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Pa. ®.C'. Rule 6.12 ST\ATZJS REP®RT
REGISTER OF WILLS OF C ~n x~-t~PP 1(~n ~ COUNTY, PENNSYLVANIA
Name of Decedent:_~ ~ Pe 1(Yl n {~C h
Date of Death: U, 1 t9, (1 '7 File Number: r~0 ~ - O 1 (7 ~'~
Pursuant to Pa. O.C. Pule 5.12, I report the following with respect to completion of the administration of
the above-captioned estate:
1. State whether administration of the estate is complete :.................:.. Yes ~ No
2. If the azisweris 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 ~o
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
c. Did the personal representative state an account
infdtmally to the parties in interest? ...................:........... DI'es ~/ To
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe
filed with the Clerlc of the Orphans.' Court and may be attached to this report.
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Form R6Kl0 reo. 10.13.06
Signature ofPerton Filing ~ its Farm
Capacity: I~'Personal Representative Counsel
~V~2Y\ ~() YV)N'CC 1'~
Nmne afPerson Filing this Farm \
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Adb~ess
S Pt`~l~y~c ~pa~~-~ 1090
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