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F.EL IjTE OF ti~i':~LS Gr~~.'".•~+, ~~ _ C;OU:QTY, P~ :~?;;i ~''~."V;~,N~?.
t`~31?le oI Decede,?~:
Date o: D°ath: ~ Z o Q File i`,u:::be,.. G~- G
:'"lsu:.:~t ~;, P•a. Q.C...°.ule 6.12 I repo t fire Fait.; ;:~ir,a u_ iti? :''c;l?;~_ t~ r.fSm ~'~`i(n,l !?f t~;~'.
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the above-ca;~tianed estate: .
1. Sta±e whether admitiistratiot? of the estate is complete :................... .
2. If the an'sweris No, state when the personal representative
reasona~ly L-elieves t~ at the administration will be coniplet~:
3. If the ails~ver to I~'o. l is YES, state tl?e following:
a. Did the persor_aI representative : le a fnal~accottnt with the Court? .......
b. The separate Orphans' Court Ivo. (if any) for the person l
representative's account is:
i:?!Stl'3t101? Of
'Y'es ~~
]Yes ~ No
c. Did the personal representative state an account
. infotn?ally to the parties in i?aerest? ...................:......... ~ ~.~ rtes ~ No
d. Copies of receipts, releases, joinders and approvals of formal or infonnal cc~t.u?ts maybe
filed with the Clerlc of the Otphans' Cow-t afar maybe at,acl ." rep rt.'
Onrc ~ ~/~ f^v~Q ~/V ~iy~
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Signrr•: re o)'Per:o» Fau:g brit Form '
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! Capacity: QPersonal :"esei~tativ ~ouns~]
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