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C~RTI~'IC ~.TIO~v O~ i~; ~.~ ~'~CP ~T~ ~~~~~ P~. O.C. ~tl~'.~ ~.~(~~
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Narr.e of De:,e~ent:_____~~j4~ /~ _~1~~ ~ ~~ ~ ._-_
Date of Deat1.:~~1./Gl1~ 1~ _ Zllb7 __ File Number: Z. /`- !!f - a 9~~~________
Date Letters Granted: S~f'%-~/~ B~/~ ~ ~~~~ _
To the Register:
I certify tl,.at Notice of F:~~ ate Adrninistra`:c:: -.quired by Pa. l).C. Ru'? J.6(3) o tr:e (~r~,hans' Court
Rules was served on or mailed to the foliewi~~g benel~ciaries or the above-captioned estat? on
Z~ ~, ~ .
dame: Ad~dr:~s:
(If more space is needed, attnc,'. separate sheet.)
Notice has now been given to all persons entitled thereto under I'a. O.C. Rule 5.6(,aj excer_~t:
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°--° S~gnurz:re oJPerson Fi1in, this .Form
- - Car city: l1~'ersonal Representative ~ Counsel
{ :dranc c f i'arson Filth; .ha Form
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~dc:'ress
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Form RW-08 rev. ('0.13.06