CERTIFICATION OF NOTICE UNDER Pa. O.C. Rule 10.5 REGISTER OF WILLS CARBON COUNTY, PENNSYLVANIA Name of Decedent: Date of Death: Date Letters Granted: File Number: To the Register: I certify that Notice of Estate Administration required by Pa. O.C. Rule 10.5 of the 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 10.5 except: Date Corporate Fiduciary (if applicable) Name of Corporate Fiduciary Name of Representative and Title Address Name of Person Address Telephone Telephone Email Signature of Officer/Representative Form RW-08 eff. 09.01.16 Signature of Person American LegalNet, Inc. www.FormsWorkFlow.com Email