INSTRUCTIONS FOR PROBATE

1. A TYPED PETITION IS REQUIRED.

2. A TYPED ESTA TE INFORMATION SHEET IS REQUIRED.

3. THE ORIGINAL WILL MUST BE PRESENTED.

'}. IF THE WILL IS NOT SELF-PROVING, THE SUBSCRIBING WITNESS MUST APPEAR IN PERSON OR THE SUBSCRIBING WITNESS FORM MUST BE NOTORIZED. IF THE SUBSCRIBING WITNESSES ARE DECEASED OR THEIR RESIDENCE IS OUTSIDE OF THE COMMONWEAL TH, A NOTARIZED AFFIDAVIT OR UNAVAILABLE WITNESS AFFIDAVIT MUST BE PROVIDED BY THE PETITIONER.

5. AN ORIGINAL DEATH CERTIFICATE rs REQUIRED.

6. FEE SCHEDULE IS ATTACHED. ALL FEES MUST BE PAID AT TIME OF FILING.

1. SHORT CERTIFICATES ARE ONLY ISSUED TO THE PETITIONER OR THE ATTORNEY REPRESENTING THE ESTATE.

8. ALL PROBATES vVITH GRANT OF LETTERS MUST BE ADVERTISED (P.E.F. CODE, TITLE 20, SECTION 31 G2) NEAR THE PLACE \1'/HERE THE DECEDENT RESIDED OR IN THE CASE OF NON-RESIDENT DECEDENT, AT OR NEAR THE PLACE WHERE THE LETTERS WERE GRANTED, AND IN THE LEGAL PERIODICAL, IF ANY, DESIGNATED BY RULE OF COURT FOR THE PUBLICATION OF LEGAL NOTICES, ONCE A \VEEK FOR THREE SUCCESSIVE vVEEKS, TOGETHER vVITH HIS NAME AND ADDRESS.

9. INHERTANCE TAX FORMS ARE AVAILABLE ONLINE AT \VWW.REVENUE.ST A TE.PA .. US

WWW.REVENUE.STATE.PA.US

10.AFTER PROBATE IS INITIATED (WILL FILED), THE FOLLOWING DOCUMENTS MUST BE FILED:

A. CERTIFICATE OF NOTICE 10.5- no later than THREE MONTHS AFTER PROBATE.

B. LEGAL ADVERTISING PA PROBATE, ESTATES AND FIDUCIARIES CODE, TITLE 20, SECTION 3162.

C. INVENTORY - NINE (9) MONTHS FROM DATE OF DEATH.

D. STATUS REPORT 10.6- no later than TWO (2) YEARS FROM PROBATE.

E. INHERITANCE TAX RETURN-,,·ithin NINE (9) MONTHS FROM DATE OF DEATH.

F. INHERITANCE PAYMENT DISCOUNT PERIOD: THREE (3) MONTHS FR01W DA TE OF DEA TH.

G. INHERITANCE PAYMENT DUE IN FULL NINE (9) MONTHS FROM DA TE OF DEA TH.

ANY LEGAL QUESTIONS MUST BE DIRECTED TO AN ATTORNEY OF YOUR CHOICE. IF YOU NEED TO HIRE AN ATTORNEY YOU

CAN CONTACT

Lackawanna Bar Association

Lawyer Referral Service

220 Penn A venue

Scranton, PA 18503

570-969-9161

THIS OFFICE IS NOT PERMITTED TO GIVE LEGAL ADVICE!

LACKAWANNA COUNTY REGISTER OF WILLS

TIMELINE FOR COMPLETION OF ESTATE ADMINISTRATION

Within Three (3) Months of Date of Death:

• Pre-pay Inheritance Tax to receive 5% discount.

(Go to the Department of Revenue web page for more information)

• Payment should be made by check payable to Register of Wills, Agent

• Check must contain Estate file number and decedent's name

• Hand deliver or mail payment to:

Register of Wills / Clerk of Orphans' Court

Scranton Electric Building

507 Linden Street

Suite 400

Scranton, PA 18503

Note: Payment must be hand delivered or postmarked within the three-month period to qualify for the discount.

Within Three (3) Months of Date of Grant of Letters:

• File one (1) copy of Certification of Notice under Rule 10.5

Within Nine (9) Months of Date of Death:

• File two (2) copies of Inheritance Tax Return with the Register of Wills office.

• File one (1) copy of Inventory with Register of Wills

• Pay Inheritance Tax due to avoid accruing penalties and interest

Note: Inheritance Tax Return and payment must be hand delivered to the office or postmarked with nine months of the date of death.

Within Two (2) Years of Date of Death:

• File one (1) copy of Status Report under Rule 10.6 with the Register of Wills

• If the Estate has not been completed within two (2) years of the date of

death, another Status report must be filed annually until administration is

completed.

mandojRectangle

mandojText BoxLCGC at The Globe123 Wyoming AvenueSuite 521Scranton, PA 18503

PENNSYLVANIA PROBATE, ESTATES AND FIDUCIARIES CODE, TITLE 20, SECTION 3162

THE PERSONAL REPRESENTATIVE, IMMEDIATELY AFTER THE

GRANT OF LETIERS, SHALL CAUSE NOTICE THEREOF TO BE GIVEN IN ONE

NEWSPAPER OF GENERAL CIRCULATION PUBLISHED AT OR NEAR THE

PLACE WHERE THE DECEDENT RESIDED OR, IN THE CASE OF A NON-

RESIDENT DECEDENT, AT OR NEAR THE PLACE WHERE THE LETTERS

WERE GRANTED, AND IN THE LEGAL PERIODICAL, IF ANY, DESIGNATED

BY RULE OF COURT FOR THE PUBLICATION OF LEGAL NOTICES, ONCE A

WEEK FOR THREE SUCCESSIVE WEEKS, TOGETHER WITH HIS NAME AND

ADDRESS; AND IN EVERY SUCH NOTICE, HE SHALL REQUEST ALL PERSONS

HA YING CLAIMS AGAINST THE EST A TE OF THE DECEDENT TO MAKE

KNOWN THE SAME TO HIM OR HIS ATTORNEY, AND ALL PERSONS

INDEBTED TO THE DECEDENT TO MAKE PAYMENT TO HIM WITHOUT

DELAY.

PETITION FOR GRANT OF LETTERS

REGISTER OF WILLS OF

Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and insupport thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form:

Decedent's InformationName: File No:

a/k/a: (Assigned by Register)a/k/a: a/k/a: Social Security No:

Date of Death: Age at death:

Decedent was domiciled at death in County, (State) with his/her lastprincipal residence at

Street address, Post Office and Zip Code City, Township or Borough County

Decedent died at Street address, Post Office and Zip Code City, Township or Borough County State

Estimate of value of decedent's property at death:If domiciled in Pennsylvania.. . . . . . . . . . . . . . . . . . . . . . . . . . . All personal property $ If not domiciled in Pennsylvania. . . . . . . . . . . . . . . . . . . . . . . . Personal property in Pennsylvania $ If not domiciled in Pennsylvania. . . . . . . . . . . . . . . . . . . . . . . . Personal property in County $ Value of real estate in Pennsylvania.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

TOTAL ESTIMATED VALUE. . . . $

Real estate in Pennsylvania situated at: (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County

A. Petition for Probate and Grant of Letters TestamentaryPetitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated and Codicil(s)thereto dated

State relevant circumstances (e.g. renunciation, death of executor, etc.)

Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pendingdivorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and did not have a child born oradopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.

NO EXCEPTIONS EXCEPTIONS

B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d.b.n., d.b.n.c.t.a., pendente lite, durante absentia, durante minoritate

If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.

Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as definedin 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person.

NO EXCEPTIONS EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (attach additional sheets, if necessary):

Name Relationship Address

Form RW-02 rev. 10/11/2011 Page 1 of 2

Oath of Personal Representative

COMMONWEALTH OF PENNSYLVANIA }

} SS:

COUNTY OF }

Official Use Only

Petitioner(s) Printed Name Petitioner(s) Printed Address

The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and correct to the best of the knowledge and beliefof Petitioner(s) and that, as Personal Representative(s) of the Decedent, the Petitioner(s) will well and truly administer the estate according to law.

Sworn to or affirmed and subscribed before Date me this day of , Date By: Date

For the Register Date

BOND Required: YES NO FEES:

To the Register of Wills:

Please enter my appearance by my signature below:

Letters . . . . . . . . . . . . . . . . . . . . . . $

( ) Short Certificate(s). . . . . .

( ) Renunciation(s).. . . . . . . .

( ) Codicil(s). . . . . . . . . . . . .

( ) Affidavit(s). . . . . . . . . . . .

Bond. . . . . . . . . . . . . . . . . . . . . . . .

Commission. . . . . . . . . . . . . . . . . .

Other . . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

Automation Fee. . . . . . . . . . . . . . .

JCS Fee. . . . . . . . . . . . . . . . . . . . .

TOTAL. . . . . . . . . . . . . . . . . . . . . $

Attorney Signature:

Printed Name:

Supreme Court

ID Number:

Firm Name:

Address:

Phone:

Fax:

Email:

DECREE OF THE REGISTER

Estate of File No: a/k/a:

AND NOW, , , in consideration of the foregoing Petition,satisfactory proof having been presented before me, IT IS DECREED that Letters

are hereby granted to in the above estate and (if applicable) that

the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.

Register of Wills

Form RW-02 rev. 10/11/2011 Page 2 of 2

Side 1

DECEDENT INFORMATION: Enter data as it will appear on all documents submitted to the Department.

Decedent’s Social Security Number

County Code Year

FOR REGISTER’S OFFICE USE ONLY

Date of Death Date of Birth

TYPE FILING: Fill in oval to indicate the nature of the return to be filed with the department.

Probate Return Joint Assets Only Non-probate Assets Only Litigation Purposes (no other assets)

LETTERS GRANTED: Fill in oval to indicate the nature of the proceedings at the Register of Wills Office.(Attach additional sheets if explanation is necessary.)

Testamentary Administration No Letters Other (Please Explain.)

ATTORNEY/CORRESPONDENT INFORMATION: Enter all information for the attorney or individual to receive tax information and correspondence.

PERSONAL REPRESENTATIVE INFORMATION: Enter all information for the personal representative(s) of the estate authorized by the Register of Wills.

Executor/Administrator

Complete general estate information questions and indicate additional personal representatives on reverse side.

Second Line of Address

First Line of Address

First Name MI

Second Line of Address

First Line of Address

Telephone NumberSupreme Court I.D. #

First Name MI

Telephone Number

First Name MI

File Number

Last Name Suffix

Last Name Suffix

Last Name Suffix

StateCity or Post Office

Attorney/ Correspondent’s e-mail address:

ZIP Code

StateCity or Post Office ZIP Code

PLEASE USE ORIGINAL FORM ONLY

OFFICIAL USE ONLY

TRANSACTION COUNT

REV-346 EX (11-15)

ESTATE INFORMATION SHEET

1

2

3

4

5

3460015105

3460015105

3460015105

Side 2

Co-Executor/Administrator

Co-Executor/Administrator

General Instructions:

This form should be filed with the Register of Wills of the county of which the decedent was a resident at death.

Please be aware the correspondent identified will receive all correspondence from the department. It is the responsibility of thepersonal representative to notify the department if the correspondent contact information changes.

The department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(i), to require disclosure of Social Security numbers in connectionwith administering state tax laws. The department uses the Social Security number to identify the decedent and personal repre-sentatives of the estate. The commonwealth may also use the information in exchange-of-tax-information agreements with fed-eral and local taxing authorities. State law prohibits commonwealth personnel from disclosing confidential tax information exceptfor official purposes.

Decedent’s Name:

Decedent’s Social Security NumberREV-346 EX (11-15)

Second Line of Address

First Line of Address

Telephone Number

First Name MILast Name Suffix

StateCity or Post Office ZIP Code

Second Line of Address

First Line of Address

Telephone Number

First Name MILast Name Suffix

StateCity or Post Office ZIP Code

3460015205

34600152053460015205

RENUNCIATION

REGISTER OF WILLS

Estate of , Deceased

The undersigned, _____________________________________________, in the capacity/relationship as (Name or Corporate Name)

_____________________________________ of the above Decedent, hereby renounces the right to administer

the Estate of the Decedent and, to the extent permitted by law pursuant to 20 Pa.C.S. § 3155, respectfully requests that Letters be issued to ____________________________________________________.

(Date)

Executed in Register’s Office Executed out of Register’s Office

Before the undersigned personally appeared the party executing this Renunciation and certified that he or she executed the Renunciation for the purposes stated within on this day of , .

Deputy for Register of Wills Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.)

Form RW-06 eff. 09.01.16

Name of Corporate Fiduciary (if applicable)

__________________________________________ Signature of Officer/Representative

____________________________________ Address

_________________________________________ Title of Officer/Representative

____________________________________

____________________________________ Telephone

____________________________________ Email

______________________________________________________ Signature of Person

_________________________________________ Address

_________________________________________ Telephone _________________________________________ Email

Sworn to or affirmed and subscribedbefore me this _______________ dayof ______________________, _______.

_________________________________________

Form RW-03 rev. 10.13.06

OATH OF SUBSCRIBING WITNESS(ES)

REGISTER OF WILLS

Estate of , Deceased

, (each) a subscribing witness to (Print Name/s)

the Will Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s)

that she / he / they was / were present and saw the above Testator / Testatrix sign the same and that she / he / they signed the same and that she / he / they signed as a witness at the request of the Testator / Testatrix in her / his presence and in the presence of each other.

(Signature) (Signature)

(Street Address) (Street Address)

(City, State, Zip) (City, State, Zip)

Executed in Register’s Office Executed out of Register’s Office

Sworn to or affirmed and subscribed Sworn to or affirmed and subscribed

before me this day before me this day

of , . of , .

Deputy for Register of Wills Notary PublicMy Commission Expires:(Signature and Seal of Notary or other official qualified toadminister oaths. Show date of expiration of Notary’s Commission.)

NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization.

Form RW-04 rev. 10.13.06

OATH OF NON-SUBSCRIBING WITNESS(ES)

REGISTER OF WILLS

Estate of , Deceased

and ,

(each) being duly qualified according to law, depose(s) and say(s) that she / he / they was / were well-

acquainted with and am/are familiar

with the handwriting and signature of the decedent, and that the signature of

to the foregoing instrument purporting to be the Last Will and Testament/Codicil of

_______________________________ is in his/her own proper handwriting.

(Signature) (Signature)

(Street Address) (Street Address)

(City, State, Zip) (City, State, Zip)

Executed in Register’s Office

Sworn to or affirmed and subscribed

before me this day

of , .

Deputy for Register of Wills

REGISTER OF WILLS LACKAWANNA COUNTY, PENNSYLVANIA

UNAVAILABLE WITNESS AFFIDAVIT

I, _________________________ (EXECUTOR) being duly sworn according to law,

depose and say that I, ______________________(EXECUTOR) in the Estate of

deceased, declare that ___________________________ appears as a subscribing witness

to the Last Will and Testament of _____________________________ deceased, is not

readily available to prove the signature of the Testa______ by reason of (his/her)

_______________________________________________________________ (reason).

______________________________ (Name)

______________________________ (Address)

______________________________

Sworn to or affirmed and subscribed before me this ________day of ___________________, 201__

_____________________________ (For the Register)

I::'\ RE:

BEFORE THE REGISTER OF \VILLS OF LACKAWANNA COUNTY, PENNSYLVANIA

Estate of_' _________________ , deceased

Estate No: ~~5-'20 __ _

AFFIDAVIT BY Pro Se Petitioner

The undersigned duly appointed personal representati\·e(s) for the above-captioned estate

confirm that I/\VE intend to administer this Estate Pro Se (without paid legal counsel) and take full responsibility for following all Pennsyh·ania Estate laws, Pennsykania Rules of Court,

and Pennsylvania Inheritance Tax regulations. I/\\'e acknowledge receipt of an estate check

list and agree that I/\Ve shall perform all required duties and shall file all required documents

on time without further notice. I /VVe ackrnm ledge that \\"e have recei\·ed the fiJllowing

documents this date:

Hule 10.5 Court

Certificate of Notice

Date: ___________ ~

Executed in Register of\Vills Office

S\\ orn to or affirmed and subscribed

Before me this ____ clay of

(For the Register)

Rule 10.6 Status Form

(SEAL)

_________ (SEAL)

,'20 __ _

TO:

IMPORTANT NOTICE

NOTICE OF EST ATE ADMINISTRATION PURSUANT TO Pa. O.C. Rule 10.5

THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE

Whether you will receive any money or property will be determined wholly or partly by the decedent's will. ff the decedent died without a will, whether you will receive any

money or property will be determined by the intestacy laws of Pennsylvania.

BEFORE THE REGISTER OF WILLS,

IN RE: ESTA TE OF ________________ , Deceased

File Number ______ _

_______________________________ (Beneficiary) _________________________________ (Address)

Please take notice of the death of the Decedent and the grant of Letters to the personal representative( s) named

below. The Decedent died on . a resident of

The Decedent died: ______ _ D testate (with a Will) or D intestate (without a Will) You may have a beneficial interest in the estate as follows:

(If additional space is needed, use separate sheet)

The name(s), address( es) and telephone number(s) of all personal representatives appointed are:

NAME ADDRESS TELEPHONE

If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of

If the Decedent died intestate. a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of

The Register's address is------------------------------------and telephone number is __________ _

A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication.

Date --------- Capacity: 0Personal Representative Ocounsel Corporate hduciary (1fapplicable)

"lame of Corporate F1duc1ary l\ame of Person

!'-:amc of Representative and Title '\ddrcss

Address

Telephone Ema ti

Email Signature of Person

Signature of Off1cer/Representati\'c ---- - ---· -------

Form RW-07 ejf 09 OIJ6

CERTIFICATION OF NOTICE UNDER Pa. O.C. Rule 10.5

REGISTER OF WILLS

Name of Decedent: _______________________________ _

Date of Death: _____________ _ File Number: ____________ _

Date Letters Granted: ______________________________ _

To the Register:

l certify that Notice of Estate Administration required by Pa. O.C. Rule 10.5 ofthe Orphans' Court

Rules was served on or mailed to the following beneficiaries of the above-captioned estate on

Name: Address:

(If more space is needed, attach separate sheet.)

Notice has now been given to all persons entitled thereto under Pa. O.C. Rule I 0.5 except:

Date ----------

Corporate Fiduciary (if applicable)

Capacity: D Personal Represcntati\·e 0 Counsel

Name of Corporate F1duciar, N amc of Person

Name of Representatl\ e and Title Address

Address

Telephone

Telephone

Email

Email

Signature of OfficcrlRepresentat1\e Signature of Person

Form RH'-()8 elf ()9.nJ.16

Pa. O.C. Rule 10.6 STATUS REPORT

REGISTER OF WILLS OF

Date of Death: ____________ _ File Number: _____________ _

Pursuant to Pa. O.C. Rule 10.6, I report the following with respect to completion of the administration of the above-captioned estate:

Date

1. State whether administration of the estate is complete: . . . . . . . . . . . . . . . . . . . . . . . DY es ON o 2. If the answer is No. state when the personal representative

reasonably believes that the administration will be complete:

3. If the answer to No. I is YES, state the following:

a. Did the personal representative file a final account with the Court? ......... 0Yes 0No

b. The separate Orphans· Court No. (if any) for the personal representative's account is:

c. Did the personal representative state an account informally to the parties in interest? ................................. Oves D No

d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans· Court or may be attached to this report.

Capacity: D Personal Representative Ocounsel Corporate F1duc1ary (if applicable)

----·-------

Name of Corporate Fiduciary Name of Person

Name of Representative and Title Address

Address

----·----- ----- -- -----· -----Telephone

Telephone Lmail

Email

---------- ------ --------Signature of Officer/Representative Signature of Person

Form RW-/() eff 09()/J6

05 Instructions10Grant of Letters - 000822-220ESTATE INFORMATION SHEET30RW 06 Renunciation Eff 09 01 16 - 00541040Oath Sub Witness - 000825-250Oath Non Sub Witness - 000824-160Unavaiable witness affidavit70 Affidavit by pro se petitioner80notice of estate adminstration90certification of notice99pa oc rule 10 6 status report

WEBLINK: WWW.REVENUE.STATE.PA.US Reset: Text8: Text11: Text14: Text15: Text16: Text17: 0Text18: Text19: Text20: Text21: Check BoxA1: OffText22: Check Box3: OffText23: Check BoxB1: OffText24: Text25: Text26: Text27: Text28: Text29: Text30: Text31: Text32: Text33: Text34: Text35: Text36: Text37: Text38: Text39: Text40: Text48: Text49: Text50: Text53: Text56: Check Box17d: OffText57: Text58: Text59: Text60: Text61: Text62: Text63: Text64: Text65: Text66: Text67: Text68: Text69: Text70: Text71: Text72: Text75: Text76: Text77: Text78: Text79: Text80: Text81: Text82: Text83: Text84: Text85: Text86: 0Text88: Text89: Text90: Text91: Text92: Text93: Text94: Text95: Text96: DecedentName: Text98: Text99: Text100: Text101: Text102: Text103: start box: arrow: Date Of Death 1: Date of Birth 1: Last name 1: Suffix 1: First name1: MI 1: Type fil 1: OffLetter Grant: OffLast name 2: Suffix 2: First name 2: MI 2: Supreme ID: Tele 1: Email 1: First line address 1: Sec address 1: City or post: State 1: ZIP 1: Last name 3: Suffix 3: Frist name 3: MI 3: First address 2: Sec address 2: City or post 2: State 2: Zip 2: Tele 2: NEXT PAGE: Dece name: Decedent's SSN: Last name 4: Suffix 4: First name 4: MI 4: First line address 3: sec line address 3: City or post 3: State 3: Zip 4: Tele 3: Last name 5: suffix 5: first name 5: MI 5: First address 3: sec address 3: City post 5: state 5: zip 5: Tele 4: Print Form: RETURN TO TOP: PREVIOUS PAGE: RESET FORM: County: [ ]Print the name of the estate of the deceased: Print your name: State your relationship to the Decedent: Print the name you request that Letters be issued to: Title of Officer/Representative: Address1: Address2: Telephone1: Email1: Address3: Address4: Telephone2: Email2: Text73: Text74: Text51: Text52: Text54: Text55: Reset Form: Text2: Text3: Text4: Text5: Text6: Text7: Text9: Text10: Text12: Text13: EXECUTOR being duly sworn according to law: EXECUTOR in the Estate of: appears as a subscribing witness: deceased is not: by reason of hisher: reason: 201: For the Register: Name: Estate of: Estate No 520: IWe: Date: undefined: SEAL: Before me this: day of: 20: IN RE ESTA TE OF: file Number: Beneficiary: Please take notice of the death of the Decedent and the grant of Letters to the personal representatives named: below The Decedent died on: estate (with a Will): Offintestate (without a Will): OffYou may have a beneficial interest in the estate as follows 1: You may have a beneficial interest in the estate as follows 2: NAME: ADDRESS: undefined_2: TELEPHONE 1: TELEPHONE 2: The Registers address is: A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication: Personal Representative: OffCorporate Fiduciary if applicable: undefined_6: undefined_7: Name of Corporate fiduciary: undefined_8: iamc oC Person: amc of Representatie and Titk: undefined_9: undefined_10: undefined_12: undefined_13: undefined_14: undefined_15: Fmail: Name of Decedent: Rules was served on or mailed to the following beneficiaries of the abovecaptioned estate on: undefined_3: Name 1: Name 2: Name 3: Name 4: Name 5: Name 6: Name 7: Address 1: Address 2: Address 3: Address 4: Address 5: Address 6: Address 7: Notice has now been given to all persons entitled thereto under Pa OC Rule I 05 except: Personal Representation: OffCounsel: Offundefined_4: undefined_5: Name of Person: Name of Representall e and Title: Address 1_2: Address 2_2: Address 1_3: Address 2_3: Telephone: Telephone_2: Name of Decendent: Date of Death: File Number: Check Box9: OffCheck Box10: Offreasonably believes that the administration will be complete: Check Box11: OffCheck Box12: Offb The separate Orphans Court No if any for the personal representatives account is: Check Box14: OffCheck Box13: Offpersonal rep: Offcounsel: OffName of Corporate Fiduciary: Name of Representative and Title: Address_2: Address: Name or Person: undefined_20: Lmail: undefined_21: undefined_11: