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Fr.ECI~TEr^. OF ~'iLLS Gr
N311?e oI Decedel?i:_~Iri~
/~' ~I .Z/ 7 Fil? 1`iuil'.1J?''. ~ ~i~ "~D •I ~ O
Date o: Death: ~ ',
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P ..- • • D !1 ((''~~ D. 1 ,C 17 T .-er,n,-t t:1e fill:~tsrino t;; itl? r?ct~?~Y` t0 O.rrr"'°tinn of the 211?illl>tl'at101? Of
1 lLl~u:ai1~ LV L tV. V.L. y~uie v. am, a • l.. va ••,~ • ••
the above-captioned estate: .
' .......... ~'es C~c
1. State whether ad?1linistration of tie estate is comple~e:......... • ~,
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2. If the answeris ;V'o, state when the personal representative
reasonably believes that the administration will be C0111p1ete:
3. If the ai?swer to No.. l is YES, state t11e follo~virij:
. ,.
a. Did the personal representative file a final~account with the Court? ....... (Yes ~ No
b. The separate Orphans' Court No. (if any) for the personal ~ j
• representative's account is:
• Y i
c. Did the personal representative state an account .
mfo>n~ally to the parties in ?ntzrest? ............................ '
. d. Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe
filed with the Cleric of tl?e O>p??ans' Court and may be attached to this report.
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Signature Pe,:on fCfir:g ti,is form
~U~ 1n ~ Capacity: Personal Representative ounce]
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C~ ~Y7 ~~~ ~ x..70 (.{i/~~~"
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~a ..._. ( ~ address ~ 70
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