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F.EC ISTEr^~ OF ~^i;'rLS Gr d C~~t~:vTY, PLI ,?~ SY'r ~V s, ~ i a,
IV31]]e CI Decedent:
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Date e: Death: QS~~a f D(v File i`iu:: ~oe~.. /Tly ~"~ L.,~J
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D• r• t•n D., f i !^ C. 10 ~ 7 7 T •~-..,,~ t .~ F.ll:, ~~ rr. tx: i] •a a-: ~~ t ~ ~ 1• ' ', r r t
. •rsua s., a t., rr_r.~ e~inn n{ 1;,, ' h:: ra.ior. of
a. iit w a a. v.~.. i~uav v.as, ~ i..rw. ~ 1...~ it 1 C ~ c.~:il:i, >•
the above-captioned estate:
1. State whether administration of the estate is con zplete:..........:......... ~ ~~es ,~N~~
2. If the answeris No, state wl]en the pe,sanal representative ~ .
reasonably believes t hat il]e administration Fill be complete:
3. If the ai]swer to I~'o.. l is YES, state t]e following:
a. Did the persor_aI representative file a fnaI~acceunt with the Court? ....... ~~'es ~No
b. The separate Orphans' Court :vo. (if any) for the personal
represer?tative's account is: '
c ,-
D1d the personal rep. ese]]~at.ve spat„ an account
informally to the parties in iraer?si? .:.................:........... ~ [~1'-rs ~] No
d. Copies of receipts, releases, joinders and approvals of folmzl or informal accp:r>r1t5 may ue
filed with the Cierlc of the 0lphan~' Court ar]d may be atia° e 'o tl?is repoi~_;
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Sgrrrr.:: t of ?er:au F:iSrg fiiiS FOrm
Capacity ~]Persura] ReT resentative '[/~Cbmscl
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