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06-21-10
R.EC1S-iP.OF i~ViLLS OF~ c~~ COtrvTY, FiVZtiSYI'.~VAItI~ '-~ Name of Decedent: ~ '~~ DataafDeath: CO-~" ~~ -rileNu;Tber: D .. ..~ ~„ D.. !1 /'` D Jn ~ 17 T .n...~.•i t~;e F.~11~1cni~R u:ith ~•?c~Pnt tQ GnTrlr',i1Q11 Qf [FC adnlinlatl'ati011 of 1 u, j~i~.u tv L u, v.v. a~~.w v. ~ s., a a..l+ , ~ ••, r -" the above-captioned estate: • 1. Mate whether administration of the estate is complete:.. •.. • • • • • • • • • • • • • • • • ' ©Yes ~' "0 2. If the an's;vecis No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to rdo. 1 is YES, state the follo~vin~: a. Did the personal representative file a final~account withthe Court? .. • •'• • •', Yes QNo b. The separate Orphans' Court No. (if any} for the personal representative's account is: N C.•'~ N ~~? ~: ,J C~ CZ -- ~~~, s ~l ~ ~. ~f'1 ti..? ~~ ~ ,~ ©_ + ~..•... `7 N c. Did the personal representative state an account . info;r~~ally to the parties in interest? .:................... • • • • • • • • • • Wes ©No d. Copies of receipts, releases, joinders and approvals of formal or infonral accounts may'oe • fled with the Clerlc of the Orphans' Court and maybe a~ this repot. ~ ~~ ~~~ ontr ~ Signnturt of Ptrrun riling thin ror ~~ Capacity: ©PersonatRepi•~sentative,~/fCounsel lN( ~~ o~ _~_ ~ Nnn,t of Ptrson tilin~g+t:,is Fo,m\,w n~ ~w^~ K 1 ll `' `'' ~ W dd:•rss t 1 *7~•1 ~ z _ I~ TelrnJ,onr j