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CIER'fIFICATEON OF NonCE UNDER RULE S.Ma)
j. Name of Decedent:
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t Date of Death:
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Will No.
~Admin. No.
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To the Register:
I certify that notice of (beneficial interest) estate administ:rll11l:.ion 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 \()- ry-o > :,.,
Name
Address
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Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
NlO 1\1 e.
Date: ~) Cf\ \ \,
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Signatur
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Name :s ~~N \~ ~f\~fE.17,- -yn
Address r; '1 () S ~en~\ L\J" \\ e K '0
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Telephone ()\'1 f, S 'I 1 ~ ~ ~
Capacity: ~ Personal Representative
_Counsel for personal representative
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