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If ron? ot the shove o ives and an exrculor or adninistr.. Ies been appointed, the following. .t: ....t.houl.l b, complety I/w/h.w. b. .. duly appoinied..... mntor... ... of the estate of the dereased, as evidenced by (Taccut or cdninistrator) ceriia.te of .pgointment herewith, adninistration having bcen taken out in the interest of. ....rinistmtion of the estate,. (Nam., mt. , and relatiunship of itereated relative or creditor) and suh appointnent is still in full force and effect. Neir. -If inaking clein as the exrcutor or aulninistrator of the estate of the decuased, no witnesses are required, but court. d.ard pragrapt.s6an7.) 6. If none of the above survives and no executor or administrator has been appointed, the following information should be furnished: Brothers and sisters (if none, so state) :. Name Ag. Street Address, City, State, and ZIP Cods. Nephews and nieces (List only the children of deceased brothers and sisters. If none, so state):. Nane, Age, Street Address, City, State, and ZIP Code Name of Deceased Parent 7. Have the funeral expenses been paid? ye9. (1f paid, receipted bill of the undertaker must be attached YorNo FINES.PFNALTIES.and FORFEITURES art impoHd by Iaw for the snnking of false gr fragd d C.d Clyde A.'j313on' of claimant) c/o.Riggs. National..Bank Personal Trust Ditsigfr.- P.O. Box llh9, Washington, D.C. 20013 (City. State, and Z1P code). TWO WITNESSES ARE REQUIRED We certify that we are well acquainted with the above ...Clyde..A..T.olson. and that witne Meet {Street address (Street addres 72. (Ciy. sh.e, nid zyp 7ode) City.Stay.andz.IP code AllC. chithpq eneation."sheuld acconpa G SGCNNTRTNGICE1--213