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11-29-10
_ .J ., itECISTER OF ~`i'''rLS Gr ~/~`KI~r~QMA CGU:vTi', PLv?;SYL~V~,~:?. 1V3111e GI DeCede;?~: ~~I l,U ~' V Da'e o: Death:_ t~•a~}~ ~Dg File i`iur::be`° ~i~'~- ~~ i~ira jiiirit in D., n.G. r., to /. 17 T r~-. ,.t t :°, f~,tl'u ~_ :' ' •n •1~~. ' v i u. v auiav v. as, a Nva ! '•Q ~;; it;t 7. C71P;~. t1 C.l1TT" ;IAtI ¢_f the aft??kt?t=iratla? Or the above-ca;~tioued estate: J - 1. State whether admrn?stration of the estate rs complete :.................... 'es C.1~'N~~ ~~ 2. If the answei is No, state when the personal representative reasonably L-elieves that the zdrrinistrationwiil Ue complete: ._1.11_._ i~- -- 1 - - - ~. , 3. If the airs Ner to I~'o.. l is YES, state tie following: a. Did the personal representative file a fnal~acceunt with the Court? ....... ~]I'fes ©No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in iraerest? .: ...............:........... ' ~] ;'~s E];`1o d. Copies of receipts, releases, joinders and approvals of formal or infonna] accotfnt$ map filed with the Cleric of tl?e Otpl~aas' Court and trtay be a<<ached to tl?is repots:. I, „„ ~ Ontc ~ ~' ~~• ~V Scgnrr::re uj Po•:on Fi'i , ti~it Farn '~ Ca};acity: ~PersuttalRepresentative [~Couuscl w _ ~. ' ~' Q 4a - N ~ t=~ ~ ~ ~ ~ ~ a C`~ ._~ ©~L~ CTl ~Cn~ .._, _ CV W Z Q cz~ ~::? <_~~ ti_~ > 0 --t'~ C~ V~W ~_: ~: ~~_:.:~ ~;- Q N ~ Nm::e dddre~~ Y7N C~~1) bl'C • t I y3 rrirp:~o,~e __ ~__i