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Free Form OC-01 - rev. 10-13-06 - Petition for Adjudication - Decedent's Estate - Pennsylvania



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Excerpt: Reset Form DECEDENT'S ESTATE COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF No. , DECEASED PETITION FOR ADJUDICATION / STATEMENT OF PROPOSED DISTRIBUTION PURSUANT TO Pa. O.C. Rule 6.9 This form may be used in all cases involving the Audit of the Account of a Decedent's Estate. If space is insufficient, riders may be
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DECEDENT'S ESTATE
COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION

ESTATE OF No.

, DECEASED

PETITION FOR ADJUDICATION / STATEMENT OF PROPOSED DISTRIBUTION PURSUANT TO Pa. O.C. Rule 6.9

This form may be used in all cases involving the Audit of the Account of a Decedent's Estate. If space is insufficient, riders may be attached. Attach the spouse's election, if any; the papers required under items 8-19 inclusive; and any instrument pertinent to the adjudication.

INCLUDE ATTACHMENTS AT THE BACK OF THIS FORM.

Name of Counsel: Supreme Court I.D. No.: Name of Law Firm: Address: Telephone: Fax:

Form OC-01 rev. 10.13.06

Page 1 of 10

Estate of 1. Name(s) and address(es) of Petitioner(s):
Name:

, Deceased

Address:

Identify any executors or administrators who have not joined in the Petition for Adjudication and Statement of Proposed Distribution and state reason:

Is this the first accounting by this fiduciary? . . . . . . . . . . . . . . . . . . . . .

Yes

No

If not, identify prior accountings, the accounting periods covered, and the date of adjudication of the prior accounting.

2.

Decedent died on Letters Testamentary or

. Letters of Administration were granted to Petitioner(s) on

Date of Will (if applicable): Date(s) of Codicil(s) (if applicable): Date of probate (if different from date Letters granted): Was a bond required? Yes No If yes, state amount: Yes No

Are proofs of advertising of the grant of Letters attached? . . . . . . . . . Dates of advertising of the grant of Letters:

Form OC-01 rev. 10.13.06

Page 2 of 10

Estate of 3. Was decedent survived by a spouse? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If yes, name of the surviving spouse:

, Deceased Yes No

4.

Has the surviving spouse filed to take an elective share? . . . . . . . . . . . . . (See Section 2201 et seq. of the Probate, Estates and Fiduciaries Code) If yes, date of election:

Yes

No

5.

In the case of an intestacy, state the names of the decedent's surviving children or surviving issue of deceased children (if none, so state):

6.

Did decedent marry after execution of Will or Codicil(s)? . . . . . . . . . . . Were any children born to decedent after execution of Will or Codicil(s)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If yes, give names and dates of birth: Name: Date of Birth:

Yes

No

Yes

No

7.

If required by the Medical Assistance Estate Recovery Act, 62 P.S. 1412, was a request for a statement of claim sent to the Department of Public Welfare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

Form OC-01 rev. 10.13.06

Page 3 of 10

Estate of 8.

, Deceased

Written notice of the Audit as required by Pa. O.C. Rules 6.3, 6.7 and 6.8 has been or will be given to all parties in interest listed in item 9 below, all unpaid creditors and all claimants listed in item 10 below. In addition, notice of any questions requiring Adjudication as discussed in item 14 below has been or will be given to all persons affected thereby. A. If Notice has been given, attach a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice. B. If Notice is yet to be given, a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice shall be submitted at the Audit together with a statement executed by a Petitioner or counsel certifying that such notice has been given. C. If any person entitled to Notice is not sui juris (e.g., minors or incapacitated persons), Notice of the Audit has been or will be given to the appropriate representative on such party's behalf as required by Pa. O.C. Rule 5.2. D. If any charitable interest is involved, Notice of the Audit has been or will also be given to the Attorney General as required under Pa. O.C. Rule 5.5. In addition, the Attorney General's clearance certificate (or proof of service of Notice and a copy of such Notice) must be submitted herewith or at the Audit.

9.

List all parties (charitable and non-charitable) of whom Petitioner(s) has/have notice or knowledge, having or claiming any interest in the estate as beneficiaries under the Will or Codicil(s) or as intestate heirs if there is a complete or partial intestacy: A. State each party's relationship to the decedent and the nature of each party's interest(s):
Name and Address of Each Party in Interest Relationship and Comments, if any Interest

Form OC-01 rev. 10.13.06

Page 4 of 10

Estate of

, Deceased

Name and Address of Each Party in Interest

Relationship and Comments, if any

Interest

B. Identify each party who is not sui juris (e.g., minors or incapacitated persons). For each such party, give date of birth, the name of each Guardian and how each Guardian was appointed. If no Guardian has been appointed, identify the next of kin of such party, giving the name, address and relationship of each.

C. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed for this Audit (see Pa. O.C. Rule 12.4).

D. If distribution is to be made to the personal representative of a deceased party, state date of death, date and place of grant of Letters and type of Letters granted.

Form OC-01 rev. 10.13.06

Page 5 of 10

Estate of 10.

, Deceased

Other than the claim for the family exemption, list the names of all known claimants and the amount of their claims and state whether each claim is admitted.

Name and Address of Each Claimant

Amount of Claim

Claim Admitted?

Will Claim Be Paid In Full?

" Yes " No

" Yes " No

" Yes " No

" Yes " No

" Yes " No

" Yes " No

" Yes " No

" Yes " No

If the estate is insolvent, attach a schedule setting forth the order of preference under 20 Pa.C.S. 3392 and the proposed payments. Was family exemption claimed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " Yes Was family exemption allowed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " Yes Family exemption claimant's name and relationship:
Name: Relationship:

11.

" No " No

Form OC-01 rev. 10.13.06

Page 6 of 10

Estate of 12.

, Deceased

The amount of Pennsylvania Transfer Inheritance Tax and additional Pennsylvania Estate Tax paid, the date(s) of payment(s), and the interest(s) upon which paid, are as follows:
Date Payment Interest

13.

On the date of death, was the decedent a fiduciary (personal representative, trustee, guardian, agent under power of attorney) or surety on the bond of a fiduciary? . . . . . . . . . . . . . . . . . . . " Yes

" No

If yes, provide the name of the estate, indicate whether an account has been filed and confirmed absolutely and all awards performed, or, in the alternative, how the decedent's estate will be discharged for the decedent's fiduciary administration of the estate.

14.

A. Describe in detail any questions requiring adjudication and state the position of the Petitioner(s) as to each question:

B. Has notice of the question requiring adjudication been given to the parties identified in Paragraph 9 above? . . . . . . . . . . . . . . . . . . " Yes

" No

15.

If Petitioner(s) has/have knowledge that a share has been assigned, renounced, disclaimed or attached, provide a copy of the assignment, renunciation, disclaimer or attachment, together with any relevant supporting documentation.

Form OC-01 rev. 10.13.06

Page 7 of 10

Estate of 16. Had the decedent been adjudicated an incapacitated person? . . . . . . . . . .

, Deceased Yes No

If yes, attach a copy of the Order if available; otherwise state the Court, term, number, date, and name of Hearing Judge.

17.

A. List or attach a separate list of additional receipts and disbursements since the closing date of the Account.

B. Has notice of the additional receipts and disbursements been given to the parties identified in Paragraph 9 above? . . . . . . . . . . . . .

Yes

No

18.

If a reserve is requested, state amount and purpose.
Amount: Purpose:

If a reserve is requested for counsel fees, has notice of the amount of fees to be paid from the reserve been given to the parties in interest? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If so, attach a copy of the notice.

Yes

No

19.

Is the Court being asked to direct the filing of a Schedule of Distribution? . . . . . . . . . . . . . . . . . . . . . . . . . . As to real estate only? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes Yes

No No

Form OC-01 rev. 10.13.06

Page 8 of 10

Estate of

, Deceased

Wherefore, your Petitioner(s) ask(s) that distribution be awarded to the parties entitled and suggest(s) that the distributive shares of income and principal (residuary shares being stated in proportions, not amounts) are as follows: A. Income:
Proposed Distributee(s) Amount/Proportion

B. Principal:
Proposed Distributee(s) Amount/Proportion

Submitted By: (All petitioners must sign. Add additional lines if necessary):
Enter Corporate Fiduciary (if applicable):

___________________________________________ Name of Petitioner: ___________________________________________ Name of Petitioner:

Form OC-01 rev. 10.13.06

Page 9 of 10

Estate of Verification of Petitioner (Verification must be by at least one petitioner.)

, Deceased

The undersigned hereby verifies * [that he/she of the above-named name of corporation

is title and] that the facts set

forth in the foregoing Petition for Adjudication / Statement of Proposed Distribution which are within the personal knowledge of the Petitioner are true, and as to facts based on the information of others, the Petitioner, after diligent inquiry, believes them to be true; and that any false statements herein are made subject to the penalties of 18 Pa. C.S. 4904 (relating to unsworn falsification to authorities).

____________________________________ Signature of Petitioner

* Corporate petitioners must complete bracketed information.

Certification of Counsel

The undersigned counsel hereby certifies that the foregoing Petition for Adjudication/ Statement of Proposed Distribution is a true and accurate reproduction of the form Petition authorized by the Supreme Court, and that no changes to the form have been made beyond the responses herein.

Signature of Counsel for Petitioner

Form OC-01 rev. 10.13.06

Page 10 of 10

File Size: 424.2 kB
Pages: 10
Date: December 28, 2006
File Format: PDF
State: Pennsylvania
Category: Court Forms - Local
Word Count: 1,581 Words, 10,381 Characters
Page Size: Letter (8 1/2" x 11")
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