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C~RTIFICATIO`vT OP NO~'~CE UN~~R Pa. O.C. Rule ~.~{a)
REGISTER. OF tiVILLS
ca~B~~e.crov~ COUNTY, PEN;~7SYLVA~t'IA.
Name of Decedent: ~ o,~d r-yy-~.,~ ~ ~`~ ~ ~..~ N„e,
Date of Death:__ /~1~y ~+ ,Z pp Si File Number: 2 O y 9 - O /L..~d _
Date Letters Granted:_ ,Q~~ ~ ~p ~~~~~
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
~T.Q~v ~ ~ o ~,~ .
Name:
Address:
.A~" s'~"i¢ Al C~Gw~n .~.~" T y .f t.4wr X ~ 7~ CR rte ~i ~c t ~~i..l ? d ~/
(Ifmore 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:
Date / 9 ~ I/D
gnature ojPers ilin; this Fonn
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v Form RW-08 rev. 10.13.06
Capacity: (Personal Representative t~ Counsel
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Name ojPerson Filir~, lhis Form
Address
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