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Oath of Personal Representative
COMMONWEAL TH OF PENNSYL VANIA
SS
COUNTY OF
The Petitioner(s) above-named swear(s) or affiIm(s) that the statements in the foregoing Petition are true and correct to the best of
the knowledge and belief ofPetitioner(s) and that, as personal representative(s) ofthe Decedent, Petitioner(s) will well and truly
administer the estate according to law.
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AND NOW,
having been presented before me, IT
are hereby granted to
Date of Death:
in the above estate
and that the instrument( s) dated
described in the Petition be admitted to probate and file
FEES
Letters ............... $
Short Certificate( s) . . . . . . . . $
Renunciation(s) .......... $
$
$
$
$
$
$
$
Register of Wills
Address:
Telephone:
TOTAL ..........
Form RW-02 rev, /0./3.06
Page 2 of2
HI05.805 REV 9/86
This is to certify that the information here given is correctly copied from an original certificate of death dJ,lly filed with me as
Local fu:gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent ffiling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Local Registrar
Fee for this certificate, $2.00
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9496037
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COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
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DATE SIGNED
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MS CAR REFERRED 10 MEOfCAf.. EXAMfHE:fUCOfIOHER?
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