HomeMy WebLinkAbout11-23-81 (2)
. ,
IN THE MATTER OF
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
Kenneth Heim
An Alleged Incompetent
.
: 21- 78 - 5 21 ORPHANS 1978
IN RE: PETITION FOR APPOINTMENT OF GUARDIAN
ORDER OF COURT
,)
AND NOW,
December 15, 1978
, it is hereby ordered and
directed that the report and recommendation of the Special Master
hereinbefore appointed in the above matter, be and is hereby
approved, and that
Jean A. Coggins
, Guardian Officer of
Embreevil1e State Hospital
, and her successors in office are
hereby authorized to receive, hold, and dispose of the estate of
Kenneth Heim
) 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
of $8.00 and a fee of '7S, (10 to
Murrel R. Walters, III, Esq. ,
~~~x court-appointed counsel for the respondent.
It is further directed that the blanket surety bond issued
by
Aetna Casualty and Surety ,Bond No.
57S28546
, is approved
as sufficient bond.
By the Court,
cc: Edward P. Carey, Esquire (2)
Assistant Attorney General
Joseph P. Alexa, Esq.
Special Master
Murrell R. ,Walters, III, Esq.
~a~~iaRXa~iiK~~X
Court-appdhted, for Respondent
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IN THE MATTER OF
IN THE COURT OF CO~MON PLEAS OF
KENNETH HElM
(name)
CUMBERLAND
COUNTY, PENNSYLVANIA
An Alleged Incompetent
ORPHANS' COURT DIVISION
;) / - 7 f - 5- /..- /
19
No.
PRELIMINARY ORDER OF COURT
AND NOW, this
21
day of
September
1978 ,
upon consideration of the foregoing Petition, it is Ordered that a
citation be issued, directed to
to show cause why
KENNETH HElM
HE
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 wi thin Petition should not be made.
JOSEPH P. ALEXA, Esq.
is hereby
appointed Special Master for the purposes of conducting a hearing on
said Petition at the institution at which
KENNETH HElM
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.
is hereby appointed by the court to act as guardian ad litem for
the alleged incompetent
regarding this hearing.
At least twenty (20) days written notice of the hearing
shall be given to
KENNETH HElM
f.- '~r'.'.~.
_'_"'~ .J_V.) I
780
t
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.
Murrel R. Walters, III, Esq., be and is hereby appointed to represent
the respondent. Sandra Gobrecht is assigned to take stenographic
notes of testimony.
BY THE COURT:
;Jvv#/~ J.
~..J.~ iGJ I,\)L 781
--,-
...
IN THE yr.A TTER OF
IN THE COURT OF CO~~ON PLEAS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
KENNEll HEIM
(name)
ORPHANS' COURT DIVISION
An Alleged Incompetent
NO.
21-78-521
19
REPORT AND RECOyr~~NDATION OF THE
SPECIAL yr.ASTER AND ORDER OF COURT
Upon hearing of the Petition and Citation for Appoint~ent of
a guardian for
KENNEll HEIM
, proof of notice of
the said hearing to his next of kin having been filed, and
attorney
Murrel R. Walters, III, ESQUire appointed as ~
~ the Special Master, appointed by this Honorable Court to hear
said Petition, finds that the said
KENNEll HEIM
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
KENNETII HEIM
should be handled by the
Guardian designated herein.
IT IS THEREFORE RECOM.c"1ENDED THAT
Jean Coggins, Guardian Officer,
and ~her successors in office
be and are hereby authorized to receive, hold and dispose of the es-
tate of the said
KENNEll HEIM
as the duly appointed guardian under Court Decree, and to pay such
debts as enQmerated :Ln said Petition, such debts having been found to
be proper and in accord with law.
.
The guardiari, within three months after real or personal es-
ta~e of the incompetent C9mes 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.
'.
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.' I. ..'..A.,., ~ 1/', . I.; -,' t',-r ('^ I _
.,' srr1ial Master f
DATE:
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/ '/7 '5
. rn THE MATTER OF
rn THE COURI' OF (l)M.K)N PLEAS OF
CUMBERlAND CXXJNTY, PENNSYLVANIA
Kenneth Heim
(nane)
ORPHANS' COURI' DIVISIOO
An Alleged Incanpetent
NO.
19
PEI'ITIOO FOR APPOINIMENI' OF GUARDIAN
The Petition of Harry L. Starr
, Superintendent of
Embreeville State Hospital
, respectfully represents:
1. Your Petitioner has custody of the alleged incanpetent
at Embreeville State Hospital
2. The alleged incx:rnpetent was admitted to the aforesaid
institution on January 3, 1973
3. The alleged incx:rnpetent is daniciled at 177 South mola Drive,
mola, Cumberland County, Pennsylvania
4. The alleged incompetent is 64 years of age, having been
born on December 29, 1913
5. The alleged incx:rnpetent' s rnili tal:y status is:
The alleged incompetent was never a member of the Armed Forces, to the
best of the Petitioner's knowledge
6. The alleged incanpetent' s marital status is:
The alleged incompetent was never married
7. Those persons, if any, who are the alleged incx:mpetent' s next
of kin and their relationship to same, of whan your Petitioner has knavledge
are as follavs:
Mr. S. P. Heim, Brother
43 Wharton Avenue
Middletown, Pennsylvania 17057
8. No other Court within this camonwealth of which Petitioner
has knavledge has appointed a guardian for the alleged incanpetent.
11.. : ;;-''1 1&>. ~ '.', l~-. 776
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MH/~1R 35-E-l - 9-77
9. The alleged inco:rpetent has incane consisting of:
(a) Maney due fran Railroad Retirement
in the arrount of $ 150'. 14 per month
(b) Money due fran
in the am::>unt of $
per
(c)
10. The alleged incanpetent has assets, real and personal, of
which the Petitioner is aware, in the amount of $ 6,817.14 consisting of:
~a) money held by the Guardian Officer of Embreeville
State Hospital in the amount of $ 5,870.98 as of September 31, 19..1]...
(b) "Vecchione Fefund" monies in the am::>unt of $ 946.1.6
ti tie to which is in dispute.
(c)
11. The alleged incanpetent has debts outstanding in the amount
of $ 4,831.13, as of August 31 , 19.1L, consisting of:
(a) $ 3,884.97 owing to the Cartnonwealth of Pennsylvania
as payment for care and maintenance received fran the period Harch 1
19~, to August 31 ,19 78, in accordance with 50 P.S. SS 4501 and 4504
and regulations promulgated thereunder.
(b) $ 946.16 aving to the camonwealth of Pennsylvania as
payment for care and maintenance rendered between July 11, 1974, and
April 4, 1975, which relates to the "Vecchione Fefund", title to which is
in dispute.
(c)
12. The alleged incanpetent is incapable of handling his
financial affairs for the reasons set forth in the attached Affidavit
and Canpetency Report, prepared by Herbert Schiff, PhD
marked as Exhibit A and made a part hereof.
,
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777
MI/~1R 35-E-2 - 9-77
13. Jean A. Coggins , Guardian Officer at
her
the aforesaid institution, and ~ successors in office, having no interest
adverse to the alleged incc::npetent, 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 IIlClde a part hereof as Exhibit B.
14. If appointed as Guardian,
Jean A. Coggins
is required to act in conpliance with regulations promulgated under Court
Order in 5 Pennsylvania Bulletin 931 et seg. (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 conpany or other individual willing to accept
appoint:m::mt as Guardian.
WHEREFORE, the Petitioner prays that a citation be issued
directing Kenneth Heim
, and those
persons, if any, listed in paragraph 7 of this Petition, to ShCM cause,
if any there be, why Kenneth Heim
should not
be declared an incorrpetent and a Guardian of the estate appointed, and
why distribution of assets and inc:::x:>Ire as payment of debts listed in
paragraph 11 should not be made. Petitioner further prays that a guardian
ad Ii tern be appointed to act for the alleged incarpetent regarding such.
hearing.
BY:
-3-
MH/MR 35-E-3 - 9-77
:',"~ O.=:
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"l~ 778
C~TH OF PENNSYLVANIA
CDUNTY OF CHESTER
Harry L. Starr
, Peti tianer in this
matter, being duly SWOTIl according to law, do depose and state that
of Embreeville State
lam
Superintendent
Hospital
and that the facts set
forth in the foregoing Peti tiOll are true and correct to the best of
my kr1<Mledge, infm:mation and belief.
~"m.AND SUBSCRIBED BEFORE
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. ~t;~"~!Jlk,\~ir;:~r!TwP" Chester Co.
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I::lA.Y OF
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~VIT
(X)M.{)NWEAL'IH OF PENNSYLVANIA
ss
COUNTY OF CHESTER
I,
Herbert Schiff, PhD
, being duly swom
acoording to law, depose and say that I am a psyc:ho 1 OEl st-
in the Comronwealth of pennsylvania employed at F.mhrRRvlllR St-;::rtp
Hospital
, and I have examined the patient, KpnnPT"h Hp;m
an alleged incx:mpetent, with care and diligence and based upon said
examination and observations am of the opinion that said patient is
inoonpetent to rranage his"" CMl1. affairs for the reasons set forth in the
attached Carrpetency Report, and that the facts and opinions oontained
therein are true and oorrect to the best of my knONledge, infonnation and
belief.
tJiO/Lj p!;t')
smm 'TO .AND SUBSCRIBED BEFORE
ME 'IHIS / C7 ---c--Z
DAY OF
ILt'i:.<. (~~v/::...e../;~j , 19 :.~;;
LULA F. POLLARD
Notary^P.u~n~~.w. ~~". Cf,c:d T.WD.. Chest~.
M~ CC,'TI_I,;. . Co ,< O~IObc~r 20~O
-"':'1'''--/ I) . \.~:::),. ': ,:;(. e .e '" d-Z-,
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Nota.l:Y Public
EXHIBIT "A"
I'<1H/MR 35-E-5 - 9-77
tlPOIH OF tOMPETHJCY EXAMINATION
'NAME
Kenneth Heim
INSTITUTION
Embreeville State Hospital
EXAMINER
WVIB
Sol Barer.baum, Ph.D.
] DATE
11/28/77
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 M R units
only) it can 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.
Vour 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 111anifestations. Factual basis refers to questions
and ,mswers regarding the four standards above. Please sign on bottom. If additional space is required, use an attached sheet.
Mr. Heim is an individual with mental and adaptive retardation-Severe-313.
I.Q. 27. Mental Age 4 years, three months.
This individual is likely to become the victim of designing persons.
He is unable to manage his property.
Competency Assessment Inventory is attached.
CONCLUSION: (Please respond Ves or No)
,
Dves
GVes
Qves
0No
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 incapability to manage his/her
financial affairs a product and/or manifestation of his/her mental retardation, mental illness,
or old age?
DNa
DNo
.JI!; D
o Inco~mtent
&{/A
SIGNA RE
/?/
F APPROVAL BY SUPERINTENDENT
.,
COMPETENCY ASSESSMENT INVENTORY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
J(~nn('th Hp.im IVJ ! /
INSTITUTION
, .
-
EXAMINER
Addrono rn h Plata
INSTRUCTIONS: The administration of the Competency Assessment Inventory (CAI) should conform carefully to the directions
provided herein. The stated questions and tasks a[e designed to elicit responses which will be used in determini~g whet~er or ~ot a
resident is capable of managing his personal property and/or is susceptible to the deceptions of others. (Pennsylvania Bulletin, Apn119,
1975, Volume 5, Number 17).
If the resident's response is correct, place the exact number of points in the space provided. One point will be given for each correct
response, except where indicated. The examiner should provide the resident's/patient's name, age, and center/hospital number if an
addressograph plat;:; is not available.
PART I - SCREENING QUESTIONS
SCORE
(
t)
1.
2.
Ask the individual to state his/her full name. (Score one (1) point if full name is given).
Have the individual write his/her full name. (Score one (1) point if the individual writes his name accurately).
~. ~
~~
ff-
Individual's Signature
f)
3.
Ask the 'individual to name the current day, month, and year. (Score one (1) point if the individual responds
correctly to all three}.
Ask the individual where he lives. (Score one (1) point if name of in~titution or family address is given).
Ask the individual to read the following:
D
()
4.
5.
/}_ 6.
FIVE TEN SIX NINE NINE HUNDRED
ONE CHECK TWENTY THI RTY.ONE DEPOSIT
lWO BANK FOUR EIGHTEEN SEVENTY-SEVEN
(Score one (1) point for 1-5 words correct; two (2) points for 6-10 words correct; and three (3) points
for 11-15 correct).
Currency Identification - Materials: Penny, nickel, dime, quarter, half dollar. Randomly place the coins in
front of the individual and ask:
_<L-7.
~ (a) Show me the dime
V (b) Show me the quarter
./ (c) Show me the nickel
(Score two (2) points if four (4) or more responses are correct).
Materials: One (1) twenty, ten, five, two, and one dollar bill. Place the bills in front of individual and ask:
v (d)
./ (el
Show me the half dollar
Show me the penny
-2_(a) Show me the two dollar bill
~__,(b) Which bill is worth the most?
o (c) Show me the ten dollar bill
(Score two (2) points if (4) or more responses are correct).
STOP here if the individual has a total score of six (6) or less points .'for items one (1) through s&ven (7).
V (d)
v (e)
Which bill is the smallest amount?
Show me the five dollar bill
PART II - FINANCIAL MANAGEMENT
SCORE
8. If you wanted to buy a radio at the lowest price (least expensive), and saw three radios marked, $7.00
$11.00 $8.00, which radio would you select? (Score one (1) point if the $7.00 amount is selected).
9. Give the individual one dollar ($1.00) in mixed change, and ask: .
(a) If \'OU bought something for 65 cents, show me how much change you would have left?
. rigl)t wrong
(bi If a pencil costs 25 cents, show me how much money you need.
right wrong
(c) If you bought something for 85 cents, how much change would you have left?
right wrong
(Score two (2) points if all three items are answered correctly).
MR 22 7n7
SCORE
10. If you only had $200.00 a month to spend, what would you do with this money? (Score one (1)
point if the following three items arc mentioned: (1) food; (2) clothing; (3) housing).
". Place fifty-two cents (quarter, 2 dimes, nickel, 2 pennies) in front of individual and ask, "How much money
is here?" (Score one (1) point for correct response).
12. Ask the question: If a stranger approached you and asked you for ten dollars, what would you do? (Score
. two (2) points for any response(s) whereby the individual docs not give money to the stranger).
13. Financial Concepts - Ask the individual to explain the following:
(a) checking account (any mention of checking account functions, Le., payment, withdrawal of funds).
(b) savings account (savings of monies in a bank; interest)
(c) social security (a source of monies from Federal Government)
(d) loans (borrowing) (a method of getting money from a source)
(e) life insurance (payment of monies upon death of owner or beneficiary)
(f) salary (wages) (monies earned for work completed)
(g) taxes (money deducted or paid to government for community services and government support)
(h) postage stamps (item bought to be used for mailing letters and packages)
(Score two (2) points if the individual responds correctly to four (4) of the eight (8) items.
14. If someone came up to you on the street and wanted you to buy two watches from them for $100.00, what
would you do? (Score two (2) points if the individual does not buy the watch).
15. Place eighteen dollars (ten, five, 3 ones), in front of individual and ask, "How much money is here?" (Score
one (1) point for correct response).
16. The examiner or the unit staff should complete the following questions by answering yes/no.
,. Does the individual receive money regularly?
2. Does the individual give money and/or possess!ons away indiscriminately?
3. Does the individual frequently lose and/or have his/her m:Jney and/or possessions stolen?
(Score one (1) point if No.2 and No.3 are marked "no").
[L]
TOTAL SCORE
NOTE: It is suggested that a total score of sixteen (16) or more points be used as a cut-off score for rendering an
opinion of competence. A score of fifteen (15) or less points would be used for the opinion of incompetence.
MATERIALS LIST:
Coins: 5 pennies; 3 nickels; 3 dimes; 3 quarters; 1 half-dollar
Bills: 3 ones; five; ten; twenty
/
Is the resident's inability to handle his/hermonies and/or possessions a product of his/her disability?
Yes V No
,../.0
1/
/
DATE
MR 22 . 7.77
-.
IN THE MATTER OF
IN THE ORPHANS' COURT OF
1<ENNEI'H E. HEIM
CIlIMBERLAND COUNTY.
An Alleged Incompetent
No. of 19
COMMONWEALTH OF PENNSYLVANIA,
58. :
COUNTY OF CHESTER
Herbert H. Schiff, Ph.D.
, being duly sworn
according to law, deposes and say that
.
1. He is a licensed or licensable, practicing
psychologist, who is employed at the State Center or Mental
Retardation Unit known as Embreeville State Hospital
located
at Coatesville, Pennsylvania 19320
where on October 16th
, 19 78, he examined a resident therein,
viz:
(Name)
Kenneth E. Heim
(Age)
64
,
(Sex)Ma.le
who was admitted from Pennhurst Center
on January 3rd
, 19~, with a history of Mental
Retardation. Birth and early development were slow. This individual could
not learn to read or write through the second grade.
At the examination of the following symptoms were observed
Mr. Heim was appropriately dressed. He readily accompanied the examiner to the
office, was friendly and cooperative in answering questions. He was unable to write
his name, was not oriented to time and place, is unable to read. He can identify
from which the diagnosis made is: coins but not paper currencv. His most
recent examination indicates a I.Q. of 27.
Severe Mental Retardation, DSM 313
.
~
."
with a prognosis as follows: This individual shows little likelihood,
in the foreseeable future, of learning the value of money and rrJOney management
skills.
2. On the basis of the foregoing history and
examination, the affiant is of the opinion that Kermeth E. Heim
"because of mental infirmities of old age, mental illness,
mental deficiency, drug addiction or inebriety, is unable to
manage his property, or is liable to dissipate it or become
the victim of designing persons," and is, therefore, incompetent.
before me this ,9V
o f(( cot; --f v~-
LUlJI. F. POLLARD
Notar.y Public, W. Bmdfnrd Twp.. Chester Co.
My Commission L;,,',;s :1, i IJ:c' 20, Hffi{l
, "> r _Y -.1" " ~~ff/:(:--;~
Notary Public
day
19 /).
tiJ~t;j1J tf10
, J
-#rB .
".sworn to and subscribed
k
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.
.
COMPETENCY ASSESSMENT INVENTORY
COMMONWEALTH OF PENNSYLVANIA
DEPART E T OF PUBLIC WELFARE
'~
INSTI
Addressogra h Plate
INSTRUCTIONS: The adm I ration of the Competency Assessment Inventory (CAI) should conform carefully to the directions
provided herein. The stated questions and tasks are designed to elicit responses which will be used in determini~g whet~er or ~ot a
resident is capable of managing his personal property and/or is susceptible to the deceptions of others. (Pennsylvania Bulletin, Apnl 19,
1975, Volume 5, Number 17).
If the resident's response is correct, place the exact number of points in the space provided. One point will be given for each correct
response, except where indicated. The examiner should provide the resident's/patient's name, age, and center/hospital number if an
addressograph plate is not available.
PART I SCREENING QUESTIONS
SCORE
I 1. Ask the individual to state his/her full name. (Score one (1) point if full name is given).
2. Have the individual write his/her full name. (Score one (1) point if the individual writes his name accurately).
f\ i~'
," j' '-~.
, li
Individual's Signature
3.
Ask the individual to name the current day, month, and year. (Score one (1) point if the individual responds
correctly to all three).
Ask the individual where he lives. (Score one (1) point if name of in~titution or family address is given).
Ask the individual to read the following:
o
o
()
4.
5.
V 6.
FIVE TEN SIX NINE NINE HUNDRED
ONE CHECK TWENTY THIRTY-ONE DEPOSIT
TWO BANK FOUR EIGHTEEN SEVENTY-SEVEN
(Score one (1) point for 1-5 words correct; two (2) points for 6-10 words correct; and three (3) points
for 11-15 correct).
Currency Identification - Materials: Penny, nickel, dime, quarter, half dollar. Randomly place the coins in
front of the individual and ask:
-l-. (a) Show me the dime
-4 (b) Show me the quarter
-+ (c) Show me the nickel
(Score two (2) points if four (4) or more responses are correct).
Materials: One (1) twenty, ten, five, two, and one dollar bill. Place the bills in front of individual and ask:
+ (d)
+ (e)
Show me the half dollar
Show me the penny
D
7.
~(a) Show me the two dollar bill
..$' (b) Which bill is worth the most?
y t> (c) Show me the ten dollar bill
(Score two (2) points if (4) or more responses are correct).
STOP here if the individual has a total score of six (6) or less points - for items one (1) through seven (7).
- l.j (d)
...... ( e )
Which bill is the smallest amount?
Show me the five dollar bill
PART II - FINANCIAL MANAGEMENT
SCORE
8. If you wanted to buy a radio at the lowest price (least expensive), and saw three radios marked, $7.00
$11.00 $8.00, which radio would you select? (Score one (1) point if the $7.00 amount is selected).
9. Give the individual one dollar ($1.00) in mixed change, and ask:
(a) If you bought something for 65 cents, show me how much change you would have left?
rigbt wrong
(b) If a pencil costs 25 cents, show me how much money you need.
right wrong
(c) If you bought something for 85 cents, how much change would you have left?
right
wrong
(Score two (2) points if all three items are answered correctly).
MR 22 7/77
SCORE
10. If you only had $200.00 a month to spend, what would you do with this money? (Score one (1)
point if the following three items are mentioned: (1) food; (2) clothing; (3) housing).
11. Place fifty-two cents (quarter, 2 dimes, nickel, 2 pennies) in front of individual and ask, "How much money
is here?" (Score one (1) point for correct response).
12. Ask the question: If a stranger approached you and asked you for ten dollars, what would you do? (Score
two (2) points for any response(s) whereby the individual does not give money to the stranger).
13. Financial Concepts - Ask the individual to explain the following:
(a) checking account (any mention of checking account functions, i.e., payment, withdrawal of funds).
(b) savings account (savings of monies in a bank; interest)
(c) social security (a source of monies from Federal Government)
(d) loans (borrowing) (a method of getting money from a source)
(e) life insurance (payment of monies upon death of owner or beneficiary)
(f) salary (wages) (monies earned for work completed)
(g) taxes (money deducted or paid to government for community services and government support)
(h) postage stamps (item bought to be used for mailing letters and packages)
(Score two (2) points if the individual responds correctly to four (4) of the eight (8) items.
14. If someone came up to you on the street and wanted you to buy two watches from them for $100.00, what
would you do? (Score two (2) points if the individual does not buy the watch).
15. Place eighteen dollars (ten, five, 3 ones), in front of individual and ask, "How much money is here?" (Score
one (1) point for correct response).
16. The examiner or the unit staff should complete the following questions by answering yes/no.
1. Does the individual receive money regularly?
2. Does the individual give money and/or possessions away indiscriminately?
3. Does the individual frequently lose and/or have his/her m.:mey and/or possessions stolen?
(Score one (1) point if No. 2 and No.3 are marked "no").
w
TOTAL SCORE
NOTE: It is suggested that a total score of sixteen (16) or more points be used as a cut-off score for rendering an
opinion of competence. A score of fifteen (15) or less points would be used for the opinion of incompetence.
MATERIALS LIST:
Coins: 5 pennies; 3 nickels; 3 dimes; 3 quarters; 1 half-dollar
Bills: 3 ones; five; ten; twenty
~]J
SIGN
DATE
MR 22 - 7-77
CXNSENT OF proPOSED GUARDIAN
I, Jean A. Coggins Guardian Officer
of Embreeville State Hospital , do hereby certify that I
and nri successors in office are willing to act as Guardian for the
estate of Kenneth Heim , an alleged inccnpetent, if
the Court shall so appoint.
Further, I do hereby certify that I am not a fiduciary of
any estate in which the alleged incompetent has an interest, nor have
I any interest adverse to the alleged inconpetent.
'Ihe facts and opinions contained herein are true and correct
to the best of nri knOt/ledge, infonnation and belief.
-r~ tb~~
EXHIBIT "B"
~ 35-E-6 - 9-77
IN THE MATTER OF
IN THE ORPHANS' COURT OF
Kenneth Heim
Cumber land COUNTY.
An Alleged Incompetent
No. of 19
COMMONWEALTH OF PENNSYLVANIA,
ss. :
COUNTY OF
Paul A. Barenberg, M.D.
, being duly sworn
according to law, deposes and say that
1. He is a regularly licensed, practicing physician
who is employed at the hospital or institution known as
Embreeville State Hospital
loca ted at Coatesville
Pennsylvania 19320
where on October 5,
, 1978
he examined a patient therein, viz: (Name)
Kenneth Heim
,
(Age) 65
(Sex) Male .
2. As a result of this examination it is the opinion
of the affiant that:
A. 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
B. Because of the physical or mental condition of
said patient, his/her welfare would not be promoted by
his/her presence in Court, and/or his/her presence might
endanger others in the court room.
Sworn to and subscribed
before me this 5th day
of ?c!ob;,r ~ ___). . 1978.
_.~ l.6I..A<F.POl:.LARD "._-~
- Notar.y Public. W. Bradford Twp., Chester Co.
My Commission Expires October :10, 1980
~cJ d~,-,"J'7
/
i
M.D.
IN THE HATTER OF
IN THE COURT OF COMMON PLEAS
Kenneth Heim
AN ALLEGED INCOMPETENT
OF CUHBER1AND
COUNTY,
PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 19
AFFIDAVIT OF SERVICE
Jean A. Coggins
being duly sworn according to law,
deposes and says that ~she personally served the within
Citation and Petition upon
Kenneth Heim
Embreeville state Hospital
on
at
October 13, 1978
~./p.m., by reading to
at 1 :00
him/lXU the contents of the Citation and Petition and 1eav~ng
with him/~ a copy of said Citation and said Petition.
Gd~c:LW~
f ,"
SWORN TO AND SUBSCRIBED
BEFORE HE-I THIS /9~~
DA Y OF[ /':' _;. , - , 19 ,)f;
Not:r.:' Public, W. Bradford T\^ill.: ester Co.
\:~9m.~iS~Sign .~s,fl'ftmier;.20. 1911""
_-,-/u~ . ;.' liA:.-:'/--'~~
NOTARY PUBLIC
IN THE MATTER OF
IN THE COURT OF COMMON PLEAS (F
CUMBERLAND COUNTY, PENNSYLVANIA
KENNETH HElM
ORPHANS' COURT DIVISION
NO. 21-78-1:)?1 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 27, 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.
9:rg. 0, ~v/}'~v
~Y E A. HORNER _
Sworn to and Subscribed
Before me this 13th day
of OCTOBER , 19~.
d.4ftjJ {llx4.AL~~~
Notary Public
f'VTa.R? meue
J' . :-:t\'r(-~
~...~ . *: ~
IN THE MATTER OF
IN THE COURT OF COW10N PLEAS OF
Kenneth Heim
(name)
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
An Alleged Incompetent
..No.
c;( / - 71(' -:-S<< I
,. .
19
CITATION
TO: KENNETH HElM
~Ye command you to appear at a hearing in the Orphans' Court
of
Cumberland
, County, to be held at
Embreevi11e. State Hospita1on
10:00 a.m.
at ---=...1'-1. I to shO\v cause \"hy you should not be adjudged an incompetent,
October 27, 1978
, 19_,
and a guardian appointed for your estate.
and to be heard
Citation Returnabl~/th~ 27." day of
October
,
19 78.
\'HTNESSETH:
Dale F. Shughart
The Honorable
President Judge of said Court, sitting in the Orphans' Court this
21
day of
September
78
, 19 , .
I _I ( 1 1\ i .
CLERK OF THE ORPHANS' COURT DIVISION
~*
~ .
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
HARRISBURG, PENNSYLVANIA 17120
JAMES R. ADAMS
GENERAL COUNSEL
September 27, 1978
TELEPHONE NUMBER
787-6398
AREA CODE 717
Mr. S. P. Heim
43 VVharton Avenue
Middletcwn, PA 17057
RE : KENNEI'H HElM
Dear Mr. Heim:
Mr. Harry L. Starr, Superintendent of Embreeville
State Hospital, has petitioned Judge Dale Shughart of Cumber-
land County Orphans' Court to declare the above listed
patient incompetent and to appoint Jean coggins, Guardian
Officer at Embreeville, guardian of his/her estate. Although
your relative has been a resident at Embreeville for some
time, without an adjudication of incompetency, 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 Mr. Starr's petition has been set for
Friday, October 27, 1978, at Embreeville State Hospital,
with Mr. Joseph Al-exa, Esquire, Master. Unless you have
some objection to the appointment of Ms. coggins 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,
rt.(L~~/ F ((~\
Edward P. Carey
Assistant Attorney General
EPC:jh Attachment
CERTIFIED MAIL RETURN RECEIPT REQUESTED
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