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REGISTER Or ~~'ILLS
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Na;ne of Decedent:~r~, ~;T~~~ t~ ;e3 ~ ~
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Date of Death: .~-~/~ Z(F,--~ 7~.t1 File Number: ?~'f0' ~:~ `"~ ~:-`~~.~
Dat;, Le~.els Granted:
To the Register:
I certify Lhat Notice of Estate Administration required by Pa. O.C. Rtae 5.6(a) of the Orr zaas' Co~Wrt
Rules was served on or mailed to the following beneficiaries of the above-captioned esta~ e on
I~'ar,e: 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) exce ot:
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Signe:ure ojPersan Filing this Form
Capacity: fd~Pe-soral Representative ..1 Counsel
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Name ojPerson Filing this Form
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