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~GISTER Or tiVILLS 0~ _ ~~ ~ ~~ ~,,~r- l ~~ ,,~ CCu~ T Y, PEti~~;~-~r'T '~"?.~iI ^_
Nsn-ie of Decedent: ;~/~ ff /'-ti ~9~~.~_ ~ ,`~. .:~`!s~ ~,
Date of Death: ~~ ~~% ~~~ `- FileNutnber~~ a~ ~~ C~~,S
Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to cornpletion of the adil7it~a ~atior_ of
the above-captioned estate:
1. State whether adnZinistlation ofthe estate is complete:.................... Yes ~] No
%. If the answeris No, state when the personal representative
reasonably believes that the administration will be complete:
3. If the answer to I~ro. 1 is YES, state the following;
a. Did the personal representative file a fliat account with the Court? .......Yes ~No
b. The separate Orphans' Couri No. (if any} for the personal
representative's account is:
c. Did the personal representative state an account
infornzally to the parties in interest? ......................:........ '.' ~"es ~] No
d. Copies of receipts, releases, joinders and approvals of formal or inforn~al accormts maybe
filed with the Cleric of the Orphala' Court and may be attached to this report.
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Signa(ure of person Fif[ng this Forni
Capacity: [Personal Representati~s~e ~ Counsel
PJnuie of Person Filing dais worm
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