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R.ECISTEr. OF tip.%;r L.S OF ~v~,,.~ ~
- -----------~'-r -~.~ n~_____ CO L~~ TY, PL'v~?v 5 Y'L -V.~.~~ I
Name of Decedent:- ~~ 1e~ ~ '
113iZ Q. Death: 3 '_. ~ ~ _ C7~
File Number: "Z C>C~~,, - UU~~~
PuiJl.i:lnt +., D., r^r >^ D, 1 7
lV 1 u. l./.`... .t\t.it~°.. 'J. L_., I le"oi~t the f'~~ir'11x/i:
the above-captioned estat°' Y ~••"" =~ ~zrith r~~pa_t to rnmpl~~in21 Qf tl,e a~11'?i?]7 tl'ati
,,. ,., s on of
I . State whether administration of the estate is cor.~plete :....... . . . . .
2. If the answer°is ~ o, state when the personal representative
reasonably believes that the administration u-i11 be complete:
3. If the answer to No. 1 is YES, state the foIlowina;
a. Did the personal representative file a final~account with the Cou --~
it........ Yes ~No
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
c. Did the personal representative state an account
infornlally to the parties in interest? . ~,/
..............................~~'es [] No
d. Copies of receipts, releases, joinders and approvals of foz-mal or info
filed with the Clerlc of the Orphan;' Court and may be attached to tlli, rel olCOllnt' nlay be •
p t.
Dnle
.~°8-lr~
SIJitCt[ure of Person i(rn this Form
CT Capacity: ~ei-sonal Representative [] Cou~~sel
~J c',• . M
!~-~ ~ :: ° N N-
i.. _. - ~ Nnnae of Person Film,; [lus Form
.`~ Cy.
~ ~' '"%:: ,~ Ada-•ess
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C::~ :, ca
N U Telephone
Form R61'-!0 rev. /0 /j.OG