HomeMy WebLinkAbout94-01120
ESTHER L. ALLEN, IN THE COURT OF COMMON PLEAS OF
plaintiff
: CUMBERLAND COUNTY, PENNSYLVANIA
:
v.
CIVIL ACTION - LAW
NO. 1/;).0 CIVIL 1994
EDDIE L. AKINS,
Defendant
CUSTODY
ORDER OF COURT
AND NOW, upon consideration of the attached complaint, it is
hereby directed that the parties and their respective counsel
appear before ----1].....p("(+ "- &,')r 0./ t'<l , the conciliator, at
.
--l/.1.J,....BoC( ( /J\," ~ . Co. (oWtA ()o')~'n the 'd IS/- day of A fir j /
1994, at q~,:?o /J .m., for a Pre-Hearing custody Conference. At
,
such conference, an effort will be made to resolve the issues in
dispute; or if this cannot be accomplished, to define and narrow
the issues to be heard by the court, and to enter into a
temporary order. Failure to appear at the conference may provide
grounds for entry of a temporary or permanent order.
For the Court,
YOU SHOULD TAKE THIS
~u~.~ ~.A.~ r~,
~
PAPER TO YOUR LAWYER AT ONCE. IF YOU
DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
COURT ADMINISTRATOR, 4th FLOOR
CUMBERLAND COUNTY COURTHOUSE
CARLISLE, PENNSYLVANIA 17013
TELEPHONE NUMBER: (717) 240-6200
( I"~
.H
j'"lT
.n
"
rl!.t:
9
l' ?l
I..
:i '9~
,I
~ " ~;,
. . I
ESTHER L. ALLEN,
plaintiff
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. CIVIL 1994
v.
EDDIE L. AKINS,
Defendant
CUSTODY
COMPLAINT FOR CUSTODY
1. The plaintiff is Esther L. Allen residing at 1368
Grandview Court, Carlisle, Cumberland county, Pennsylvania 17013.
2. The defendant is Eddie L. Akins, residing at 2512
catalina Drive, orlando, orange county, Florida 32805.
3. plaintiff seeks custody of the following child:
~
Present Residence
~
10 (9/19/83)
Crystal Victoria Akins
2512 Catalina Drive
Orlando, Florida
The child was born out of wedlock.
The child is presently in the custody of Eddie Akins, who
resides at 2512 Catalina Drive, orlando, orange county, Florida
32805.
During the child's lifetime, she has resided with the
following persons and at the following addresses:
~
Address
~
plaintiff, defendant,
Daniel Allen
(plaintiff's son),
Loukisha Akins,
(defendant's daughter),
Eddie Akins, Jr.
(defendant's son), and
Crystal
1330 Brooks Street
Orlando, Florida
1986-87
Plaintiff, defendant,
Daniel Allen
(plaintiff's son),
Loukisha Akins,
(defendant's daughter),
Eddie Akins, Jr.
(defendant's son), and
Crystal
Plaintiff, defendant,
Daniel Allen
(plaintiff's son),
Loukisha Akins,
(defendant's daughter),
Eddie Akins, Jr.
(defendant's son), and
Crystal
Plaintiff, Daniel Allen,
and Crystal
Defendant and crystal
Seabrooks Street 1987-88
Orlando, Florida
orange Blossom Trail 1988-90
Orlando, Florida
1368 Grandview Court 1990-2/5/94
Carlisle, PA
2512 Catalina Drive 2/5/94-present
Orlando, Florida
The mother of the child is Esther Allen, currently residing
at 1368 Grandview Court, Carlisle, Pennsylvania.
She is divorced.
The father of the child is Eddie Akins, currently residing
at 2512 Catalina Drive, Orlando, Florida.
He is divorced.
4. The relationship of plaintiff to the child is that of
mother. The plaintiff currently resides with the following
persons:
~
Daniel Allen
RelationshiD
son
5. The relationship of defendant to the child is that of
father.
The defendant currently resides with the following persons:
~
RelationshiD
Crystal Akins daughter
6. Plaintiff has participated as a party or witness, or in
another capacity, in other litigation concerning the custody of
the child in this or another court. A case involving custody was
dismissed by the Ninth Judicial Circuit Court in orange County
Florida on or about November 27, 1991. See attached exhibit A
incorporated by reference.
On or about December 6, 1991, when the child was living
with her mother in Cumberland County, a support petition was
filed in this county, and a support order was entered on or about
January 28, 1992, by this Court in cooperation with the state of
Florida. See attached exhibit B incorporated by reference. As
of February 9, 1994, the case was still pending.
7. Plaintiff has no information of a custody proceeding
concerning the child pending in a court of this Commonwealth.
8. Plaintiff does not know of a person not a party to the
proceedings who has physical custody of the child or claims to
have custody or visitation rights with respect to the child.
9. The best interest and permanent welfare of the child
will be served by granting the relief requested because:
a. The mother has been the primary caretaker of the
child.
b. The mother offers a more stable environment than
that of the father.
c. The child has been adversely affected by the
father's actions including the following: snatching the child
from her mother's custody where she has been since 1991 and
removing her from school mid-semester.
d. Since the father took the child on or about February
5, 1994, he has not acted in the children's best interest by
denying the mother contact with the child in spite of the
mother's repeated requests, and the mother has been denied phone
contact with the child.
10. Each parent whose parental rights to the child have not
been terminated and the person who has physical custody of the
child have been named as parties to this action.
WHEREFORE, the plaintiff requests this Court to grant
custody of the child to the plaintiff.
The plaintiff requests any other relief which is just and
proper.
Respectfully submitted,
~J
an Carey
ttorney for Pla~ntiff
LEGAL SERVICES, INC.
a Irvine Row
Carlisle, pa 17013
(717) 243-9400
The above-named Plaintiff, Esther L. Allen, verifies that
the statements made in the above Complaint are true and correct.
Plaintiff understands that false statements herein are made
subject to the penalties of 18 Pa. C.S. 64904, relating to
unsworn falsification to authorities.
;? c.;
Date:, - I 0- 7 Y
~/k, dffi--
Es her L. Allen, Plaintiff
'.
'. ". I
;,......o.::Lo_.- -A ,,1:-;..\'"1:"0-
o
,'---
,'::. -
. ...-...
~
, ,.J ,,~ -
,,( 0,
.' ~"
,J'",:$.
-,-
"'l",
.
. .~
.. ..'
.
,
,
"
,....
.
-' ""17' n~
, ":'," 2 I' \'11 _' r."
I, .
j
.' L:.' ';~~:'~: .
\...,~:~ft,tt.. (,1
. 1t.1;
\;, '
. ::,.;
"
,.
,,'
IN THE CIRCUIT COURT ..',~i:.,
NINTH JUDICIAL CIRCUIT
oRANGE COUNTY, PLORID~'OS
.', \
CASE NO.JU~\~.': ;
" ....;
...."'..~.
.....,~"\!
"'~r;", .
. ,'t' . ~
, ';:1' IN THE INTEREST OF:
':/!1:':~' , (} III. '
','.oJ..'..,' ~ '-~
. .' '". ~ ." , .
:, '1. ,CH (REN)
, ,
. . ..~~'\. .
..'So'
I.,
," '.'
,,' 1.
, ..
"
/
~ 'i.:":;~.;"'~... .":", 1._.
WHEREAS
t dd J'e. ~~
;,
has tillleS a Petition, under oath, in 'jthill Court alleqinq that the
above-named childfreR) is;.ave tl 11 ~j...t/dependent within the intent
and meaning of Chapter 39, Florida Statutes, and it appearing to the
Court that all persons entitled to no~ice of h8arinq have been duly
notified thereOf, aneS the said child(ren) having had due examination
upon the evidence adduced at the hearing, the court tinds as follows:
,
That the above-named child(.eera) is/ee child(:aoeft) within the
jurisdiction of this court, and that the allegations ot the saieS
Petition are not sustained; that the said child~) is/aee not
Il.U_"S~.....t/dependent within the intent and meaning of Seotion 39.01,
- ,-. Plorida--statut'es,--as"alleged," 'lmd th1fco~rt'lJiv.tmr'thi's' "llIatter .tull .. ('
consideration, it is thereupon (,
::
,
ORDERED AND ADJUDGED as follows:'':
It is hereby Ordered that this case Je and the same is dismissed.
~
I ~
DONE AND ORDERED this~dat of~Jfl~\.bf,/'" A.D.,19~.
,~~~ . ~,
a;~uit JUdge
Copies to:
Detense
SA
\ / DHRS
vQ
25-74 ~l?ff,1
.-
.....( ,
\1" .
1:: rh,bd f)
..'
...
r-
.
IN THE INTEREST OF:
a child ~fj {oj)
OJ~
<,.-,-"~...<,,..,
.-
r"
(
~
IN THE CIRCUIT COURT
NINTH JUDICIAL CIRCUIT
ORANGE COUNTY, PIDRIDA
JUVENILE DrgjIO~C:::
CASE NO. JU - ODIJ.
1
-=>
!;:
~ .'"
::-
~
:::;,
N
N
~
-"
CUSTODY ORDBR
In the name of the State of Florida, to the Sheriff
all Law Enforcement Agencies therein:
a
a ~/female ld, ate of Birth
subject to the jurisdiction of the Ju en
( ) Failed to appear for a hearing.
( ) Failed to cooperate with Counsel.
( ) Ran away from
( ) Alleged to have Violated conditions
(~Alleg t ave V 01 ted ond tions
(If Other ' ~
WHEREAS
~,'
--9
of said County,' and
, bel eve to be an age
e Law:
You are, therefore, commanded to take into custody the above named Child
and transport said Child to ~lr.ndo Re~i"R.l T"van~'" na"-R~L_u
€8R"8~/e~ea'e SaliS Villag8/DHRS Intake to be produced before the Court to
be dealt with according to law. RBTUllJI 'fO ISSUING COURT Vl'OH CHILD'S
IIIINETBBHTJI (19TH) BIll'l'JlDAY.
Oh.Ud tn b< ~
lAJl R>... 'tfu.r lA.p0Y\ fU& -up I
.
~
day
Physical Description:
Race~sex Parents ~ddJ e a..~.n")
injO- '70 lbs. Address 017 fY:U..n.e..ola.. Dr
Tt OrF!OI~~; 1~~;::~,;:,~~07('\CV\d D I ..p ( 3 ifrok
. trut COr) cr t~f crltinal hltC: ir. thl!. ollter,
Ittk at ~":t elf:.:l! CgUrt
Phone .:
Sehool:
Charge(s) :7\. ''\. I +
~~ f'C)f-1 \ '
IlIpu!y Cler_
e.l.d. --/. - d-~ -9 I
~::'u.,.,oI ~ 'fo E~d;.. AI'i"'!>/
(3/90) M-h..n:.I. ~
tluld ~~J ~b ~ 0I~ih:,.- D.h~? r, ~t{\ ,0 , . -, '1
PAGE 01
J
CERTIFICATE AND, ORQER
II
I'lArHf"',l'ffITIONUI
o I~ NOH AlIle
Dl lV-O AllICIIV.EfOSfUl CAllI
ONOHlV-O
INITIATING CASIIOOCKIT NO,
ESllIER L. AU.m
",
DR 19,631 / No. 11 Suppor 1992
~ISTATE
QJnberland / PA
OTHEllIlUUI!HCl! NO,
'IU ......
DEFENllAHTlRESPONDENf
, EDDIE L. AlCINS
RISPONDINO CASI/DOCIln NO.
IXlUNTYIlfArI
Orange / n.
OTHER IlEFEIIEHCE NO.
The undcrsigned, Kevin A. Hess
Illdsc/Fft#fNJ1lfJ/.(rIor the above named Coun/ AdminislRli\'C Agency. hereby "nlncl U (ollows:
I, A petition was filed by the Plalntiff/Petilioncr in Ihis Coun/AdminlllrlllYC AScnc:y in a proceedln, l,alnIt the
DeCcndantlRespoIldcal under ~ provisions of the reciprocal suppon SlalUte: _kin, suppon oC the dependeats
umed In the Ill\&cbcd petition,
2. Thc Defcndanl/Rapondentls belicved to be residing in your jurisdlc:don at:
2512 Catalina Drive
Orlando, Florida 32805
3. In the opinion o( lhc,lII1denlllled Judgc/'fr/>;tY-;; r:;fo/r/t. the eacloscd petition and testimony N' 'OM IICII
from whlch It may be determined thllthe Defendant/Respondent owel a dUlY of suppan 10 thl namlcl depel\dellll
and that such petitioa should be dealt with ac:c:ordlnglo law, A TRUE COpy FROM RECORD
4. AU paymenls should be made payable to and scntto: In Tl8limony whellof, I hire unlo HI my hind
.mJ the 0011 01 Bllld COurt II Ca/111e PA
Domestic Relations sectio ~ '
P.O. Box 320 This., d Il 19 q;z.
Carlisle, PA 17013
WHEREFORE, Ills ORDERED thalthrcc copies or Ihls Cenlncate. with Ihe petllion, I..dmony,
copies of thi, state's ....;p.ucal suppon 1I11Ule, be Iransmlned 10:
,'. ;/1f1 1P ~
, un,
Interstate Centrel Registry
Florida Department of Health and Rehabilitative Services
Olild Support ~forcement
1317 Winewood Boulevard
~ehassee, Florida 32399-0700
AI
4
................
Fxb'lbf ()
PRAECIPE TO PROCEED IN FORMA PAUPERIS
To the Prothonotary:
Kindly allow, Esther Allen, Plaintiff, to proceed in forma
oauoeris.
I, Joan Carey, attorney for the party proceeding in forma
oauoeris, certify that I believe the party is unable to pay the
costs and that I am providin9 free le9al services to the party.
The party's affidavit showing inability to pay the costs of
litigation is attached hereto.
~@- '
o n Carey ~
Attorney for Plaint,ff
LEGAL SERVICES, INC.
a Irvine Row
Carlisle, PA 17013
(717) 243-9400
EDDIE L. AKINS,
Defendant
NO,
CIVIL 1994
v.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
ESTHER L. ALLEN,
Plaintiff
AFFIDAVIT IN SUPPORT OF PETITION
FOR LEAVE TO PROCEED IN FORMA PAUPERIS
1. I am the plaintiff in the above matter and because of my
financial condition am unable to pay the fees and coata of
prosecuting, defending, or appealing the action or proceeding.
2. I am unable to obtain funds from anyone, including my
family and associates, to pay the costs of litigation,
3. I represent that the information below relating to my
ability to pay the fees and coets is true and correct.
Addrese:
Esther L, Allen
1368 Gr8ndv~w Court
Carliele.-EA-17013
(a) Name:
Social Security Number:
261-90-2328
(b) If you are presently employed, etate
Employer:
Address:
~f1ce ManftAement
,;lJtQ,~,Ji8dlitA.lt Dr i ve
qj\!I!fLlilll, PA 17011
Salary or wages per month: _,_tllOO.OO
Type of work: ___QLeOD-Ql.fio..es
If you are preeently unemployed, state
Date of last emp 1 oyment: ,_....--":ILA
Salary or wages per month:
Type of work: ____
."~'....-- "','.,_'",-"",""
(c) Other income within the past twelve months
Business or profession: 0
Other self-employment: 0
Interest: 0
Dividends: 0
Pension and annuities: 0
Social Security benefits: 0
Support payments: 0
Disability payments: 0
Unemployment compensation and
supplemental benefits: 0
Workman's compensation: 0
Public Assistance:
$2.430.00/for 6 months crior
to emclovment
Other:
o
(d) Other contributions to household support
(Wife)(Husband) Name:
N/A
If your (husband) (wife) is employed, state
Employer:
Salary or wages per month:
Type of work:
Contributions from children:
(e) Property owned
Cash: $15.00
Checking Account: $ 0.00
Savings Account: $ 0.00
Certificates of Deposit: 0
Real Estate (including home): N/A
r--" ^--~----
"-~"-;--
Motor vehicle: Make Honda
Year
1982
Cost S300.00
Amount owed SO.OO
Stocks; bonds:
o
o
other:
(f) Debts and obligations
Mortgage:
o
Loans:
S12.00
SO.OO
Rent:
Monthly Expenses:Groceries S240.00: Electric S30,OO:
Gas for cooking/heating S75.00: Insurance for vehicle
S65.00: Gas for vehicle S50.00: TV Cable S40.00: '
TeleQtLone S60.00: Life insurance S48.00: Clothing
S50.00: Miscellaneous household exoenses S75.00
(g) Persons dependent upon you for support
(Wife) (Husband) Name:
N/A
Children, if any:
Name: Daniel Allen
Age:
17 vears
Crvstal Akins
10 vears
4. I understand that I have a continuing obligation to
inform the court of improvement in my financial circumstances
which would permit me to pay the costs incurred herein.
5. I verify that the statements made in this affidavit
are true and correct. I understand that false statements herein
are made sUbject to the penalties of 18 Pa. C.S. 4904, relating
to unsworn falsification to authorities.
Date:
.:2 - I ct - 9',/
~/~.~ ./f?a:v-
E her Allen, Plaintiff
-;:r
~
>-,..
~..-
,"':r:
~ ~ ,~: : T"'t
::c
~-
~
....
-::r
::;. -~) -:
=
'"
"
::.:::
"
,.
Allen, . IN THE COURT OF COMMON PLEAS OF
.
Plaintiff .
.
CUMBERLAND COUNTY, PENNSYLVANIA
VS. .
.
\ CIVIL ACTION - LAW
Eddie L. Akins,
Defendant NO. 1120 CIVIL 1994
.
.
CUSTODY
AFFIDAVIT OF SERVICE
I, Michelle D. Smith , did personally send first by
registered mail and then again by ordinary mail a certified copy
of the above-captioned Complaint for Custody and Order of Court
to the defendant, Eddie Akins, on March 15, 1994 and on April 19,
1994, at 2512 Catalina Drive. Orlando. Florida. 32805.
The defendant, Eddie Akins, did not accept service of the
above-captioned Complaint for custody and Order of Court when
served by certified mail.
I verify that the statements made in this Affidavit of
Service are true and correct. I understand that false statements
herein are made subject to the penalties of 18 Pa. C.S. section
4904 relating to unsworn falsification to authorities.
Date:
if /11 /tit!
iJlkJult/ @ -6lvd
-;:r
en
-
:.-~
oJ< ,_
..... ~
~~~:~~
-.>-.'. ,.
. ~::...
',.,
::c
a..
l"-
Ilt
,;>')
C"') ..;oJ
...;.;.l.
.-
~ o:..j
0Cl:
...
;'1AY 16 au J",
ESTHER L. ALLEN,
PlaintifE
: IN THE COURT OF COMMON PLEAS OF
:CUHBERLAND COUNTY, PENNSYLVANIA
v
.
.
:NO. 1120 - CIVIL - 1994
EDDIE L. AKINS,
DeEendant
.
.
.
.
:CIVIL ACTION - CUSTODY
COURT ORDER
AND NOW, this II.~ day oE ,.,,~, 1994, upon consideration oE
the attached Custody Conciliation Report, it is ordered and
directed as Eollows:
1. It is directed that the Mother, Esther L. Allen, and the
Father, Eddie L. Akins, shall have shared legal custody oE
Crystal Victoria Akins, born September 19, 1983.
2. The Mother, Esther L. Allen, shall have primary physical
custody oE the minor child.
3. The Father, Eddie L. Akins, shall have temporary custody oE
the minor child at such times as agreed upon by the parties.
4. This Order is entered pursuant to the attached Custody
Conciliation Report. In light oE the Eact that the Father
did not attend the Custody Conciliation Hearing, this Court
will entertain any appropriate Petition Eiled by the Father
which Petition may request a Hearing on the merits oE the
Custody Order and may also raise any issues the Father Eeels
are pertinent pertaining to this Court's jurisdiction over
the minor child.
5. Mother's counsel is directed to serve a copy oE this Order
on the Father by certiEied mail, by regular mail and attempt
through the appropriate public oEfices in Orange County,
Florida to achieve a personal service oE the Order upon the
Father.
BY THE COURT,
cc:
/ ,/
-1\ t-. /j. f;k...
Judge ,fCevin A. Hess
Joan Carey, Esquire .f n. ("14 (\"f-U.., p...kt ,( ~4....
/
uLL.
t-- :1/,.
nAY /7 8 112 ~H 'S~
(',"5
I). . H..;'1~i'AM}
f.Ul-:';':"!'l;)''':''':'';'''
''["', " ~: ' '. ',' /. '1' :_~
.....
ESTHER L. ALLEN,
PlaintiU
:IN THE COURT OF COMMON PLEAS OF
:CUMBERLAND COUNTY, PENNSYLVANIA
v
.
.
:NO. 1120 - CIVIL - 1994
EDDIE L. AKINS,
DeEendant
.
.
.
.
:CIVIL ACTION - CUSTODY
PRIOR JUDGE: KEVIN A. HESS
CONCILIATION CONFERENCE SUNHARY REPORT
IN ACCORDANCE WITH CUMBERLAND COUNTY RULE OF CIVIL PROCEDURE
1915.3-8(b), the undersigned Custody Conciliator submits the
Eollowing report:
1. The pertinent information pertaining to the child who is
the subject oE this litigation is as Eollows:
Crystal Victoria Akins, born September 19, 1983.
2. A Conciliation ConEerence was held on April 28, 1994, with
the Eollowing individuals in attendance:
The Mother, Esther L. Allen, with her counsel, Joan Carey,
Esquire.
3. There was an attempt made to serve the Father with notice oE
the Conciliation Hearing. An attempt to make service by
certiEied mail was returned as "Unclaimed". PlaintiEE's
counsel has Eiled an AEfidavit oE Service indicating that
notice oE the Conciliation ConEerence was sent by regular
mail on April 19, 1994.
4. This case has a unique procedural history. The parties
resided in Florida Erom 1987 through 1990. In 1990, the
Mother moved to Carlisle with the minor child and instituted
custody proceedings in Cumberland County. At that time, the
Father contested jurisdiction in cumberland County and
Cumberland County declined to accept jurisdiction. There
was then litigation filed in Florida in the nature oE a
Dependency Claim at Orange County, Florida Docket No. JU91-
2004. This litigation was dismissed by Order oE November 27,
1991. Mother maintained custody oE the child while the
litigation was pending in Florida, and Mother maintained
custody oE the child after the litigation in Florida was
concluded. The child remained in Mother's custody through
February 5, 1994. Father had temporary custody with the
minor child Eor the summer months in 1992 and 1993. The
Mother instituted a Support Action against Father in
December oE 1991. Judge Hess certiEied the support papers
Eor reEerral to Florida in January oE 1992. The Father
contested paternity and a Hearing was not scheduled in
Florida until February 10, 1994. On February 5, 1994,
the Father came to Carlisle and took the minor child
back to Florida without the permission oE the Mother. On
March 9, 1994, the Mother instituted this Custody Petition
in order to obtain a Custody Order to have the child
returned to her.
5. Based upon the inEormation that was presented to the
Conciliator at the ConEerence, it appears that Pennsylvania
has jurisdiction over the minor child. The child attended
school in the Carlisle Area School District Erom December
1990 through February 1994. The child's contacts with
Florida were limited to visiting the Father during the
summer. The Mother is not aware oE any pending custody
proceedings in Florida.
6. The Father may contest the jurisdictional issue. The
Father may also contest whether it is appropriate Eor the
child to be in the custody oE the Mother. However, it
appears to the Conciliator that the Father is attempting
to avoid service of the Pennsylvania proceedings and it
appears that the Father did have notice oE the Conciliation
ConEerence which took place on April 28, 1994.
7. In light oE the above inEormation, the Conciliator recommends
an Order in the Eorm as attached.
5'1'1J1 q '{
~
6~~
Hubert X. Gilroy, Esqui e
Custody Conciliator
ESTHER L. ALLEN
Plaintiff
v.
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 1120 CIVIL 1994
EDDIE L. AKINS,
Defendant
CIVIL ACTION - CUSTODY
AFFIDAVIT OF SERVICE
I,
~\
hand a certified
copy of the Court Order of
and the Conciliation
Conference Summary Report in the above-captioned case to the
defendant, Eddie L. Akins, at 3:/0
1994, at N"'kI c:h-r~rA.1A Z)?
?m. on <:".ho
O'~""D-? /-'"L .. ':fZ?C:X-
.
(add ress )
I verify that the statements made in this Affidavit of
Service are true and correct. I understand that false statements
herein are made sUbject to the penalties of 18 Pa. C.S. 64904
relating to unsworn falsification to authorities.
Date:
6/Clh-Y
/
<?4G .,."
~ . :"~lL> :?a~
, ~.,,;........
~
~ >.
:.-. V'~
~ _i
.,
--. ..
-. ,
::::-
'-:,
!.;S '.
..., .. ,