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~ REGTSTE,R OF ~'vILLS
~'~~-n h~'T r!~'~7e~ COL~1vTY, PEN?vSYLVA~ZA
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Name of Decedent: c' "~~~ s r' ~ ~ ____ ~_~.._____~_T .
Date of Death: / ° 2 ~? ~ File Number; ~ G` ~ ~~-`C / CC? L1 _
iJ C1ic L.cilelJ VI Q~IIC:Q: ~G' ~' / -~~ S _. ._ ~~~~_ ~~~'~'..~`~~ ~'~~~~'C~
To the Register:
I certify that Notice of Estate Administration required by Pa. O.C. Rule ~.6(a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
Name•
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Address:
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(If more space is needed, attach separate ,rlTeet.)
Notice has now been given to all persons entitled thereto under Pa. O.C. Rule 5.6(a) except:
Date ~ ~ C`'Gl
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~ormnw=GB rev. i0.13.G6
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Signatur of Person Filing this F
Capacity: ~ ~Yersonal Representative ^ Counsel
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Name of Person Filing this~j°/~''` f
.Address J ~~
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