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Nave of Decedent: _ L~4 14~/fG~~~ ~~'s _
Date of Death: 02 _ / c7 ~SC3 g+_,,,e~_ File : umber: ~G~ -' ~~~~~
Late Letters Granted:
To the Register:
I certify that Notice of Estate s,dn;inistrationrequired by Pa. O,C. Ru1e 5.6(a) of the Orphans'' Court
Rules was s° don or mailed to the following beneficiaries of the above-captioned estate on
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Address:
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(Ij more space is needed, attach separate sheet.)
Notice has now been Jiven to alt persots entitled thereto under Pa. O.C. Rule 5.6(a) except:
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Capacity: ~ Personal Representative ^ Counsel
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