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/ .J . C:RTIFIC~TJO~~FNoT;F~u'lRULE5.6(a)
Name of Decedent: }1}~- !i- / 1.Ih!J/ZA1..5-'~
Date of Death: . )"', 1 ~ .z y
Will No. J.. 0 () . ,,- 0 D / t{ '-f Admin. No. f7a}ta ZI-I!ur - c:1 /9 Y
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on
- A.M'1 " fP )~~~J11J;' Jl}JJ,-~c&/kSi:
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: ./{:. 2 '3 - 0 4--
Signature
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Name
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Address
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Telephone (
Capacity: _ Personal Representative
_Counsel for personal representative
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