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CERTIFICATION OF NOTICE UNDER Pa. O.C. Rule 5.6(a)
/'� REG[STER OF WILLS
f��/��r�"�ah�/CpWi TY, PENNSYLVANIA
Name of Decedent: ,�G S e,��`► C�t, �
Date of Death: /�-?- /� File Number: ��I � �3�G j6�.�
Date Letters Granted:
1'o the Register:
t certify that Notice of Estate Administration required by Pa. O.C.Ruie 5.6(a)oi tne Orpnans'CouR
Rules was secved on or mailed to the following beneficiaries of the above-captioned estate on
Name: Address:
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(If more space is needed, altach separate sheet.) �
Notice has now been given to aU persons entitled thereto under Pa.O.C.Rule 5.6(a�except:
Datr �`��/ �
Signat n fdmg rhit Form
Capaciry: ❑Personal Represe�tative Q Counsel
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