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11-15-10 (2)
~ T_. _ _ _ s ~, ~. g p~ ~, .SF{+.iii4 ~.3..~ L~.i 7..~j.A/iJ.~J ~~4r~.~~-i:+P. . F.ECTSTEiti OF ti^i? LS G .~`e~- a1~C~ {;rLvTY, PF1,~iSY•r •~•~,~;?. Name of Decedent: DKi ~- Date o:'D°ath: ~/• Zl. C~~ File hlul~:be:: 1 lit 7lt.;.1\lt LV D[:. V1.~. j,\tile V.li, 1. ivy../• : •. - o . f ~ .°-•.,•"t rl:~ f;'ll:"=~I"a ts:ah 1•_cn?°:t.~ rrm••l~`ir~~ of t1~~ ~'.~i7?i:~islt•3tion of tile above-ca;~tioned estate: ~ ~ ~ . State whether admil~istration of tae estate is complete: E ................ Q ~'~s ~''No 2. if the answer'is Iv'o, state when the personal representative reasonably believes t ;at the adlrinistration Fill be comple Z ~ 3. If the ai?s.uer to I~'o.. l is YES, state t;le following: a. Did the personal representative file a fnal~account wit the Court? ....... DY b. The sepzrate Orphans' Court Ive. (if any) for the perso : l • representative's account is: '~ c. Did the personal representative state an account 111folTl;aliy to the parties in ilaerest? .:........... ....:........... ' ~~YG d. Copies of receipts, releases, joinders and approvals of t'oirnzl or informal filed with the Clerk of"the O~haas' Court and may bejat~ached to this re~ Onr~ ~ ~ ~ ~0 ~' ~ ~,• ~J ~ Si~nrr;:r uj ? ,a~ Fair; ri,' orm ~~ ~ ~; N ~ _ ~~~ ~ Capacity: © erso::al I? presentati~~ , _,~ C' ~,.~ '~s ~~4 7 ' --a-~' a t/? ~ ~Q ~-4-~! } , ~ ~'xlw -~ ~ ~ r`:rc:e ojP~ on fi u:; rF:r~~ ' ~ t ` t _; : ' ¢v r C ~ s -~ - s" r~~~;.::o,:r Q No Q No may L-e .8 ~_