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CERTIFICA'FI~`d ~~' h'~~'~C~ TJ~'~~P. P~. ~.C. R~~le 5.~(?)
Name of Decedent: >~~~ ~-~ C
Date of DeaL't: ' v ~ File Number. ~,6 ~ ~ "~ ~~ ~'
Date Le~-ers Granted:
To the Register: ~ __-_ , .
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- I certify that Notice of Estate Administration required by Pa. O.C. Rule S.ti(a) of the Orphans' Court
Rues was served on or mailed to the following beneficiaries of the above-captioned estate on
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°' ~ ddress: .
(If more space rs needed attach separate sheet.)
Notice has now been given to all persons entitled thereto under Pa O.C. Rule S.ti(a) except:
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Form ~w'•G8 rrv. 10.13.66
Si ojPerson FiG'ne this Form
Capacity:Personal Representative ~ Counsel
Nome of Person Filing this Form '
.address
Telephone
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IZ.GIST£R OF ~VILLS
COUNTY, PE~~'SYLVA~Z:~