Certification of Notice Under Rule 5.6(a) IN RE Orphans' Court Division Estate of _________________________________________ No.:_______________________ _________________________________________ _________________________________________ Name of Decedent:____________________________________________________________________________ Date of Death : ___________________________________________________________________________ To the Director, Department of Court Records: I certify that notice of beneficial interest 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 __________________________ (attach additional sheets, if necessary) Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except ____________________________________________________________________________________________ ____________________________________________________________________________________________ Date:__________________ Signature _________________________________________________ Name : ________________________________________________ Address : _______________________________________________ _______________________________________________ _______________________________________________ Telephone : ______________________ , _______________________ Capacity : ________ Personal Representative ________ Counsel for Personal Representative [certheir_fillin] American LegalNet, Inc. www.FormsWorkflow.com