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C~RTIFICATI~~i ~~ NO~IC~ UNI7I;~ P~. O.C. ~.ule ~.~(a)
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# REGISTER OF tiVILLS
~.. a y~i~.~t~ r t ~~ i~ ~ COUNTY, PENw'SYLVANI A
Name of Decec~ent:-~1~___ ,(•. _~v,c T a- _
Date of Death:_ --~ f,T ~Q~______~,__ File Number: , ~'~-'~` `~' t'!~'-~-•~~~- __
Date Letters Granted: ~ ~` t> / c' 3
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 beneficia; ies of the above-captioned estate on
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Name: Address:
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`.., 1'1 Y- l~ ~ !\ illy'-! L "`J/',.-c` ,`r~_'(c"ti",~...G~'~, /~° G~'Gt' ~__L tf ~ S 1. !~''i j ~`t ~~ 5
(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:
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Signature of Person Fifing this Fonn
Capacity: Q Personal Representative ~ Counsel
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.Nome of Person Filing lhis Forn~
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