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REGISTER OF WILLS
COUNTY, PEti~TSYLVA:~~IA
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Name of Decedent: ' ~'-~ ~ ~ -.
Date of Death: ` '" 1~-- o~-~~ ~ File Number: ~~ ~~ -` ~ ~ 1 ~~~
~u~c ~.e«cis vrdntea: _
To the Register:
I certify tha*. Notice of Estate Administraticr, required by pa. Q.C. Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
Nan-,e: Address:
(}'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:
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Date "' _-
Signcture of rson F" ing this Form
t,,-_ ;F~ Capacity: Personal Representative ~ Counsel
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~~~ ~ y~ ~__ { \`,: Nnme oJPerson fling this Form ___.
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IMPORTANT NOTICE
NOTICE OP ESTATE AI~~~II~tI~'TRATION
PI~~.SI.TAI~T TO P~. O.C. R~~~ ~.6
THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE
Whether you will receive any money or property will be determined wholly or partly by
the decedent's will. If the decedent died without a will, whether you will receive arty
money or property will be determined by the intestacy laws of Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF f~'~z~., _ , PENNSYLVA:!~TL4
IN RE: ESTATE OF ~Cti M ,Deceased
File Number --
TO:
(Beneficiary}
(Address)
Please t<~ke notice of the death of the Decedent and the grant of Letters to the personal representatives} named
below. The Decedent died on the d' of ~,~~c2 ~, ~~ c~~~ L~ , a resident of
(~ Q R.,Ny~~~trA...~-~.~ County, PA.
The Decedent died:_~testate (with a will) or intestate (without a will).
Yo~ay have a beneficia interest in the es~ t~ folloy.~s: ~r~-~- ~~ ~~.~-~-
(If additional space is needed, use separate sheet)
The name{s), address{es) and telephone number(s) of all personal representatives appointed are:
NAME ADDRE ELEPH
If the Decedent fed testate, the will has been filed with Office of the Register of Wills of
(~ .L.,~4°v~ .~1,-U--~...~ County.
If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the
Register of Wills of ~ County.
The Register's address is,.-. ~~k,1~.~v~-~- ~ , ~~~ ~--- ,
d
and telephone number is
A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges foi•
duplication.
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Date f ~ ~ ~ O
Signature of Person fling this Form r!
Name of Person Filin is Form 11 ~~
Capacity: ~ Personal Representative Address/'~1 , 1 ,
~ Counsel for Personal Representative `-~,~,-.. l,` ~, ~' ~--~,,~-
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~'eiep e r!
Fo~7n F.W-07 rev. 10.1?.06