HomeMy WebLinkAbout08-03-15 (2) IN RE: IN THE COURT OF COMMON PLEAS
ESTATE OF BETTY UMPHRED ; CUMBERLAND COUNTY, PENNSYLVANIA
LATE OF LEMOYNE BOROUGH,
CUMBERLAND COUNTY, PENNSYLVANIA, ORPHAN'S COURT DIVISION
NO. 2-D15— 0.1ZW
AFFIDAVIT
I depose and certify that the following of which I have personal knowledge:
1. Decedent's Name: DAVID T. UMPHRED
2. Decedent's Date of Death: August 11. 2011
3. Decedent's Date of Birth: March 23, 1967
4. Decedent's Social Security No.
5. Place Where Death Occurred:
Harrisburg, PA 17104
6. Method of Disposition: Cremation
7. Place of Disposition: Cre maforu
8. Name and Complete Address of Funeral Facility: Hetrick-Bitner Funeral Home
3125 Walnut Street
Harrisburg, PA 17109
In witness whereof, I have hereunto set my hand and seal on this a 3rd day of 2015.
(Seal)
Witness neral Director
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
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o
SWORN to and subscribed COMMONWEALTH OF PENNSY VANIA Orn
NOTARIAL SEAL
before me this �3 da of Bryan K.Kenworthy,Notary Public
y Susquehanna Twp.,Dauphin Comity b rn r 1
// My Commission Expires Jan.1S,2640 M
2015. MEMBER.PENNSYLVANIA ASSOCIATION OF NOTARIES �. -s^ b p
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fiaiden Name (/Y ry - $:�.
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TOTAL
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the Deceased niece,Vze toz id;Sec en
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uns RoonipztGertetra ) u Memorial Cards
Q`!'tNFORMATtON` t�rt3C1•tlltlfiStalT1:!?i I7U55 � _. ,.._....._.._..._.,,_ .._••..,,..,..•-",.__.Y, ___ �„
rP1117 Burial Vault
kdclress taementa arc beiisb
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Vit,
Lot Nn.. E3tlnez [i�nertzl IiOtno - CASH ADVANCES - k `
Section No '#,Q solid o0itdo,1vndes,t6_the Death Certificate rr
V i7niptted tii , tn{,p UObrimtuiatryandOwner vtviv,hetrtut7eath Notices C
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PASTE TOP EDGE OF NOTICE HER” Pallbearers __ __ ---
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