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NOTICE OF CLAIM
(Filed Pursuant to 20 Pa. C . S . § 3532)
/~OURT OF CP MMON PLEAS OF
~~Ar .0~,~ //~./ d COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF ~~ ~~ry~ ~y /U /~ ,DECEASED
No. L/ - I U // - d/ 7/
To the Clerk of the Orphans' Court Division:
/ ~/ in the
Enter the claim of ~ ~- '~ --
~p (Claimant)
amount of $ w `~~• ~3, against the above entitled Estate.
d at ~ ~ ~ /~ ~ -- /
The Dcc~cnt, why residc
said claim was given to
at ~ ~~
/I / ~ ~ ~ G / ~ (Address)
on l//v (Date)
(Claimant's Counsel) (Supreme Court LD. No.)
(Address)
(Telephone)
Form OC-07 rev. 10.13.06
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dicd on ~/ ~'!~e Z U v `Nritten notice of
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rr- __ p~ersonal Repr se a or hi.~er co el) _7
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