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C~R~IFICATIO~vT OP NO~'~C~ UIVI~~R P~. O.C. R~1~ ~.~{a)
I~,GISTER. OF tiVILLS
COtJ~1TY, PEN~TSYLVA~'IA
Name of Decedent:_ ~~~~ ~ ~ .
Date of Deatl:: File Number:_ ~~' ~~~- Q 9/ 3 _
Date Letters Granted: ~ ~1
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 beneficiaries of the above-captioned estate on
Name: Address:
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(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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Capacity: ~ P rsonal Representative l~. Counsel
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Name of Person F-hn, this Form
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Address
Telephone
Form RW-08 rev. 10.13.06