HomeMy WebLinkAbout08-21-14 (2) IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
In Re:
ESTATE OF
BABY GIRL DULAM-KASIREDDY, Docket No.
deceased, late of Wormleysburg Borough,
Cumberland County, Pennsylvania
D nOF
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AFFIDAVIT
The undersigned, Bharath Kasireddy, states the following:
1. My name is Bharath Kasireddy. I am an adult individual who resides at
416 Meadow Drive, Camp Hill, Cumberland County, Pennsylvania 17011.
2. I am married to Mrudula Dulam, who also resides at 416.Meadow Drive,
Camp Hill, Cumberland County, Pennsylvania 17011.
3. My wife and I were the victims of a motor vehicle accident which
occurred on September 29, 2013, in Fairfax County,Virginia.
4. At the time of the accident,my wife was six months pregnant with our
unborn daughter. Due to injuries sustained in the accident, my wife underwent an
emergency procedure to deliver our daughter.
5. Our daughter, known as Baby Girl Dulam-Kasireddy, survived for five
hours in the hospital.
6. The Death Certificate issued by the Commonwealth of Virginia,
incorrectly identifies the residence of Baby Girl Dulam-Kasireddy as 7339 Ardglass
Drive, Lorton,Virginia 22079.
7. At the time of the accident, my wife and I resided at our current
residence located at 416 Meadow Drive, Camp Hill, Cumberland County,
Pennsylvania 17011. We did not reside at the Lorton,Virginia address listed on the
Death Certificate. Rather, that is the mailing address for the relative we were merely
visiting at the time of the accident.
8. The correct residence of Baby Girl Dulam-Kasireddy at the time of her
birth and death was 416 Meadow Drive, Camp Hill, Cumberland County,
Pennsylvania 17011.
Dated: �g rQ! 2a/ n �'^� (SEAL)
Bharat sireddy
VERIFICATION
COMMONWEALTH OF PENNSYLVANIA
SS.:
COUNTY OF c3�rua
I, Bharath Kasireddy swear or affirm and verify that
the statements made in the foregoing Affidavit are true and
accurate to the best of my knowledge, information and belief.
�i o'
Sworn to and subscribed
before me this \ '�'i _day
COMMONWEALTH OF PENNSYLVANIA
,1'JV�V S NOTARIAL SEAL
Of > 2O 1 DONALD TRAUBE
Notary Public
LEMOYNE BOROUGH,CUMBERLAND COUNTY
My Commission Expires Jun 3,2017
Notary Public
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