SUPREME COURT ORPHANS’ COURT RULE 6.12 STATUS REPORT BY PERSONAL REPRESENTATIVE NAME OF DECEDENT: DATE OF DEATH: WILL NO.: ADMINISTRATION NO.: Pursuant to Rule 6.12 of the Supreme Court Orphans’ Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1.) State whether administration of the estate is complete: YES NO 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. 1 is YES, state the following: a.) Did the personal representative file a final account with the Court? NO YES 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? NO YES d.) Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans’ Court and may be attached to this report. I certify under penalty of perjury that the foregoing information is correct to the best of my knowledge, information and belief. Date: , 20 SIGNATURE: ADDRESS Capacity: or Personal Representative Counsel - I.D.# TELEPHONE APPENDIX A: Form 6 - Status Report American LegalNet, Inc. www.FormsWorkFlow.com