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COMMONWeAUIl OF PtiNNSVLVANIA' DIIPARlMENT OF IU!ALlH' VITAl. RECOROlJ
CERTlflOATE Of DEATH
(Coroner)
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STATUS REPORT UNDER RULE 6.12
Name of Decedent I Go.r~3 R. Fill.{tL
Date of Deathl__~j2~1
Will No, Admin, No. ICfq~1 - (p~~ I
Pursuant to Rule 6,12 of the Supreme Court orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate I
1. State whether administration of the estate is complete I
Yes 1../' No
---
2, If the answer is No, state when the personal
representative reasonably believes that the administration wUl be
complete I
3. If the answer. to No, 1 is Yes, state the following I
a. Did the personal represontative file a final
account with the Court? Yes __ No I..-/'~,
b, The separ.ate Orphans' Court No. (if any) for
the personal representative's account is I l
/Jo.
c. Did the personal represen ative stat~ an
account informally to the parties in interest? Yes~ No
d, Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Dj!te I 9th J /AlA,'
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Signature
JY1lcl,elle P. (O.t w t-
Name (Please type or print)
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Address l7iJ(~
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CapacitYI _____Personal Representative
~'Counsel for personal
representative
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