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10-12-10
~~RTIFICATIO~i ®~' CIO ~ ICIJ Ui~~IJ'~~ P~. O.~'. JE~uI~ ~.~-(a~ _ -- REGISTER OF tiVILLS ~~t ~,.~ CGtJNTY. PE~+~'SYLVAti'IA Narr,e of Decedent:~e..g-4~o~/1 ~u5s~.(~, rt~a,(~e,r ~r~j , Date of Dead.: ~u-L1~_~, 2010 _ File i~Iumber: a,~l~- ~~~~_~ Date Letters Granted: ~ ~,~„~, t..____~, ~©~ ~ To t~;o, R.egister: I certify that Notice of Estate Administration required by Pa. O.C. Rule ~.6(a} of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the aoove-captioned estate on. dc.~-. 3 , ao ~ O Name: Address: ~,~~p_s~o~ ~.. ~at~n~r Vic. 1~~~1 S 333. E ~~. Cow.a..~4~a,~ol~ ~yy~9 .Pura .Q.~ s ~7 .~/ ,~:. ,~ ~ ~ ~o~ ~~ ~ ~n ,~-~s~- L` ~--Y, D K ''~~i/0 'M ar ~- hard set 33417 ~• t8t ~' S~#: So~-h Por~.r O K ~~yy~~ (If more space is needed, attach separate sheet,) Notice has „~u~ hAO., ~,;.r,., .,. ,.~i o~..,„~~ e~~:~, _ ; „ r ., _ ., i. ~, ~.:i .V :i:i p~..:.iv:::a t1l:l1Cl1 111~~1GtV UIIUel" .C'a. ~..1...t~llle J.O~a) eXCe~l: ~._1~ r _ --~ ,_C~ Date !/ ( / ~a ~ Sio ature of Pers Filin,; this .Fonn~ ~' Q:. .. ~°- Capacity: ~1 Personal Representative '~ Counsel f~~ «'I ~t `'~ ~" ~ - ~ :Name of Per n Filin; lhis Form N t~ Jo <~_ _._.~ ~.: ~ x:- ~_ }-"~ C..7 ~ L~-= Address tJ ~ C ~..~ Tzlephone Form RW-a8 rev. 10.13.06 _ __ _ _ _ _ ~ _