#1706788
De bhrí go bhfuair ba as , éagach, bás ina bhaintreach fir agus ina dhíthiomnóir ar, nó um, an lá de 19 , i [más i gClárlann Phrobháide Cheantair a dhéantar an t-iarratas, cuir leis: agus go raibh aige tráth a bháis áit chónaithe sheasta i laistigh de cheantar ], agus gur fhág sé de chlann dhleathach , agus iadsan amháin, ar mionaoiseach an sin agus gan aige/aici ach bliana d'aois, agus ar mionaoiseach freisin an sin agus gan aige/aici ach bliana d'aois.
Whereas late of deceased, died a widower and intestate, on or about the day of 19 , at [where application is made in a District Probate Registry, add having at the time of his death a fixed place of abode at within the district of ], leaving his lawful and only children, the said being a minor of the age of years only, the said being also a minor of the age of years only.