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/~ REGI TER OF WILLS
L- la COUNTY, PEIv~SYLVANIA
Name of Decedent: - ~~~ ~' /~'~~~C~',~'~/ t''Z,
Date of Death: t Z '` ~~'~'~ File Number: ~ ~~ ~ ~ `J d ~~-~ ~
Dutc ici~cl's Gt`jdnted: ~~ ~ / ~' ~ ~ ` L')
To the Register:
I certify that Notice of Estate Administration required by Pa. O.C. Rule 5.6(a) of the orphans' Cou~-c
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
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Name:
Address:
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(If more space is needed, attach separate sheet. )
Notice has now been given to all persons entitled thereto under Pa. O.C. Rule 5.6{a) except:
Date ~'7 ~ ~ f
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Signa of Person Filing this Form
Capacity: Personal Representative ^ Counsel
Name of Person Filing this Form
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.4ddress
Telephone
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