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'• 1?.ECISTE~ OF ~~rIL LS OF C~YY1~~~0~-n~ COU`i~TY, PE'vT1SYLVANI~
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Name of Decedent:~~ ~a ~[ ~~e~__ ~-•~!~~
~a 2~o S - CX~ 351
Date o: Death: fY1C~'C~1 ~ ZC~Og File Number:
p, /~ ~ 1 ~ T +•~,•.n,-t thn f.•,lln,z~i;,v ~;,,;ith r~cr~Pr;.t to r.nmpleiinl1 Qf tl,e administration of
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1 UL Jll 01111 !V 1 U.. tJ .l.'. 1\611v V. 1:., l ivNvir ~~iv i•.: sav . .~. t'~
the above-captioned estate: .
~._ _Stat~-wh~tller adnlinistrati-oil-~f ~lre estatz is cornp~ete:..... -:- .............: Yes _ - -Q~o
2. If the answe>"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 ersonal representative file a final~account with the Courl? ....... Yes ' . IvTo
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b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
c. Did the personal representative state an account
informall to the parties in interest? ............... • .. • ~ • • • • • • • • • .. ~ Yes ~No
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d. Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe
filed with the Clerk of tiie Orphans' Court-and Irr~.y be attached to tlris report.
Signature of Person ding thrs m
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Capacity: QPersonal RepresentativeCounsel
1Jnme of Person Frling this Form
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