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COU?VTY, PEiv~`Sn-VA~IA .
Name of Decedent: L" N ~ lti' I ~ 6 y/
Date of Death: O ~ 2.d/ File Number: ~,1~ ~~ - Ob~'L2
Late Leers Granted:__ (~7 Z. ~ 7~ /~
To the Register:
I certify that Notice of Estate Administration required by Pa. O.C. Rule 5.6(a) of the Orphans' Court
Ric wa serve nor mailed to the following beneficiaries of the above-captioned estate on
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am-~ ddress•
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(IJ>nore 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:
DQ-t ® o ~ 1 w ,
Signcarc aJPc n Fafine rhir Form
Capaciry: 'P'ersonal Representative ~ Counsel
Namr ojPenon ilin, r6i1 Form
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Addrett , /
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