8

STATEMENT *X*

(1) Persons entitled in distribution under the intestacy or partial

intestacy.

MA

AK

Rehabzade to the dockaved

(ii) Personal representatives of such of the above as have died since the death of the deceased.

Name of peɔwdk

ne preventative

Addreu

Naune of Hoe deceased Dope of death pr

person represented ach deceased person

(ii) Beneficiaries under the will who survived deceased and have since died or who predeceased him/her but did not thereby lose their benefits.

Nude

Ap

Dane mi Name of perconul

darth

CLİPE

Addrew of penal REVERENLEDİYE

STATEMENT “Y”

Part 1.

Name (including "tong" or family names) in which the deceased personally held property in the Colony.

How did he come by the muse Ge.. was de ælven 10 tulen, #dogrand by him, or did he wagreed to be?)

For what purpose LE the Dude ed

Part 2.

Name (including "tong" or family names) other than those falling under Part 1. by virtue of which the deceased had an interest in properly in the Colony.

Name

Name of the person e be pose the name: relaitonabtp o The cetsart

Falepler of the

HOD:

Etten ad deceased's intencu

NOTE -The deponent is required to sign the following certificate. I certify that, save as appears from the above Statement, the deceased to the best of my knowledge and belief held no property in this Colony under any family or "toog" name; nor had the deceased any interest in any property in this Colony held under any family or "tong" name or under any name whatsoever.

Signature of deponent

SAREENAAR DARI |

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