Application For Page 6

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QUALIFICATION AND STATEMENT OF ACCEPTANCE
I accept this appointment and agree to perform the duties and discharge the trust of the office of Personal
Representative of this estate.
Signature:
Name:
Address:
E-mail:
Telephone (O):
(H):
Signature:
Name:
Address:
E-mail:
Telephone (O):
(H):
Attorney:
Address:
E-mail:
Telephone (O):
FORM #300PC (9/11)
Page 6 of 6

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