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Home My WebLink About09-12-14 CERTIFICATIfl`ti C��' iv OT'��E LT'�'�E1� �a. O.C. Rul� S.b��) /� REGISTER GF `Z'ILLS l �(.,�-�'Yl�'�Q.�'I_ CUL�'TY, YE��SYLVANIA Name ofDecedent:__ v �� ','�'1 �x,'� Date of Death: �2I2��`L..�. File Number:_�Q, 2� "' GU�t-�''Q�� Date Letters Granted: �l-�'T�`-I-��I� To the Register: I certify that Noti�e of Estate Ad�nir�str�t5er.r�:;��:-ec'.�y Pa. O.C.Rule 5.6(a� of th� Q.�,nra�s' �ourt Rules was served on or mailed to the follo�ving beneficiaries of the avove-captioned estate on �r D�- ,�`L : Name: Address: .��.r�rle�`Px�x.}�Y _ .�..� h('(9�n 1�('u'iL rrrr�n�r� t� , � 17D91j `T D�i�I�-r�-i �I�I�.r Ket� S�r�ee-� l�/mrn1�u_c��u�3 (If more space is r..eeded, attach separate slleet.) Notice has now Ueen given to all persons entitled theretn uncier P�. O.C.Rule S.G(a; ex;,ept: � �1e �� _ O C!� r--1 "= 1 ` 5ignal r •rsat ilii l iis orua .,,� ft.. U.! � M r,_ � y ��:a � . a ity: �Person�:l Representative �Counsel �- E c:: �J�. �- � �.. � � I �� l . c� c� _ r :; G] 6�' � ..' �,� �r;; n4�me ojPersan Fili�g d�is l�onr� W t.1.f � L;�d "-- _.,t � � � � � .y�__��4 JI 1�� (/'3 � C� � �,y� p � � � p :1d�L�ess � �-' �- ° � ��rn � `''�,Ur��1�T0� � � a �, - , �, � vj _�___ ' �/� _�-l� �� TCIP)lll0ll(' `,` �\� i FormR4V-OS rer. /0.!i.0(