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1V3111e Gf Decedel?t:_ ~~ .._.t-.
Date o: D°ath:
File Nut::1~~r: y( 6~ ~7 ='
D............• ~.. D.. f i T B.,la % 17 T ,•~-,.,.t t::~ F~,ll.~~crir.a ~Litn r?c;,a~ t to t1rTh~a>`ir.1 C?{thy ~~Tl?~;1?~tl'3tlol: Oi
t ut xtnu~ W i c. v.~,. i~t:.v v. u, a . S..v• .., ..
tl7e abOVe-Ca~ltlGnZd estate: ', L
.., to i c ^'+ ~• ............ ~ e5 ~ NO
1. Spa... whether admltilstrat.oa of the e.,tate Is cU..ipl..~e:........
2. If the allsweris ;,'o, state when the personal representative
reasonably L-elieves tiat the adlninisttationwill becomplete:
J
3. If the ails.uer to I~'o. l is YES, state file follo~vinj:
a. Did the ersor_zl re resentative :ile a fnal~accettnt with the Court? ....... I Yes ~o
P P
b. The separate Orphans' Court Ivo. (if any) for the personal
representative's account is:
c. Did the personal rep esen~at:ve ~ta~e an account L
!' ~
iuforn;al:y to the parties in Int;.r.~~. ~s Duo
d. Copies of receipts, releases, }oinders and approvals of fot7rlal or informal accori~its, nay L-e
filed with the Clerlc of the Olpha, s' Court and may be anached to this repot~_. ',
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