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Gu m Be r �, a�_ COL�T'z', i�'E'��"SY`L`'�`�I.=1
tiame of Decedent: TfT G O � �fl n�G ( e� 1- i o���� � �
Date of Death: �6 3 �- �, O � � File ��.;,�'��er:__��' '� � �
Date Letters Granted:�-r1 � a.� � � y^ a' �� 1,�
To the Register;
I certify that Notice of Estate Administration required by Pa. O.C'.Rule 5.6(a) of the Orphai�s' Court
Rules was served on or mail�d to the follo�ving beneficiaries of t�e a�ove-captioned estate on
Oe c.e �r•b e ti�_, ao,�
Name: Address:
'��..� �1 � ��e� �ie����e�- D� 5� �� y �n- S � Re-� -�' _
W Oc �+•l�-� g �a v a.s t ri 1"1D'(3
(If nzoi•e space is n.eeded, attacl2 separnte sheet.)
Noticc has now Ueen given to all persons entitled thereto under F�:i, O.C.Rule 5.6(a)except:
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isnnnu ojPersor.fi/mg'11irs Form
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