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REGISTER OF WILLS OF CD l1'1 b~ r \ c><v d. _ COUNTY, PFN"NSYL VANIA
1'1 a)11O of Decedent, \....-a \J 1":;>1. 13 1'1'+ yo ,'c e.. '! () h e.-
Date of Death:~1J ~+ I, ':},~o.5 _ File Number:!), 0 0 ."i - () 0 q 'I ~
Pursuautto P a. O. C. Rule 6.12, I report ihe following with respectto completion 0 f d1e a dministrati on of
the above-captioned estate:
l. Stite wheiher administration oithe estate is complete: . . . . . . . . . . . . . . . . . . . . ~es 01'10
2. If the answeris No, state when the personal representative
reasonably believes that the adrilinistration will be complete:
3. lIthe answer to No.1 is YES, state the following:
a. Did the personal representative file a final account wiih the Court? . . . . .' lEYes
b. T11e separate Orphans' Court No. (if any) for the personal
representative's account is:
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c. Did the personal representative state an account
infom,.lly to the parties in interest' ............................... $Y es 0 No
d. Copies of receipts, releases, jo inders and appro v als 0 fionnaI or'infonnaI accounts may be
filed wiih ihe ClerIc of the orphans' Court and may be attached to ihis repOlt
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Signature of Per SOil Filing lhis Form "
Ca-pacity: DPersonal Re-presenta:tive 0 COul1sel
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Name of Person Filing this Fo,.,,,
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Address
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