HomeMy WebLinkAbout02-19-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of German A. Rovnyansky ---
also known as
_ . ,Deceased
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE `A' or `8' BELOW )
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the
last Will of the Decedent dated and codicil(s) dated
named in the
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
^X B. Grant of Letters of Administration
Petitioner(s~ after a proper search has /have ascertained that Decedent left nolWill and was survived by the following spouse (if any) and heirs: (/f
Administration, c. t. a. or d. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.)
Name
Relationship Residence
Alek
G
sey
. Rovnyansky Son
41 Grandview St., A 6 ~'
Sant
C °
Sergey Kaimov a
ruz, CA 950 ,4 ~
"'~ ~~
;~7- ,w ~
1 .~'- fTl .~. ._.. ~ _
r.-..
(COMPLETE IN ALL CASES:) Aftach additional sheets if n
Decedent was domiciled at death in Cumberland ecessary. ~....; __
County, Pennsylvania with his /her last principal resid~;e
t
~~
~
38 Johns Drive, Enola, Cumberland Coun
Li a
ty, PA 17025 (Borough of Enola)
r ~
.~
~'~
(
st street address, town/city, township, county, state, zip code)
Decedent, then 48_years of age, died on 02/16/2010 at Hol Spirit Hospital
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $
(If not domiciled in PA 15,000.00
Personal property in Pennsylvania $
(If not domiciled in PA) •Personal property in County $
Value of real estate in Pennsylvania $
situated as follows: 38 Johns Drive, Enola, Cumberland County, PA 17025 130,000.00
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Signature Typed or printed name and residence
Y L/~~' /// Aleksey G. Rovnyansky 41 Grandview St., Apt. 806
r> ~~ Santa Cruz, CA 95060
~~~~
Form RW-02 Rev_ ~a~s_~rna
COUNTY, PENNSYLVANIA
File Number 21 ~ ~ ~ I -~ 2
Social Security Number 164-72-6036
Copyright (c) 2006 form software only The Lackner Group, Inc.
Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF Cumberland }
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me this ~~ day of
~.~~ ~, ~ ~
For the Register
~~
ryf
Signature of Personal Representative Aleksey G. Rovnyansky
Signature of Personal Representative
Signature of Persona! Representative
File Number: 21 - 1 U U 1 -1 ~
Estate of
German A. Rovnyansky
,Deceased
Social'Securityhumber: 164-72-6036 Date of Death: 02/16/2010
AND NOW, ~ ~ l ~~ l.J~-~ O , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters of Administration
. ~~
,~ ~r..,r
are hereby granted to Alekse G. Rovn ansk in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES
Letters ............................................ $ ~COC=~ vo
_,.,.
Short Certificate(s) ........................ $ ~ • ~-x.•
Renunciation(s) ............................. $
~...~C S $ ~3 . S~
~ z~>~cY~o~~ ~ yr $ L~ - C~
$
$
$
$
$
$
$
TOTAL .................................... $ 3 i~~ • S~
A'
Supreme Court I.D. No.: 23989
Law Offices of Debra K. Wallet
Address: 24 North 32nd Street
Camp Hill, PA 17011
Telephone: 717/737-1300
y Inc. Page 2 of 2
Form RW-OZ Rev. 10-13-2006 Copyright (c) 2006 form software onl The Lackner Group,
Attorney Name: Debra K. Wallet
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 15935593
Certification Number
SHOULD READ AS FOLLOWS:
_ __ _ ___
_. _ .
. _ ~-
~~ ~~
__
3 REV 11!2008
• !PRINT IN
RMANENT
J1CK INK
t. Name of Decedent (Firs!, middle, last, suffix)
German A. Roan ansk
5. Age (Last &rfhdey) Under 1 r Under 1 da
Months Days Fbun AMnutes
48 vrs.
Bb. County of Death Bc. City, 8oro, Twp, of Death
Cumberland Camp Hill
Hol s irit Hos ital
12. Was Decedent ever in the 13. Decedent's Education (Sprxx;llly
U.S. Amled Forces? Elemenlery I Secondary (0-12)
^ Yes J~ No ~ n
COMMONWEALTH OF PENNSYLVANIA .DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
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STATE FILE NUMBER
2. Sex 3. Soda! Secudy Number 4. Date of Death (Month, day, year)
Male 164 - 72 - 6036 Feb 16 2016
8. Date of Bkhl !Month. day w•.t , o~..~___ ,,._. _ _, . _.
Aug 6, 1961 (Kiev Ukraine
Bd. Fadhry Name (If not institution, give street and number)
PA
Kind of Work Kind of Buekless /Industry
16. Decedents Mafiing Address (Street, city !town, state, zip coda)
38 Johns Drive
18. Esthete Name (First, middle, last, suffix)
20a. Infomlents Name (type /Print)
Aleksey G. Roan'
21a. Method of Disposition
,_„ ^ BuriM ^ Rertavel from State
' }~ Cremafion ^ Donation
Wa Cremetbn or DonsBan Authorixsd
by Ms~cN Examkwr/Cororler7
22e. SlgneMfltof F feI Service Lice ~ (or
~ ~~ - •i
Complete items 23a-c only when 'ng
pfysklan ie rat available et time of death to
certlly cause of dash!.
arson actkg as such)
l..
23a. To the best death n„r,.,n
8a. Plwx of Death Check one
Hospital: Other:
npatient ^ ER !Outpatient ^ DOA ^ Nurein Home ^ Residence ^ Other .
g Specify:
9. Was Decedent of Hispanic OrlginT~ No ^ yes 10. Race: American Indian, Black, White, etc.
(If Yes, spedly Cuban, (~M
Mexican, Puerle Rican, etc.) white
highest grade corrgleted) 14. Medial Status: Mertied, Never Married, 15. Surviving Spouse (If wife, give maiden name)
College (1-4 or 5+) Widowed, Drvaced (~Nl
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
~~~„~, ~ FE 1 7 010
Local Registrar Date Issued
Decedents ui V V L rr
Actual Residence 17a. State PA Dk1 Decedent --
Live in a 17c. ^ yw Dent Lived in
17b. Cou Cumberland T0W"N'ro? TWP
nh' 17d. ^ No, Decedent Lived within
Actual Limitsol ~~la City/Boro
19. Mother's Name (First, midtAe, maiden surname)
Nad ' a Dzuba
20b. InfortnaM's Meiling Address (Street, chy /town, state, zip coda)
41 Grandview Street #806 Santa Cruz Calif 95060
21 b. Date of Dispositon (Month, day, year) 21 c. Place of Dispositbn (Name of cemetery, crematory or odler ace
a ) 21d. Location (City/town, state, zip code)
Yee^ No Feb 18 2010 Con-O-Lite Vault C
b. Llanse Number 22c. Name and Address of Facility
01394.5-r. _„__ Neumyer Funeral Home
time, date and place stated. (signature and tMe)
hems 24.28 must be completed by person 24. Time of Death 5. Date Pronountxd Dead (Month
day
year)
who proraunas death. 4,.J., t / C% ,CI~,~I M, ,
,
/ / ! rh ~C~ / C
CAUSE OF DEATH (See inatructbna end exemptee)
Item 27. Part I: Enter d» chain of event -diseases, injures, or tartlplicatbns • tllat directly caused the death
DO NOT enter termi
l
,
na
events such as cardiac arrest,
respiratory anent, or ventricular fibdllatlon widlotx showing the edobgy. List Doty one cause on each Ilrle.
IMMEDIATE CAUSE (Fins) daease or
condfion resutng in death)
~ ("'
w het candidona, h any, b.
IO }•p q fit :. ,~ St{- ~ c
t
L
ale awe Hated On Ilne 8.
Enter UNDERLYING CAUSE I
C C 1 Y~ 4 Ywq
Due to (or as a consequence o :
(disease or kljury that xdt~ated the
events resWbng m death) LAST. c.
Due to (or as a consequence of):
` """"'"' 23c. Date Slr,~led (Month, day, year)
26. Wes Case Referred Medical Examiner /Coroner (a a Reason Ot er than Cremation or Donation?
^ Yes
Onset to Death I but rat resulting in the urxlerrying cause given in Part I.
/`Y~
M~~
d. r
l
~. PW& anAutopsy 30b. Were Autopsy Flndlrgs 31. Manner of Death r
Aveileble Prior to C 32a. Dale of Injury (Momh, day, year) 32b. Describe How Injury Occurred
ompletlor~ ~{,
of Cause of Death? °~ Natural ^ Homiade
^ Yes ~ No ^ Yes ^ Nc ^ Acddent ^ Pending Investgeuon 32d. Time of InlurY 32e. Injury at Work? 32f. If Transportation Injury (Sexily)
^ Suicide ^ Coukl Not be Determined ^ Y ^ N ^ Driver/Operator ^ Passe ^
~uuaccv use ~on[noute to Death?
^ Yes ^ Probably
^ No ~ Unknown
29. If Female:
^ Not pregnant within past year
^ Pregnant at time of death
^ Nol pregnant, but pregnant within 42 days
of death
^ Not pregnant, but pregnant 43 days fo 1 year
before death
^ Unknown if pregnant within the past year
32c. Place of Injury: Home, Farm, Street, Factory,
Ohlce Building, etc. (Specify)
32g. Location of injury (Sheet, city /town, state)
M es o nger Pedestnan
33a. Certifier (txledt only one) ^ Other • Spxiy:
• Grthytng physician P y .. P - - - - 33b. Signature and Title of Cedar
(Physician certhying cause of death when arather h sister has raraunced death arM completed Item 23) .~~ '~ I ' r~ / /~ ^
To the Iteet of my knowledge, death occurred due to the awe(s) and manner as stated _ _ _ _ - J / I,~O,~ C_..~.,L,__ y J
• Pronouneln and art -------------------------
g Itying phyeklan (Physician both pronouncing death and arttlying to ease of death) 33c. Llanae Number
To fM best of mY knowledge. death occurred M the time, daN, and plea, and due to tM ease(s) and manner ea stated_ _ _ _ _ 33d. Date Signed (Month, day,
• Madkal Examiner /Coroner - - - - - - - - - - - - - ^ / e i ~,l ~ cF i ~ ~ i L ~' ~.
On the bole of exeminatbn and / a investigation, in my opinion, death occurred tp the time, date, end plea, and dw to the au ~ ~ ~ t?
as(s) and manner as staled. ^ 34. Name and A~areal ode Completed~euse of Death (Item 27) Type / Prnt
- t ~ , 3s Date led (Mon , day,1~) T ~~ U ~ ~`' 2
LEI / I ~ I % I I d~ ~ ~l ~~ ~4'~ ~ ~~~(c~ CG~,,~~4 d
~^f
Disposition Permit No. #0420260 Y ° - /