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07-15-15
I �VIII. II ll■ 1 �'�R�IFIC:�T�C�� �F :����CE ����)l�r�? P�:, �,+C. Ru?� �.b�a� ��c����_� or- -,��,�;L���. "��`1 �-1�.� No .._, _. CCL�T�T � il�\\�r: L LV:1\t:.'1 �c7::�2 Oi 17C'C�'.C�'.^�:__IL�LL�---a \7lC \ � �'� i� �___ Date of Dea�n:���f� F�ie \�.;,,�'aer:_ �.��j--�J � �J�� Date Le':e;s Gran,e:'.: � i OU� (�� 5 (Sf EI�'_ �' ��!��.'�I �}�S ( h� -���/�.) To the Reoiste�: i ceitify ti:a±;�otice o;Es,a,e Adii,inistratien required by Pa. O.C.R_��ie 5.6(a) of the Orpnai;s' Co;:r: Ru:es was ser oll o;n:ai!�d to tne follov�ing ber,eficiarie; cf?.`,e r.:;c�.�e-captioned esta,;, or, � �1S . , Name: � �r�4 Add;ess: �,�AuKtS{-1 fl� W ISCON51 ti --�--�-1�Jl�f�-�-� ,(l M IL1-�I� - tc��z 1 c�;z 1���F>>,_,Ti rnaE�xae� �-�t�;� � �l I��C � ���t1� '�� Cc�r�Gcv�i�t:���i��M� �D���oc�:�% � PA � �7�S 7 _�A- t��5 C k��U�; 5o�u�-��-i �,�j��''�-�a ���cS��.e���'� �� �� /� I��(2—�� � �J L(�'C'�.���.�-�.� � t�---c`� 7 O i� � r (If more space is reedzd, at�ach separrte sh�et.) i�oticc has no�.v b�e;l giv�;l to all pe;so��s er�t:;;ed t'lereto under Fu. 0.(:.Ru',�5.6(a) except: , , L)r.;e_� /� 1� ��;.�":.._�/,1 ,rc/�__ c �,. `i��:,n;ur�o'/'c;��,,,.c:i;;I;r. f�c;;n ����-�� C1� �„!!V: LSd���:l'S�li'.i }�C :;C,:IdiIGC ��COC;I��I a � o �{�i�L�_f 1�=�� --�_�D K��f1 l � � ,t���;;�,���;,��:,�. 4� .�-� �, ; .;�:- �: G.7 ,"` r"`I �„ []' —_.[v_� ( `^'�.1,,.�^ifJ�� I�-� tr.., � r� . _ . — --- � �;� ._, �_,� ,i:!: �:» C7 C`, � 4J � `.-% /�1j L1./�A � ��..� I � � �r, t � I'f.• � r3 --��-llv� I I_.._t�__------- � L..,".�� � i,'�,.� P� �� QC1 �--•. �..� �,y J ,� Q �1 i 1 '�I '�fJ (! C�/� '`� ''T' "1 -- -.�_.� - �----------- � � � � � Z' � 1_,'���i�u;ir l,tJ 41 "'J � p-�j \/�\, �' � r-n C"� ,�' r� � b �