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05-21-09
~a. ®.C. l~u~~ 6.12 ST'~.'~US ~P®~~' REGISTER OF WILLS OF L~ti'7~?6Cr"ta-~t~ CO~~TY, PENNSYLVANIA Name of Decedent: ~' ~p/app ^~_______ File Number: eSL4~ ~T "' ~o S~3 Date of Death: D,,,_,,,,,,,.++„ D., n r' n„1o ~ 1'7 T,•o..^,-+t1,P fOllO~z,ina ~z,itl; racr~ent to ~.nmpletioil of the administration of 1 LLLJUGt11L iv 1 ct. v.t.~. t~~ii~. v• i~'f i i"rw'i~ ~+av ,7 I'- the above-captioned estate: ..... Yes E] No 1. State whether administration of the estate is complete :.............. . 2. If the answei is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final account with the Court? ....... ' -Yes 0 No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest'? ............................... ~ Yes (~ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe filed with the Cleric of the Orphans' Court and maybe attached to this rep rt. Dnte~ (l """i© „ ature of Person Filing th Form Capacity: ~ersonalRepresentative QCounsel _~ra.~1 Y'I n ~ i.~n Narne//~~eeo~~fPersoncFilingthis~Flor~mq c _tat i '' .,~ Addr s ~. ~ ~S ry~p,~~.r7cs~F1 ~~ I-70 ~ v-iir° Telephone Form R61'-10 rev. 10.13.0/