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11-22-10
_ _____ _. _ ~- I 1 i 1• ~.!'.~•. 1{.:ice V.3.. a,~i..'~X CiC A'4.. ~ R , icEC1STEi: OF ti~i='rLS G --~~~~ ~ COt~:~TY, Pi?•-~;3YL~~'..\`?. 1ti3me of Decedent:_~~~ /~~S ~'~~S - --• Date o: D_ath: 1 a -aa ~ a~Og File i`lut::ber: '-~ -~D''7 '' TJ....,,...,..r.,, D., /1 r^ P.,1~ +: t7 1 .-e-..~.~ t~~~ f,P., ;crir.a c;:ith ;?c;ia:-.t to nrrr;ri;'.~i(?t1 f?f t11P. 2wi1':1;1'!ja'3t!01: Oi 1 I~iJV:llll lV L V• V•..'• 1\~~lv V.1Y, 1 a YVl • ~ ..J .. .~ ~ i tine above-captioned estate: 1. State whether administration of the estate is complete :.................... ~]Y'es OU'~"o 2. If the answeris V'o, state when the personal representative reasonably believes that the administration will be com~le ~ ~~~~~~~ 3. if the airs-,ver to I~'o.. l is YES, state Cle follo«•inj: a. Did the personal representative file a fnal~accettnt with the Count? ....... ~]~'es []>\o b. The separate Orphans' Court No. (if any) for the person: l representative's account is: c. Did the personal representative state an account .. iufornialiy to the parties in itaerest? .:................... .... • ~~l'rs E]No d. Copies of receipts, releases, joinders and approvals of fotTnal or informal acco!lnts nlay be filed with the Clerlc of the O tFh~rs' Court atzd maybe a~ ached to tl?is repot•-:. S:gnrr::re of er:on F36 ; ri+it Form ~ ~ ~ •" ~ C2}i3City: [~Persoral Re~TCS[11t311Vt OUPSe.I !`r" - ~ ~..: ._ a. OG. ~ ,:; r:e o~Ptrsa: Filie~ rbli Forur '' ~ ~ ~ ~ ~ y ~ ~'^_ ~Lf ~ cS r J LL ` `~ © ~ te , 7 J ~~!/~ 71/l ~~~~~ ~( / ~ ~i ' C_.• ^ C o (r O . . . 1 ~TJT/V ~- y ~ V ~r~--moo -arcs N r01t~.;rOnt