1969-HKRS30-16-29_Part04 — Page 63

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15

STATEMENT “X”.

(1) Persous entitled in distribution under the intestacy or partial intestacy.

NE

ARE

Relacionship to the deceased

STATEMENT "Y".

Part 1

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

Flow and be combe by the BADAG (eg. was it alwen to halen,

#dopted by kakan, 'or di

he pucend 15 17)

For what purpose wa

the need owed.

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

Name of perousal fitprometacrve

Addresa

Nama of the descared Stepmom PETTERENIED

Dae of depth of #DEN dccBASED THEREON

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

Name

Asc

Date of drench

Nate of personal TEDIESER LAUDİON

Address of penkal representative

Part El.

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

Name of the DESCHL entitled to use the

144

date: relationship to the decessed

Partitadark b

abe proper

Etical of decegand's forest

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