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Home My WebLink About05-13-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of Aniefiok James Umana also known as COUNTY, PENNSYLVANIA File Number 21 - ~ ~~ --~~~~f,~ ,Deceased Social Security Number 468-04-0893 Rose Umana Petitioner(s), who is/are t 8 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 named in the last Wilf of the Decedent, dated and codicil(s) dated 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 app ica e, en er. ¢ .a.; . n.c.t.a.; pe en e i e; uran e a sen ia; uran a moron a e Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If Administration, c. t. a. or d. b. n. c. t. a., enter date of loll in Section A above and complete list of heirs.) Name Relationship Residence Emem Umana Child 1202 Summit Way Mechanicsburg, PA 17050 Imeime Umana Child 1202 Summit Way P Nsima Umana Child 1202 Summit Way 1 (COMPLETE INALL CASES:) Attach additional sheets if necessary. $gg COntlnUatlon Schedule attached Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at 2213 Orchard Road, Camp Hill, Lower Allen, Cumberland, PA 17011 (List street address, town/city, township, county, state, zip code) Decedent, then ~7 years of age, died on 04/20/2010 at 2213 Orchard Road, Camp Hill, Cumberland County, PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) (If not domiciled in PA) (If not domiciled in PA) Value of real estate in Pennsylvania situated as follows: All personal property $ 2,000.00+;_? Personal property in Pennsylvania $ c`.:. n `~ - Personal property in County $ ~ =)-~ ~~ ~~ $ - T;C t:l -[ W . , '~ ,,~~ ~~m ~~ i ~) -i ~ _. ,.. , _. ,.. _.___- Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters the undersigned: ftfrm to ._ J ~ > t'~J . '~~ Form RW-02 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page t of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland } SS } 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 ~~n before me this day of ~G~~ ~~ ~ `. ' F he egister i~ File Number: 21 - ~~ --c;~~f~~ Estate of Aniefiok J Umana r' -; n -;~ J:~ ;.~: ' ~-_, ~ __ -.~ --~ :=> Deceased W "'C7 i'V L~ ~ - ~`~"1 _•~~,'> Social Security Number: 468-04-0893 / / /Date of Death: 04/20/2010 AND NOW, ,' ~ ~~ /' ~ ~ ~ t..-~/ t-' , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS CREED that Letters of Administration are hereby granted to Rose Umana 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 .......................................... $ r ~, Short Certificate(s) ....................... $ ~ 7 . ~~(~ /h ` '°i Renunciation(s) ............................ $ / ~~ , t ~~ t", ~~ ~a Register of Wills ~_ Attorney Signature: ~ '~~ Attorney Name: G Ra liff Es uire Supreme Court I.D. No.: 32112 Address: 3448 Trindle Road na c:-~ Camp Hill, PA $ $ $ $ $ Telephone: (717) 737-0100 TOTAL ................................... $ .~ Form RW OZ Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Signature of Personal Representative Page 2 of 2 PETITION FOR PROBATE AND GRANT OF LETTERS (Continued) REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Aniefiok J Umana File Number 21 also known as ,Deceased Social Security Number 468-04-0893 Name i#ia~a. Umana ~.- Rose Umana Relationship Residence Child 1202 Summit Way Mechanicsburg, PA 17050 Wife 1202 Summit Way Mechanicsburg, PA 17050 ~~ ` _.M O -. ~ -~;~ -r r.i } , ~; r ~ ... _ J - :- ~.~ ~ ~~ . -"~ `~~' ~ -~ 1 _'~I ^., t`J ~, "~ C:,J L~ l-/Cf e.~~~r ~f:~:~d~ti~t~; it is iileg~! ±~ ~u~iin~~r~ i3~)i~ a;:gray ~y ~°~Ot<~;.4~~a# ~1~ , z;~r°.:;., ,, 1E~~?7'~58 _ _ _ _ I ~ ~:,: nvl,L , -~,~~, •, _ . I -, N -_ ~ -- ., -~ ~ : 1 ,:p, _ - ; -~ , -r j ;, _ _ 'rl~ W t: I•V C..rl • REV tt/zoos PRINT IN 9ANENT K INK ~k'i7-?4R COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CORONER'S CERTIFICATE OF DEATH (See Instructions and examples on reverse) STATE FILE NUMBEiR 1. Name of Decedent (Frst mitltlle, last. sufllx) _ 2. Sex 3. Social Secudry Number 4 Date of Death (Month. tlay, year) Aniefiok James Umana Male 468 - 04 ~- 0893 April 20, 2010 5. Aga (Last Blnhtlay) Under 1 year Under 1 day 6. Data of Blnh (Month, day, year) 7, Bidhplace (Gilt' and state or for eign country) Be. Place of Death (Ghack only one) Mvmns Days rrours Nmutes Hospital. Other. 57 V March 27, 1953 Nigeria ^ ^ ^ I ^ ~ fe In ahem p ER /Outpatient DOA Nursing Home Pesidence ^Omer ~ Specir y Bb. County of Death Be. Ciry, Bor Twp. Deatn ed. Feclllly Name (If not institulbn, glue street and number) 9 Was Decedent of Hispanic Origm2 ^[ Ne ^Ves t D Race Amencan Indian Black. White etc Cumberland Lower Allen 2213 Orchard Road (II yes, speciry Cuban, Mexman PuangRicaPem) ISOerrM , African American tt. Decedents Usual Occu non Kind of work tl one tl urin most of world life. Do not stale refired 12. Wes Decedent ever In the 13. Decedents Education (SDecity only highest grade compl eted) 14. Marllal Status. Marrietl. Never Manned. t 6. Surviving Spo use (If wife. g~.ve maiden na Kintl of Work Kintl of Business / Intlustry U.S. Armed Forces? Elementary / Secontlary (C-12) College (1 ~4 or 5+) Wtlowed, Divorced (Specrry) ' Data Manager State Government ^vea ®Nn 12 8 Married Rose Eyoma I6. Decedent's Mailing Address (Street city !town, slate. tip code) Decedent's Did Decetlenl v state Pennsylvania AdualResitlence 77a nq L]Yea DecedemL:vedm Lower Allen v i 2213 Orchard Road . . . Two m wn shp? 17d^N D d mt d ah Cam Hi11, PA 17011 n, we w ece e m nb.cpenty Cumberland Agwal ^mita nr Ciry,Boro 78. Father's Name (First, middle. last. suflixi 19. Mother's Name (First, mitltlle, maitlen surname) James Umana Eno Ebe 20a. Informant's Name (Type ' Pnnt) 20b. Inlormant's Mailing Adtlress (Street city /town, slate, zip code) Ini Aniefiok Umana 1202 Summit Way, Mechanicsburg, PA 17050 2ta. Method of Disposition ^ Crameaon ^ Donatlon 21 b_ Date el Disposition (Month, tlay, year) 21 c. Place of Disposdion (Name vl cemetery, crematory or other place! ltd. Location (City /town, stave. ziv nodal [~' Burial ® Removal from Stale ~! Was Cremation or Donation Authorized ^ omen-spear: ; byMedlgalExamlrler/coroner? ^Yea^Nq May 5, 2010 Nigeria Nigeria 22a. Signatur of Funer Servi e (or pens fing as such) 22b. License Number 22c. Name and Address of Facility c ~ FD 013 340 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070 Complete Items 23a~c only when cenirying 23a. To the best of my knowledge, tleam oecurted at the Time. tlate and place statetl. (Signature and title) 23b. License Number 23c Date Signed !Month tlay. year) physkian Is not available at lime of tleam b cenity cause of tleam. Items 24-26 must be completed by person 24. Tine of Death Ap rX , 26. Date Pronounced Deatl (Month, tlay. year) 26. Was Case Referretl to Metlical Examiner .Coroner for a Reason Other Iran Cremation nr Dnnaticnn who pronounces death. 11:0 0 A . M. A r 11 2 0 , 2 010 ~ves ^ No CAUSE OF DEATH (See Instructions and examples) ~ Approximate interval: Pad II'. Enter other significant conditions coninbut~g to tleath. 28. Did Tobacco Use Connibu;e to Deem? Item 27. Pad I: Fitter the gn~insgl ygnys -diseases, injures, or complications -That direAly caused the death. DO NOT enter lertninal events such as cardiac anest r Onset to Death but not resuAing In the untlerlying cause g•voo in Pan :. ^ Yes ^ Probably respiratory arrest, or uentncular fibrillation wAhout showing the etiology. List only one cause at each line, ^ No ^ Unknown . IMMEDIATE CAUSE (Final disease or , ' 29 "Fema'e' cwditbn resulting in each) Probable Myocardial Infarction r -~ a. . ^ Due to (or as a consequence of)~. ~ Not pregnant within past year Sequentially list contlitions, if any, b. H}zpertenS lVe Cardiovascular Disease l ^ Pregnant at tine of death eatlin~ to the cause listetl on bite a. Due to f or as a copse uence of Enter the UNDERLYING CAUSE D )~ ^ Not pregnant. out pre a thin a2 days gn n'. w (dsease or Injury that initiated the events resulting m tleath) LAST. V al death Due to (or as a consequence up. r ^ Nat pregnant, out pregnant 43 days to t year d I belore deal': . ^ Unknown it pregnant within the past year 30a. Was an Autopsy 30b. Were Autopsy Flntlings 31. Manner of Death 32a. Date of Inlury (Month, day, year) 32b. Describe How Inlury Occurred 32c. Place of Injury. Nome. Fenn, Street, Factory, Padormetl' Available Prior to Gompletign Natural ^ Homigide Office Building. eta (Spenryi of Cause 01 Death? , ^ yes No ^Ves ^ No ^ Accident ^ Pentling Investgation 32d. Time of Injury 32e. Injury at Work? 32f. It Tmnsponation Injury (Spealy) 32g. Location of Injury (Street city I town. state) ^ Suicide ^ Coultl Not be Delertnined ^ Yes ^ No ^ Onver / Operator ^ Passenger ^Petlestrian M ^Other - Speciy 33a. Cenifier (cneck Doty Doer 330. Signature and Title • Certifying physician (Physican cenHying cause of death when another physician has pronounced tleam and completed Item 23) , ~ r O n e r To the best of my knowledge, deaM occurred due to the cause(s) and manner as statetl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • Pronouncing and certifying physician (Physician both pronouncing death and cenitying to cause of tleath) T th t f k l d d th ^ be d 33c. License Number 330. Date Signed (Monih, tlay yeah o e s o my now e ge, ea occurre at lbe Ilme, date, and place, and due to the cause(s) and manner as statetl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • M di l E i l C Ap T 11 2 1 2 n 1 0 oroner e ca xam ner On the beats of examination and 1 or investigation in my opinion death occurred at the time and due to the cause(s) and manner as statetl date and lace ~ , , , _ , , p , 34 Nam ntl tl es f Pers W o Completed " use of D to Item 271 Type' Print ~o~~ (°. ;r°c~cenroc~e ~orone 36. Registrar's Bi wre and OSm a ~ ~ ~ ~ '°'~ 3s. Date Filed( th, day. year) , 6375 Basehore Rd. , Suite 4k1 h'i 1~ I I I I ~, ,;~ Mechanicsbur Pa. 17050 i n I ni<rx,sixna Pum,u Nn (7't ~- ']~ r~)~ ~ ~c~ ~~~ ~` ; REGISTER OF WILLS OF RENUNCIATION CUMBERLAND COUNTY, PENNSYLVANIA Estate of Aniefiok James Umana t. Imeime Umana (Print Name) Child Deceased in my capacity/relationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Rose Umana ~; v~ (Date) n ,~t v (Signature) Imeime Umana 1202 Summit Way (Street Address) Mechanicsburg, PA 17050 (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 Rev io-is-zoos dd~~~ I ~ ~ k;, t Y ~,~~'~~~ Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on tnday of f / ~~,.~ ~o`,,t,,J Notary Public My Commission Expires: ~ (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) gZ :1 Nd £ i ~~~ OI~Z GC7MMONWEA~rH o~= taE~N~ti~~W~~~, , Notarial Seal _.__~ __` ~2borah L. ~intey, Notay Publir, Comp Hilt t3oro, Gumtaeriar3d Goursty t `~ ': , : ' ~ - ti~ Gommissi~r E~irer Sept 23:201 ? ' . Cppynght (c) 2006~tbrm software only The Lackner Group, In - ,~~ -~ ~ ~ ~ ~~~~~ _ = Member, Pennsyfva .~ -'~s5uciaY~c~~ or ~~~tarica .. RENUNCIATION REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Aniefiok James Umana I, Ini Umana Child (Print Name) .~,~, VrG !! . J t ~, : ~ `~~~t i "'~tJ administer the Estate of the Decedent and respectfully request that Letters be issued to Rose Umana -, y; (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me thi>~ day of Deputy for Register of Wills Fornt RW-OB Rev. f0-13-2006 Deceased in my capacity/relationship as of the above Decedent, hereby renounce the right to ~~, , 1 „ ~~', ~,~ .~.. .. (SignBtwi:) Ini Umana 1202 Summit Way (Street Address) Mechanicsburg, PA 17050 (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the re ciation for the purposes stated within on ttu~day of 1 ~~' ~ .i ~ Notary Public My Commission Expires: (Signature and seal of Notary or other official qualified to ~'~ administer oaths. Show date of expiration of Notary's commission.) ~:GMMUNWEALTH l'3F PENNSYLV,~!'~: -. Notarial Seal _____.___.~.. . ~ ~ ~ ~ ~~t~ ~ ~ ~~ ~ ~'~~ Deborah L. Donley, Not~a~°y Public Camp Hill Boro, Curnbetland County i t Nly Commission E~ires Se•~i 23; 20? 1 ~ ~. ~ .,'~opyngh(,(c)2008 forfnsoftware only The Lackis~l®~td6~, nrGnnSylV~n;x~. AS5C1Cid-..~r, ~f NGte~ !=s ...I ~.,' _ ...'j RENUNCIATION REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Aniefiok James Umana I~ Nsima Umana Child Deceased in my capacity/relationship as (Print Name) of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Rose Umana ~~ (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of, Wilts ~t , ,~ ti,., ~;l tJ ;:' sir i f:_:% ~ ~ ~ '.t:ilJ 9 ~ ~ i ~~ci u I ~~~ Q 3 ul ~,c~n~~oraw~;~~-~H ~~ P~r;~~~ ~, .~z~- 9 ivotarial Seal ___. . _ ~ Deborah L_. 't~onley, Notary Publi,, ` ' ~ _ Camp Hill Boro, Curnberiand County _, y ~ Commis ,ion E~ires Sepi~ 23, 20° 1 Form RW-OB Rev. 10-13-2006 ?!~% ,~` _w, _ ,__ _ _', ~ . _'.j Copyright (c) 2006 form software only The Lackner Group, Inc. (ember, PBnnSrlvOnl~ ~48sOClatlo!', ;lf !v~~t2~t ' V""' -v~` `''~'~ (Signature) Nsima Umana 1202 Summit Way (Street Address) Mechanicsburg, PA 17050 (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on ~ day of-~~-, ;l c, A Notary Public My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.)