oc tober 1978 . \vITNESSETH: The Honorable Dale F. Shughart President Judge of said Court, sitting in the Orphans' Court this 13 day of September , 19 78 . ~LERK OF THE ORPHAN ' COURT DIVISION t~,'il~ ". -,,-'.~-,~' IA . - COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE HARRISBURG. PENNSYLVANIA 17120 JA'II1ES R. ADAMS GENERAL COUNSEL September 18, 1978 TELEPHONE NUMBER 787-6398 AREA CODE 717 Bruce Crouse 240 W. King Street Shippensburg, PA 17257 RE: J03EPH A. CROUSE Dear Mr. Crouse: Dr. John B. Logan, Superintendent of Harrisburg State Hospital, has petitioned Judge Dale Shughart of Cumberland County Orphans' Court to declare -the above listed patient incompetent and to appoint Ken Dissinger, Guardian Officer at Harrisburg, guardian of his/her estate. Although your relative has been a resident at Harrisburg for some time, without an adjudication of incompentency, such an adjudication is now necessary because a Federal Judge has decided that a Pennsylvania State Employee may not fulfill the role of guardian without an official court adjudication of incompetency. A hearing on Dr. Logan's petition has been set for Thursday, October 12, 1978, at Harrisburg State Hospital at 9:30 a.m., with Richard W. Stewart, Esquire, Master. Unless you have some obj ection to the appointment of Mr. D'issinger as guardian you need not attend the hearing. I have, nevertheless, attached a copy of the Court's Citation which has been served on your relative. If you do'intend to be present please give me a call at the above number. Also, if you have any questions about this matter please feel free to call me. Sincerely, /'" '-1/ 1" Z(.(;.~"".~J '. ((;1.(\ Edward P. car~t Assistant Attorney General EPC: jh Attachment CERTIFIED MAIL - RETURN RECEIPT REQUESTED ----;:----:--::-----------.--~-_.......-.-..- ~.__.~- LEE-VEZ-o-LL61 : Odllli- S1YI.1.INI S.>UI310 :3snY:>3S ~3^113a 0.1. 31SYNn '9 l,-!djjllP')Z!~Oql.[] d,)SS,llpPV 0 3~n.1.YNeIS 'ilAoql! p;,q!-l:>S;'P ;'P!l-Ill ;,ql P;,A!;'3;'.1 ;'Al!q I CIU." .10 ..SUJpp. JO .Jnl.u2ls ullqqo s.<*MIY) I (((;6(;91 'ON 03~nSNI 'ON 031.:11.1.~30 ON 03~3.1.Sm3~ t :NOI.1.dI~OS3a 3101.1.~Y 'E ~ LS(;L 1 Vd' bmqsuaOO1QS ::! ~~S 6~ OM Ov(; ~ asnm;:) ooru:g ~ II: :0.1. 03SS3~aOY 31:>1.!.~Y 'Z 1B~SVW'i~.R[1~Jlcg1 , (SHE 110<1 ---,'"$ , bd"'!I;'p JO S~Jppe pUll ';'lep 'woq,'d Ol ,'doqS , ! 'AlI3:An:3:G G3:.I.::>IUS3:lI 0 JI---:---r' " ' . . . , , , 'pd.l;'A!I;'P ;,lep pUll woq,'d Ol ,'doqS ~ AlI3:An:3:G G3:.I.::>IlI~S3:lI 0 JI-' '..u;'A!I;'P JO S~ppll pUll ';'lep 'woq,'d Ol ,'doqS 0 JI-' . , . . " , . 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'" ...... ....,..... . -<'" ..c< w",. oz..... 0......... .- ~fI/F.."" ~ ~.'......"_,,......., ~,..L-. - -'" - - ill " .~ . ,;..... . ~~li3 ,~' -- ,~~ ~~ I'. " COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE HARRISBURG, PENNSYLVANIA 17120 JAMESRo ADAMS GENERAL COUNSEL September 18, 1978 TELEPHONE NUMBER 787-6398 AREA CODE 717 MrS. Zelda Mooney R.D.#l, Box 302 Shippensburg, PA 17257 RE: JOSEPH A. CROUSE Dear Mrs. Mooney: Dr. John B. Logan, Superintendent of Harrisburg State Hospital, has petitioned Judge Dale Shughart of Cumberland County Orphans' Court to declare the above listed' patient incompetent and to appoint Ken Dissinger, Guardian Officer at aarrisburg, guardian of his/her estate. Although your relative has been a resident at Harrisburg for some time, without an adjudication of incompentency, such an adjudication is now necessary because a Federal Judge has decided that a Pennsylvania State Employee may not fulfill the role of g~ardian without an official court adjudication of incompetency. A hearing on Dr. Logan's petition has been set for Thursday, October 12, 1978, at Harrisburg State Hospital at 9:30 a.m., with Richard W. Stewart, Esquire, Master. unless you have some objection to the appointment of Mr. Dissinger as .guardian you need not attend the hearing. I have, nevertheless, attached a copy of the Court's Citation which has been served on your relative. If you odo intend to be present please give me a call at the above nu~ber. Also, if you have any questions about this matter please feel free to call me. 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IN TPE HATTER OF IN THE COURT OF COHHON PLEAS OF Cumberland COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION 494 of 1978 Joseph Crouse (An Alleged Incapacitated Person) ANNUAL REPORT OP GUARDIAN .. Assets at Beginning of Period: 1. Cash, Certificate of Deposit, Savings Account 2. Burial Fund 3. 4. S 1.538.56 2,122 .18 TOTAL S 3,660.74 Income from November 17, 1995 to' November 16, 1996 . . 1. .Social Security for ___ ~onths at S 2. Social Security for ___ months at $ 3. Interest added to Burial Fund 4. Interest added to Regular account(s) s. per month per ~onth S 69.82 TOTAL S 69.82 Uisbursements from November 17, 1995 to November 16, 1996: 1. Care/tlaintenance at Ha'Crisburg State Hospital from to S 2.. Personal Spending 3. Clothing/~hoes/Hiscellaneous 4. Room/board outside a State facility s. 510.60 TOTAL S 510 . 60 SUHHARY Assets as of Income froll 'November 17, 1995 .November 17, 1995 S 3,660.74 S 69.82 S 3,730.56 S 510.60 S 3,219.96 2,122.18 S 1,097.78 including Burial Fund to Novwmber 16, 1996 SUBTOTAL to November 16, 1996 Disbursements from November 17, 1995 Balance as of November 16, 1996 Less Burial fund Account ACTUAL CASH ON HAND '. - .. . Joseph Crouse IN THE COURT OF COMMON PLEAS OF Cumberland COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION 494 of 1978 IN THE MATTER OF 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. GU?!.~fi~ SWORN TO AND SUBSCRIBED BEFORE ~IE THIS.y'~AY OFJCflC~ ' 1991 ..., !\ .'.....- NOTARY PUBLIC NOTARIAL SEAL WAY.i\NOERSON. Notary Public PA Dauphin County f:.,~i"res 3.'lj9:97