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CERTIFICATION OF NOTICE UNDER Pa. O.C. Rule 5.6(a)
REGISTER OF WILLS
~~~ COUNTY, PEA ~ ~SYLVANIA
Name of Decedent: ref ,~,,;~ ~ ~~ ~,~~
Date of Death:~~,., - ~,~2 a2 pCi~ File Number:? ~~ p,~.~ ~ p y ~~
Date Letters Granted: ~ ~ p Q~
To the Register:
I certify that Notice of Estate Administration required by Pa. O.C. Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the following ber_eficiaries of the above-captioned estate on
,~:
Name: Address:
(If more space is needed, attach separate sheet.)
Notice has now been given to all persons entitled thereto under Pa. O.C. Rule 5.6(a) except:
Date e~ /e~ l~ L%V C~ --~~~~%v~CJ ~~
Signature of Person Filing this Form
O
~ ~-- a Capacity: Personal Representative Q Counsel
-- ~r__ >>//
'd ~-~ --~ ~ Name of Person Fikng this Form
- ~.~,~. c
r c~ ~ 7tb2 P,.¢Tk' ~ GK ~~ /J12 Y t ~
._ _ ` [X] L~ -'- '(_ Address
o v 7
Telephone
Farm RW-08 rev. 10.13.06
./~/~
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I1~IPORTANT NOTICE
NOTICE OF ESTATE ADIVIINISTRATION
PURSUANT TO Pa. O.C. Rule 5.6
THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHER~~'ISE
Whether you will receive any money or property will be determined wholly or partly by
the decedent's will. If the decedent died without a will, whether you will receive any
money or property will be determined by the intestacy laws of Pennsylvania.
BEFORE THE REGISTER OF WILLS, OUNTY OF ,~ ~, ~ f
IN RE: ESTATE OF ~~ ~ (~ • v~~ ~"'` ,PENNSYLVANIA
,Deceased
File Number o? DDQ- (~ yrj ~, t
T{~
(Beneficiary)
_ (tiddress)
Please take notice of the death of the Decedent and the grant of Letters to the personal representative(s) named
below. The Decedent died on the day of _~~,~~ ~ ~DO~--
_~~`~,, ~~, ~ hn ~ , a resident of
ou(~ nty, PA.
The Decedent died: ~ testate (with a will) or Q intestate (without a will).
You may have a beneficial interest in the estate as follows:
(If additional space is needed, use separate sheet)
The name(s), address(es) and telephone number(s) of all personal representatives appointed are:
NA1~IE ADDRESS
TELEPHONE
„-.-
If the Decedent died testate, the will has been filed with Office of the Register of Wills of ~~._~,,. ~oa (~~,,~
County.
If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the
Register of Wills of
County.
number is 7/~ ~,ijp-~'~~___
A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for
duplication.
Register's address is
Dnte ~-C,?-oZ[9D~}
Capacity: ~Jpersonal Representative
(]Counsel for Personal Representative
Form RW-07 rev. /0./3.06
S//ig~nn~tur~~e of Persaz Filing this Form
Name of Person Fzkng thzs Form
D
Address
~ ~~' ~3
pia-~~~ ~ ya. ~
Telephone