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i°.ECI~TER LF 1~~i;BLS Gr ~~~•~,~f C;pL_vTi', .F.:~~+~Y~r ~~•' ~.t?.
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Name of Decedent:- ~~ -~----~ ---
Date o: D°ath: s~~/U ~ File hiur~'ber• ~^
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the above-ca;~tioned estate:
1. State whether administration of the estate is complete :.................... Q1'es ~io
2. If the an'sweris l~'o, state when the personal representative
reasona~ly believes t; at the administration will be coniplet~: ~,
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3. If the ai~s.ver to 1V'o.. l is YES, state tae iollowin;:
a. Did the personal representative file a f nal~accoirnt with the Court? ....... (,Yes ~ No
b. The separate Orphans' Court No. (if any) for the persar:al
representative's account is:
c. Did the personal representative state an account
. informally to the parties in iraerest? .:.................:........... ' ~] ~'es ~No
d. Copies of receipts, releases, joinders and approvals of forrnzl or informal acc :u~ts nlay be
filed with the Cleric of the Orphans' Court and maybe at~ached to rt.
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Signnr::rc of?er;pn Fliir:~ riri; /'nrrn
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,1.; -- ~, ~._ ~ Cap~aciry:~ ~P~e:-solyal~Rep*ese»iative
~~ - ~ ~ ~' O~:a P%nr.:e o~ erswt filir.,ll:it Form
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