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CERTIFICATION OF NOTICE UNDER Pa. O.C. Rule ~.6(a)
REGISTER OF WILLS
1~L' ~'''~ b ~ k.~ A n p COUNTY, PEN>~ S YL VANIA
Name of Decedent: ~~¢vV t ~ ( ~~ ~ ~ t ,~ ,,.Z ~t.~,tlf
Date of Death: / / ' / ~ - 0 ~
Date Letters Granted:
To the Register:
File Number: 0~00~ " 4 / ~ Ll d
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 beneficiaries of the above-captioned estate on
Name: Address:
~~' a.r~ ~ ICtm a.~enl~ X33 yUrk ~~~~ ~s.le_ p~
1 ~Oi s_-
(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:
~nte_ ~' ~ _ Q ~ /
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`.`.'_<' ' ~ ~ ~- Stgt2nture ojPerson Filing this Form
_ ~ ~~
.; a- O ~ Capacity: [Personal Representative ^ Counsel
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~ t~i.t ~,~ ~ L (ti MC D ~.J C v~ K-~ S/~
~~ ~ U~ Nnme ojPerson Filing this Forst
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1. _,. a X133 C~®,~ K~ rQ.1~
N (,~~ Address
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Te[epltotte
Forst RGV-08 rev_ 10.13.06
IMPORTANT NOTICE
NOTICE OF ESTATE ADMINISTRATION
PURSUANT TO Pa. O.C. Rule 5.6
THIS NOTICE DOES NOT tiIEAN THAT YOU ~~~ILL RECENE
ANY ~~IONEY 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 WIL ,COUNTY OF ~ G,J~~, ~,~,
IN RE: ESTATE OF ~ .~---~ PENNSYLVANI.-~
~ 'en ,Deceased
File Number ~Od~_ C"1 / f r~ O
TO
eneficiary)
(Address)
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 /7/d~ ~ b ~-~- ~ y ~UO
~'V,r,.~ be~f'~ ~ ~ , a resident of
County, PA.
The Decedent died: [~ testate (with a will) or ^ 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:
NAME ADDRESS
L
D
If the De~Sedent died testate, the will has been filed with Office of the Register of Wills of
/yJ. berc.(.f,-,~ 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.
The Register's address is _ $3 ~ ~~ /L K ~ ~ ('~ ~~~ Q , ~O/~
and telephone number is _ ~~ S~`~, yGj/~_
A copy of the Will or Petition maybe obtained by contacting the Register of Wills and paying the charges for
duplication. p
Dnte~(L f ~ ~ - ~~~
Stg nture of Person Filing thi~Form
GIB .A~e p ~l ~' n r.S ~i~ ,
Nmne of Person Filing thrs Form
Ca acit ~ ~~~~~ ~~
P y: Personal Representative Addre
^ Counsel for Personal Representative /~ ~ ~~ 1.70 /S
~~' ~~i
Telephate