SUPREME COURT RULES DOCKET NO. 702 (Pa. Aug. 9, 2016)

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In re Order Amending Pa. Orphans' Court Rules

SUPREME COURT OF PENNSYLVANIA

Aug 9, 2016

SUPREME COURT RULES DOCKET NO. 702 (Pa. Aug. 9, 2016)

Opinion

SUPREME COURT RULES DOCKET NO. 702

08-09-2016

IN RE: ORDER AMENDING THE INDEX AND RESCINDING AND REPLACING FORMS OC-01 THROUGH OC-06 AND RW-06 THROUGH RW-10 IN THE APPENDIX TO THE PENNSYLVANIA ORPHANS' COURT RULES

PER CURIAM

ORDER

AND NOW, this 9^th day of August, 2016, upon the recommendation of the Orphans' Court Procedural Rules Committee; the proposal having been submitted without publication pursuant to Pa.R.J.A. No. 103(a)(3) in the interest of justice and efficient administration:

IT IS ORDERED pursuant to Article V, Section 10 of the Constitution of Pennsylvania that:

1) The Index to the Appendix of the Pennsylvania Orphans' Court Rules is amended; and

2) Forms OC-01 through OC-06 and RW-06 through RW-10 in the Appendix to the Pennsylvania Orphans' Court Rules are rescinded and replaced

in the attached form.

This ORDER shall be processed in accordance with Pa.R.J.A. No. 103(b) and shall be effective September 1, 2016 for all legal papers, pleadings, or notices filed or served as of that date. Additions to the Index are shown in bold and underlined
Deletions from the Index are shown in bold and in brackets

INDEX TO APPENDIX

ORPHANS' COURT AND REGISTER OF WILLS FORMS

ADOPTED BY SUPREME COURT

PURSUANT TO Pa. O.C. Rule [1.3] 1.8

Available as Fill-in Forms on Website

of Administrative Office of Pennsylvania Courts

http://www.pacourts.us/Forms/OrphansCourtForms.htm

Orphans' Court and Administration Forms

A. Audit and Administration Forms

1. Decedent's Estate: Petition for Adjudication /Statement of Proposed Distribution Pursuant to Pa. O.C. Rule 2.4 [- Decedent's Estate (Pa. O.C. Rule 6.9)] .... OC-01

2. Trust: Petition for Adjudication /Statement of Proposed Distribution Pursuant to Pa. O.C. Rule 2.4 [- Trust Estate (Pa. O.C. Rule 6.9)] ................................... OC-02

3. Guardianship of Incapacitated Person: Petition for Adjudication /Statement of Proposed Distribution Pursuant to Pa. O.C. Rule 2.4 [- Guardian of Estate of Incapacitated Person (Pa. O.C. Rule 6.9)] ....................................................... OC-03

4. Guardianship of Minor: Petition for Adjudication /Statement of Proposed Distribution Pursuant to Pa. O.C. Rule 2.4 [- Guardian of Estate of Minor (Pa. O.C. Rule 6.9)] ................................................................................................... OC-04

5. Principal's Estate (Under Power of Attorney): Petition for Adjudication /Statement of Proposed Distribution Pursuant to Pa. O.C. Rule 2.4 [- Principal's Estate under POA (Pa. O.C. Rule 6.9)] ................................... OC-05

6. Notice of Charitable Gift (In Accordance with Pa. O.C. Rule 4.4) [(Pa. O.C. Rule 5.5 )] ................................................................................................................... OC-06

7. Notice of Claim .................................................................................................. OC-07

B. Guardianship Forms

1. Important Notice - Citation with Notice (Pa. O.C. Rule 14.5) .............................. G-01

2. Annual Report - Guardian of Estate ..................................................................... G-02

3. Annual Report - Guardian of Person .................................................................... G-03

4. Guardian's Inventory ............................................................................................ G-04

5. Guardianship of Incapacitated Person: Petition for Adjudication /Statement of

Proposed Distribution Pursuant to Pa. O.C. Rule 2 .4 [- Guardian of Estate of Incapacitated Person] ................................................................. OC-03

6. Guardianship of Minor: Petition for Adjudication /Statement of Proposed Distribution Pursuant to Pa. O.C. Rule 2 .4 [- Guardian of Estate of Minor] ......................................................................................... OC-04

Form OC-3 is not reprinted here and is located under Audit and Administration Forms at No. 3.

Form OC-4 is not reprinted here and is located under Audit and Administration Forms at No. 4. --------

C. Abortion Control Act Forms

1. Minor's Application for Judicial Authorization of an Abortion (Pa. O.C. Rule 16.10) ............................................................... ACA-01

2. Confidential Unsworn Verification by a Minor (Pa. O.C. Rule 16.10) ............ ACA-02

D. Register of Wills Forms

1. Estate Information Sheet ................................................................................... RW-01
(Not adopted by Supreme Court; form promulgated by Department of Revenue and maintained with Register of Wills forms for convenience)

2. Petition for Grant of Letters ............................................................................... RW-02

3. Oath of Subscribing Witness(es) ........................................................................ RW-03

4. Oath of Non-subscribing Witness(es) ................................................................ RW-04

5. Oath of Witness(es) to Will Executed by Mark .............................................. RW-05

6. Renunciation ...................................................................................................... RW-06

7. Notice of Estate Administration Pursuant to Pa. O.C , Rule 10.5 [Pa. O.C. Rule 5.6 Notice] ............................................................................................. RW-07

8. Certification of Notice under Pa. O.C. Rule [5.6(a)] 10.5 ................................. RW-08

9. [Estate] Inventory ............................................................................................. RW-09

10. Pa. O.C. Rule [6.12] 10.6 Status Report ............................................................ RW-10

E. Model Forms of Account

1. National Fiduciary Accounting Standards Project -
1983 Report of Fiduciary Accounting Standards Committee

2. Model Estate Account

3. Model Trust Account

4. Model Charitable Remainder Unitrust Account

F. [Foreign] Adoption Forms

1. Notice of Orphans' Court Proceedings to be Filed With Clerk in Dependency Proceeding by Solicitor of County Agency (Pa. O.C. Rule 15.6(b)

a. Praecipe to Clerk in Dependency Proceeding of Filing of a Petition to Terminate Parental Rights , Confirm Consent or Adopt

b. Praecipe to Clerk in Dependency Proceeding of Entry of Decision Disposing of Petition

c. Praecipe to Clerk in Dependency Proceeding of Filing of Notice of Appeal

d. Praecipe to Clerk in Dependency Proceeding of Entry of Decision Disposing of Appeal

2.[1.] Foreign Adoption Forms

a. [Registration] Form[s] for Registration of Foreign Adoption Decree [-] (Pa. O.C. Rule 15.8), including Instructions for Filing Petition, Petition to Register Foreign Adoption Decree, and Proposed Final Decrees

[a. Petition to Register Foreign Adoption Decree

b. Final Decree - Granted

c. Final Decree - Denied

d. Instructions for Filing Petition]

[2.] b. [Completion of Foreign Adoption Forms] Form Petition for Adoption of a Foreign Born Child [-] (Pa. O.C. 15.9), including the Petition for Adoption of a Foreign Born Child, Report of the Intermediary, Verification of Translator, Preliminary Decree, and Final Decree

[a. Preliminary Decree

b. Final Decree

c. Petition for Adoption of a Foreign Born Child

d. Report of the Intermediary

e. Verification of Translator]

DECEDENT'S ESTATE

COURT OF COMMON PLEAS OF

ORPHANS' COURT DIVISION

ESTATE OF__________, DECEASED

No. __________

PETITION FOR ADJUDICATION /

STATEMENT OF PROPOSED DISTRIBUTION

PURSUANT TO Pa. O.C. Rule 2.4

This form shall be used in all cases involving the Audit or Confirmation of the Account of a Decedent's Estate, if space is insufficient, riders may be attached. Attach the papers required under items 1, 2, 4, 8, 10, 16-19, as applicable, 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: __________ Email: __________ 1. Name(s) and address(es) of Petitioner(s):

	Petitioner:	Petitioner:
Name:	__________	__________
Address:	__________	__________
	__________	__________

Identify any Executors or Administrators who have not joined in the Petition for Adjudication/Statement of Proposed Distribution and/or the Account and state reason:

__________

Is this the first accounting for this estate? ............................ [ ] Yes [ ] No

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

__________

Pursuant to 20 Pa.C.S. § 3501.2, if property from a trustee, guardian, or agent acting under a power of attorney is being received into the estate, an Account of the administration of such trust, guardianship, or principal's estate may be annexed to the Estate Account. Is any such Account annexed to this Estate Account? ..................... [ ] Yes [ ] No

If so, the annexed Account and the appropriate fully completed Petition for Adjudication/Statement of Proposed Distribution for the annexed matter should be filed as Exhibits to this Petition. 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: __________

Are proofs of advertising of the grant of Letters attached? ......... [ ] Yes [ ] No

Dates of advertising of the grant of Letters:

__________ 3. Was decedent survived by a spouse? ............................. [ ] Yes [ ] No

If yes, name of the surviving spouse:__________ 4. Has the surviving spouse filed to take an elective share? ........ [ ] Yes [ ] No [ ] N/A

(see 20 Pa.C.S. § 2201 et seq.)

If yes, attach a copy of the election and state date of election:__________ 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)? ............ [ ] Yes [ ] No [ ] N/A

Were any children born to decedent after execution of Will or Codicil(s)? ........................................... [ ] Yes [ ] No [ ] N/A

If yes, give names and dates of birth:

Name:	Date of Birth:
__________	__________
__________	__________
__________	__________
__________	__________

7. Was a request for a statement of claim, as required by the Medical Assistance Estate Recovery Act, 62 P.S. § 1412, sent to the Department of Human Services? ............................. [ ] Yes [ ] No [ ] N/A 8. Written notice of the Account's filing as required by Pa. O.C. Rule 2.5 has been or will be given to all interested parties 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 15 below has been or will be given to all persons affected thereby. If one of the beneficiaries is a trust or another estate and any of the accountants is also a fiduciary of the receiving trust or estate, provide written notice of the Account's filing to the beneficiaries of the trust or receiving estate, as applicable, if known.

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 or filed before the date of the last day for filing objections in counties without separate Orphans' Court Divisions together with a statement executed by a Petitioner or counsel certifying that such Notice has been given.

C. If any such interested person is not sui juris (e.g., minors or incapacitated persons), Notice has been or will be given to the appropriate representative on such party's behalf as required by Pa. O.C. Rule 4.2.

D. If any charitable interest is involved, Notice has been or will also be given to the Attorney General as required under Pa. O.C. Rule 4.4. 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 or filed before the date of the last day for filing objections in counties without separate Orphans' Court Divisions.

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 (if beneficiary is a trust, name the trust and trustee as the Interested Party ) or Codicil(s) or as intestate heirs if there is a complete or partial intestacy. This list shall:

A. State each party's relationship to the decedent and the nature of each party's interest(s):

Name ami Address of Each Interested Party	Relationship and Comments, if any	Interest

Name and Address of Each Interested Party	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 (see Pa. O.C. Rule 5.5).

__________

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.

__________ 10. 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	ClaimAdmitted?	Will ClaimBe Paid InFull?
		[ ] 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. 11. Was family exemption claimed? ....................................................... [ ] Yes [ ] No

Was family exemption allowed? ....................................................... [ ] Yes [ ] No

Family exemption claimant's name and relationship:

Name: __________ Relationship:__________ 12. The amount of Pennsylvania Transfer Inheritance 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 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. On the date of death, was the decedent a party (as a plaintiff or defendant) in any litigation? .......................... [ ] Yes [ ] No

If yes, provide the caption of the litigation, docket number, where the matter is currently pending, and its status.

__________ 15. 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 16. 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.

__________ 17. Had the decedent been adjudicated an incapacitated person? .......... [ ] Yes [ ] No

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

__________ 18. 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 19. 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 interested parties ? ....................................... [ ] Yes [ ] No

If so, attach a copy of the notice. 20. If prescribed by local rule as permitted by Pa. O.C. Rule 2.9, is the Court being asked to direct the filing of a Schedule of Distribution? ...... [ ] Yes [ ] No

As to real estate only? ......................................... [ ] Yes [ ] No

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. Place additional signatures on attachment if necessary): Corporate Fiduciary (if applicable) /s/_________
Name of Corporate Fiduciary /s/_________
Name of Representative and Title /s/_________
Signature of Officer/Representative /s/_________
Name of Petitioner /s/_________
Signature of Petitioner /s/_________
Name of Petitioner /s/_________
Signature of Petitioner

(Verification must be by at least one petitioner.)

Verification for Individual Petitioner

The undersigned hereby verifies that the averment of 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). __________
Date /s/_________
Signature of Petitioner

Verification for Corporate Petitioner

The undersigned hereby verifies that he/she __________ is title __________ of the above-named name of corporation __________ and that the averment of 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). __________
Date /s/_________
Signature of Representative for Corporate Petitioner

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. __________
Date /s/_________
Signature of Counsel for Petitioner

TRUST

COURT OF COMMON PLEAS OF

ORPHANS' COURT DIVISION

NAME OF TRUST

(TRUST UNDER WILL OF __________

or

TRUST UNDER DEED OF __________

DATED__________)

No.__________

PETITION FOR ADJUDICATION /

STATEMENT OF PROPOSED DISTRIBUTION

PURSUANT TO Pa. O.C. Rule 2.4

This form shall he used in all cases involving the Audit or Confirmation of Trust Accounts. If space is insufficient, riders may be attached. Attach the papers required under items 2, 4, 15-19, as applicable, and any instrument pertinent to the adjudication.

INCLUDE ATTACHMENTS AT THE BACK OF THIS FORM.

	Petitioner:	Petitioner:
Name:	__________	__________
Address:	__________	__________
	__________	__________

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

__________ 2. Pursuant to 20 Pa.C.S. § 7799.1, if property from a personal representative or a trustee of another trust is being received by this Trust, an Account of the administration of such estate or trust may be annexed to the Trust Account. Is any such Account annexed to this Trust Account? ..................................................... [ ] Yes [ ] No

A. Appointment of Trustee .................................................. [ ]

B. Interpretation ........................................................... [ ]

C. Discharge of Trustee ..................................................... [ ]

D. Transfer of Situs ......................................................... [ ]

E. Appointment of Ad Litem ................................................ [ ]

F. Minor, Unborn or Unascertained Beneficiary(ies) ............................ [ ]

G. Principal Distribution .................................................... [ ]

H. Partial/Full Termination of Trust .......................................... [ ]

I. Missing Beneficiary(ies) ................................................... [ ]

J. Cy Pres .................................................................. [ ]

K. Other Issues ............................................................. [ ]

List:

__________

Please note:

A detailed explanation of issues checked should be set forth at item 15 below. 4. Testamentary Trust:

Decedent's date of death: __________

Date of Decedent's Will: __________

Date(s) of Codicil(s): __________

Date of probate: __________

Judicial District or County where Letters were issued: __________

Inter Vivos Trust :

Date of Trust:__________

Date(s) of Amendment(s):__________

If Settlor is deceased and letters were not issued or the personal representative did not advertise the estate, state dates when the Trustee advertised Settlor's death and attach proofs of advertising:

__________

Is this inter vivos trust a Special Needs Trust established under 42 U.S.C. § 1396p(d)(4)? .................................... [ ] Yes [ ] No 5. Explain why venue is proper before this Court (see 20 Pa.C.S. § 7714), and why the Trust's situs is located in this judicial district or county (see 20 Pa.C.S. § 7708).

__________ 6. A. If any other Court has taken jurisdiction of any matter relating to this Trust, explain:

__________

B. Is this the first accounting of this Trust? ........................ [ ] Yes [ ] No

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

__________ 7. A. State how each Trustee was appointed:

__________

B. If a Petitioner is not a Trustee (e.g., executor or administrator of deceased trustee, agent or guardian of an incapaciated trustee), explain:

__________ 8. State how and when the present fund was awarded to Trustee(s):

__________ 9. Period covered by this Account: __________ to __________. 10. Current fair market value of the Trust principal is $__________ (see page __________of Account.) 11. State concisely the dispositive provisions of the Trust:

__________ 12. Explain the reason for filing this Account (if filed because of the death of a party, state name of person, relationship to Trust and date of death):

__________ 13. A. State the amount of Pennsylvania Transfer Inheritance Tax paid (including postponed tax on remainder interests), the dates of payment and the interests upon which such amounts were paid:

Date	Payment	Interest
__________	__________	__________
__________	__________	__________
__________	__________	__________

B. If any such taxes remain unpaid or are in dispute, explain:

__________ 14. Describe any questions requiring adjudication and state the position of Petitioner(s) as to each question and give details of any issues identified in item 3:

__________ 15. Written notice of the Account's filing as required by Pa. O.C. Rule 2.5 has been or will be given to all interested parties listed in item 16 below. If any person is being asked to represent the interests of another interested party (whether sui juris or not), the person asked to serve as a representative has been so notified and given an opportunity to decline pursuant to 20 Pa.C.S. § 7725. In addition, notice of any questions requiring adjudication as discussed in item 14 above has been or will be given to all persons affected thereby. If one of the beneficiaries is a trust or estate and any of the accountants is also a fiduciary of the receiving trust or estate, provide written notice of the Account's filing to the beneficiaries of the receiving trust or estate, as applicable, if known.

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. Unless contained in the attached Notice, attach a copy of the written notice provided to any person who is being asked to represent another or attach such person's consent to serve.

B. If Notice is yet to be given, a copy of the Notice as well as a list of the names and addresses or the parties receiving such Notice shall be submitted at the Audit or filed before the date of the last day for filing objections in counties without separate Orphans' Court Divisions together with a statement executed by Petitioner(s) or counsel certifying that such Notice has been given. Unless contained in the Notice or previuosly attached, a copy of the written notice provided to any person who is being asked to represent another or such person's consent to serve shall be submitted at the Audit or filed before the date of the last day for filing objections in counties without separate Orphans' Court Divisions.

C. If any such interested party is not sui juris (e.g., minors or incapacitated persons), Notice has been or will be given to the appropriate representative on such party's behalf as required by Pa. O.C. Rule 4.2.

D. If any charitable interest is involved, Notice has been or will also be given to the Attorney General as required under Pa. O.C. Rule 4.4. 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 or filed before the date of the last day for filing objections in counties without separate Orphans' Court Divisions.

E. If the Account before the Court is a Special Needs Trust established under 42 U.S.C. § 1396p(d)(4), Notice has been or will also be given to the Pennsylvania Department of Human Services, Special Needs Trust Depository and to the applicable department of any other state that has provided the special needs beneficiary with medical care under a state medical assistance program ("Department"). In addition, the Department's letter of no objection (or proof of service of Notice and a copy of such Notice) must be submitted herewith or at the Audit or filed before the date of the last day for filing objections in counties without separate Orphans' Court Divisions.

16. List all parties of whom Petitioner(s) has/have notice or knowledge, having or claiming any interest in the Trust (if beneficiary is a trust, name the trust and trustee as the Interested Party), whether such interest is vested or contingent, charitable or non-charitable. This list shall:

A. State each party's relationship to the Settlor/Decedent and the nature of each party's interest(s);

Name and Address of Each Interested Party	Relationship and Comments, if any	Interest

Name and Address of Each Interested Party	Relationship and Comments, if any	Interest

B. If any interested party (whether sui juris or not) is not receiving Notice of the filing of the Account and the Petition for Adjudication/Statement of Proposed Distribution because another individual is proposed to represent such interested party pursuant to 20 Pa.C.S. §§ 7721-7726, provide the information below for each proposed representative. If there is more than one proposed representative, attach a rider setting forth the information below for each additional proposed representative:

(i) Name of Proposed Representative: __________

Describe Proposed Representative's Interest(s) in Trust:

__________

Name of the interested parties or description of the class of interested parties whom the person named above is to represent and describe such persons' interest in Trust:

__________

(ii) Has any person who is proposed to be represented as identified in the question above notified a Trustee in writing that he or she objects to such representation? ......................... [ ] Yes [ ] No

If yes, provide Name(s) of Person(s) objecting to being represented:

__________

(iii) Specify the subparagraph(s) under 20 Pa. C.S. § 7723 authorizing representation:

__________

(iv) Is there any conflict of interest? ........................ [ ] Yes [ ] No

If yes, explain conflict and why representation should be permitted:

__________

(v) Has Proposed Representative provided writen consent? ...... [ ] Yes [ ] No

If no, has Proposed Representative declined in writing to act in the representative capacity as requested? .............. [ ] Yes [ ] No

If Proposed Representative has neither consented to act in writing nor declined in writing to act, provide date of the letter in which Proposed Representative was notified that he or she is to represent another person or class of interested parties: __________

C. 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.

__________

D. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed (see Pa. O.C. Rule 5.5).

__________

E. 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

__________ 17. If Petitioner(s) has/have knowledge that a Trust share has been assigned, renounced, disclaimed or attached, provide a copy of the assignment, renunciation, disclaimer or attachment, together with any relevant supporting documentation.

__________ 18. If a Trustee's principal commission is claimed:

A. If based on a written agreement, attach a copy thereof.

B. If a principal commission is claimed, state amount. $__________

C. If a principal commission is claimed, state the amounts and dates of any principal commissions previously paid in prior accounting periods.

__________	__________
__________	__________
__________	__________
__________	__________

19. 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 interested parties? ......................................... [ ] Yes [ ] No

If so, attach a copy of the notice. 20. If prescribed by local rule as permitted by Pa. O.C. Rule 2.9, is the Court being asked to direct the filing of a Schedule of Distribution? . . . [ ] Yes [ ] No

A. Income:

Proposed Distributee(s)	Amount/Proportion
__________	__________
__________	__________
__________	__________

B. Principal:

Proposed Distributee(s)	Amount/Proportion
__________	__________
__________	__________
__________	__________

Submitted By:

(Verification must be by at least one petitioner.)

Verification for Individual Petitioner

Verification for Corporate Petitioner

Certification of Counsel

GUARDIANSHIP OF INCAPACITATED PERSON

COURT OF COMMON PLEAS OF

ORPHANS' COURT DIVISION

ESTATE OF __________, AN INCAPACITATED PERSON

ACCOUNT OF __________, GUARDIAN

No.__________

PETITION FOR ADJUDICATION /

STATEMENT OF PROPOSED DISTRIBUTION

PURSUANT TO Pa. O.C. Rule 2.4

This form shall be used in all cases involving the Audit or Confirmation of the Account of a Guardian of the Estate of an incapacitated person. If space is insufficient, riders may be attached. Attach the papers required under items 2, 3. and 5, as applicable, and any additional decree or instrument pertinent to the adjudication.

INCLUDE ATTACHMENTS AT THE BACK OF THIS FORM.

	Petitioner:	Petitioner:
Name:	__________	__________
Address:	__________	__________
	__________	__________

Identify any Guardians of the Estate who have not joined in the Petition for Adjudication/Statement of Proposed Distribution and/or the Account and state reason:

__________ 2. Judicial District or County issuing Adjudication of Incapacity:

Date of Adjudication of Incapacity:__________

Date of Appointment as Guardian:__________

Attach copy(ies) of Decree(s). 3. A. Explain the reason for filing this Account (if incapacitated person has died, state date of death, name and address of personal representative and of his or her counsel and attach a Short Certificate if available. If incapacitated person has been adjudged to have regained capacity, state date of Decree and attach a copy. If Account is filed for any other reason, state address of incapacitated person):

__________

B . Is this the first accounting for this estate? ....................... [ ] Yes [ ] No

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

__________ 4. A. Identify each unpaid claim against the incapacitated person or the incapacitated person's estate and describe each in detail (if none, so state):

__________

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

__________

C. If guardian or attorney fees are being claimed, state amount and the period covered for the requested fees:

__________ 5. Written Notice of the Account's filing as required by Pa. Q.C. Rule 2.5 has been or will be given to all interested parties listed in item 6 below. In addition, notice of any known unpaid claim not admitted, all questions requiring adjudication and any requested fees as discussed in item 4 above 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 or filed before the date of the last day for filing objections in counties without separate Orphans' Court Divisions together with a statement executed by a Petitioner or counsel certifying that such Notice has been given.

C. If any such interested party is not sui juris (e.g., minors or incapacitated persons), Notice of the Account's filing has been or will be given to the appropriate representative on such party's behalf as required by Pa. O.C. Rule 4.2.

6. List all parties of whom Petitioner(s) has/have notice or knowledge, having or claiming any interest in the estate, including the incapacitated person's heirs at law. This list shall:

A. State each party's relationship to the incapacitated person and the nature of each party's interest(s):

Name and Address of Each Interested Party	Relationship and Comments, if any	Interest

__________

C. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed (see Pa. O.C. Rule 5.5).

__________ 7. If prescribed by local rule as permitted by Pa. O.C. Rule 2.9, is the Court being asked to direct the filing of a Schedule of Distribution? ...... [ ] Yes [ ] No

A. Income:

Proposed Distributee(s)	Amount/Proportion
__________	__________
__________	__________

B. Principal:

Proposed Distributee(s)	A mount/Proportion
__________	__________
__________	__________

Submitted By:

(Verification must be by at least one petitioner.)

Verification for Individual Petitioner

Verification for Corporate Petitioner

Certification of Counsel

GUARDIANSHIP OF MINOR

COURT OF COMMON PLEAS OF

ORPHANS' COURT DIVISION

ESTATE OF__________ , A MINOR

ACCOUNT OF __________, GUARDIAN

No. __________

PETITION FOR ADJUDICATION /

STATEMENT OF PROPOSED DISTRIBUTION

PURSUANT TO Pa. O.C. Rule 2.4

This form shall be used in all cases involving the Audit or Confirmation of the Account of a Guardian of the Estate of a minor or late minor. If space is insufficient, riders may be attached. Attach the papers required under items 2 and 5, as applicable, and any instrument pertinent to the adjudication.

INCLUDE ATTACHMENTS AT THE BACK OF THIS FORM.

	Petitioner:	Petitioner:
Name:	__________	__________
Address:	__________	__________
	__________	__________

Identify any Guardian of the Estate who have not joined in the Petition for Adjudication/Statement of Proposed Distribution and/or the Account and state reason:

__________ 2. Judicial District or County Appointing Guardian: __________

Date of Appointment as Guardian: __________

Attach copy(ies) of Decree(s). 3. A. Explain the reason for filing this Account (if minor has come of age, state date minor attained majority).

__________

B . Is this the first accounting for this estate? ...................... [ ] Yes [ ] No

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

__________ 4. A. Identify each unpaid claim against the minor or the minor's estate and describe in detail (if none, so state):

__________

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

__________

C. If guardian or attorney fees are being claimed, state amount and the period covered for the requested fees:

__________ 5. Written Notice of the Account's filing as required by Pa. O.C. Rule 2.5 has been or will be given to all interested parties listed in item 6 below. In addition, notice of any unpaid claim not admitted, all questions requiring adjudication, and any requested fees as discussed in item 4 above 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 or filed before the date of the last day for filing objections in counties without separate Orphans' Court Divisions together with a statement executed by a Petitioner or counsel certifying that such Notice has been given.

C. If any such interested party is not sui juris (e.g., minors or incapacitated persons), Notice of the Account's filing has been or will be given to the appropriate representative on such party's behalf as required by Pa. O.C. Rule 4.2.

6. List all parties of whom Petitioner(s) has/have notice or knowledge, having or claiming any interest in the estate, including the minor's heirs at law. This list shall:

A. State each party's relationship to the minor and the nature of each party's interest(s):

Name and Address of Each Interested Party	Relationship and Comments, if any	Interest

__________

C. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed (see Pa. O.C. Rule 5.5).

__________ 7. If prescribed by local rule as permitted by Pa. O.C. Rule 2.9, is the Court being asked to direct the filing of a Schedule of Distribution? ...... [ ] Yes [ ] No

A. Income:

Proposed Distributee(s)	Amount/Proportion
__________	__________
__________	__________

B. Principal:

Proposed Distributee(s)	A mount/Proportion
__________	__________
__________	__________

Submitted By:

(Verification must be by at least one petitioner.)

Verification for Individual Petitioner

Verification for Corporate Petitioner

Certification of Counsel

PRINCIPAL'S ESTATE

(Under Power of Attorney)

COURT OF COMMON PLEAS OF

ORPHANS' COURT DIVISION

ESTATE OF __________, PRINCIPAL

ACCOUNT OF __________, AGENT(S) ^*

No.__________

PETITION FOR ADJUDICATION /

STATEMENT OF PROPOSED DISTRIBUTION

PURSUANT TO Pa. O.C. Rule 2.4

This form shall be used in all cases involving the Audit or Confirmation of the Account of one or more Agents acting under a Power of Attorney. If space is insufficient, riders may be attached. Attach the papers required under items 3, 4 and 9, as applicable, 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:__________ Email: __________ ^* The term "Agent" shall include any person designated as an "attorney-in-fact" or acting in a similar capacity by the Principal's delegation. 1. Name(s) and address(es) of Petitioner(s):

	Petitioner:	Petitioner:
Name:	__________	__________
Address:	__________	__________
	__________	__________

Name(s) and address(es) of Agent(s) (if not Petitioner(s)):

	Agent:	Agent:
Name:	__________	__________
Address:	__________	__________
	__________	__________

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

__________ 2. Name and address of Principal (and, if applicable, of any Guardian appointed for Principal, of each personal representative for any Principal or Agent who has died, and of his or her counsel, identifying the capacity of each):

__________

Judicial District or County where Principal resides, or if Principal is deceased, where Letters were issued: __________ 3. A. Date of Principal's Power of Attorney under which Agent(s) acted:

__________

B. Date Agent(s) first exercised control of Principal's assets under Power of Attorney:

__________

(Attach copy of each different Power of Attorney granted to Agent(s) by Principal and copy of any Decree involving Agent(s) for Principal). 4. A. Explain the reason for filing this Account (if Principal or Agent has died, state date of death, and attach a Short Certificate; if Principal has been adjudicated incapacitated, state date of Decree, and attach a copy):

__________

B. Is this the first accounting for this Principal's estate? ............ [ ] Yes [ ] No

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

__________ 5. Describe all gifts/transfers for less than full and adequate consideration made under the Power of Attorney. Identify each recipient's name, address, and relationship to Principal and/or Agent, amount of each gift/transfer, nature of each (cash or kind), and date made, with any additional explanation deemed appropriate (if none, so state):

__________ 6. Identify every asset or interest (include title or registration and value) of Principal known to Petitioner(s) and not identified in Account, whether or not in possession or control of Petitioner(s) (if none known, so state):

__________ 7. Identify each existing safe deposit box of or for Principal and each one closed by Agent(s) (if not applicable, so state):

Institution & Address	Box No,	Title or Registration	Date Closed (if applicable)

Are the entire contents of each safe deposit box identified in item 7 above included in the filed Account? ............................ [ ] Yes [ ] No

If not, explain:

__________ 8. A. Identify each known unpaid claim against Principal or Principal's estate and describe each in detail (if none, so state):

__________

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

__________

C. If fees are being claimed by the Agent or an attorney, state amount and the period covered for the requested fees:

__________ 9. Written Notice of the Account's filing as required by Pa. O.C. Rule 2.5 has been or will be given to each interested party in the matter. In addition, notice of any known unpaid claim not admitted, all questions requiring adjudication, and any requested fees as described in item 8 above has been or will be given to all parties 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 or filed before the date of the last day for filing objections in counties without separate Orphans' Court Divisions together with a statement executed by a Petitioner or counsel certifying that such Notice has been given.

C. If any such interested party is not sui juris (e.g., minors or incapacitated persons), Notice of the Account's filing has been or will be given to the appropriate representative on such party's behalf as required by Pa. O.C. Rule 4.2.

10. List all parties of whom Petitioner(s) has/have notice or knowledge, having or claiming any interest in the Principal's estate. This list shall:

A. State each party's relationship to the Principal and the nature of each party's interest(s):

Name and Address of Each Interested Party	Relationship and Comments, if any	Interest

__________

C. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed (see Pa. O.C. Rule 5.5).

__________ 11. If prescribed by local rule as permitted by Pa. O.C. Rule 2.9, is the Court being asked to direct the filing of a Schedule of Distribution? ...... [ ] Yes [ ] No

A. Income:

Proposed Distributee(s)	Amount/Proportion
__________	__________
__________	__________

B. Principal:

Proposed Distributee(s)	A mount/Proportion
__________	__________
__________	__________

Submitted By:

(Verification must be by at least one petitioner.)

Verification for Individual Petitioner

Verification for Corporate Petitioner

Certification of Counsel

NOTICE OF CHARITABLE GIFT

(In Accordance with Pa. O.C. Rule 4.4)

COURT OF COMMON PLEAS OF

ORPHANS' COURT DIVISION

ESTATE OF__________, [ ] SETTLOR [ ] DECEASED

No.__________

Chief, Charitable Trusts and Organizations Section
Office of the Attorney General Dear Sir or Madam:

Notice is given of a charitable gift as follows:

1. The nature of the present proceeding is an Account: [ ] Yes [ ] No If no, please proceed to Question 2.

(a) The Account is filed in a court with a separate Orphans' Court Division and has been or will be listed for Audit on __________, in__________. (State name of Courthouse and town/city.)

The time and place of the Audit is Court Room __________ at __________ o'clock.
If not provided herein, the time and location will be provided upon request when that information becomes available.

(b) The Account is filed in a court without a separate Orphans' Court Division, and the last day for filing written objections is __________, at __________ o'clock.

Any objection shall be filed with __________ (State name of Courthouse and town/city.) on or before the date and time above.

(c) The Account concerns an estate or trust in which a charity has an interest or is a potential distributee. [ ] Yes [ ] No

If NO, the Account concerns an estate or trust in which all or part of the balance of assets remaining on hand will be distributed to:

[ ] an estate in which a charity has an interest; or

[ ] a trust in which a charity is named as a qualified beneficiary as defined in 20 Pa.C.S. § 7703.

* If more space is required, attach additional sheets. 2. If the proceedings are other than an Account, state the nature of the proceedings and the place, date and time fixed for hearing:

__________ 3. Charitable gifts are made as follows:

(a) Give full names and addresses of charities, and the names and addresses of counsel for any charity who has received notice or has appeared for it:

__________

(b) If pecuniary legacies, state exact amounts and indicate whether legacies will be or have been paid in full; if not, give reasons therefor.

__________

(c) If the charitable interest is a future interest and the estimated present value of the charity's future interest exceeds $25,000, a brief description thereof including the conditions precedent to its vesting in enjoyment and possession, the names and ages of persons known to have interests preceding such charitable interest, and the approximate market value of the property involved.

__________

(d) If residuary gift, state nature and value of share.

__________ 4. Provide a brief statement of all pertinent questions to be presented to the Court for adjudication or other disposition, including unresolved claims and any material questions of interpretation or distribution which may affect the value of the charitable interest.

__________ 5. The names and addresses of the fiduciaries are (state whether Executors and/or Trustees):

__________ 6. The names and addresses of counsel for the fiduciaries:

__________ 7. (a) A copy of the instrument creating the gift is attached hereto.

(b) If the gift is other than a pecuniary legacy which will be paid in full, there is attached hereto:

(1) A copy of the Account, if one has been filed

(2) A copy of any other relevant documents

Very truly yours,

__________

Date

/s/_________

Signature

/s/_________

Name of Counsel

/s/_________

Supreme Court I.D. No.

/s/_________

Name of Law Firm

/s/_________

Address

/s/_________

Telephone

/s/_________

RENUNCIATION

REGISTER OF WILLS

Estate of __________, Deceased The undersigned, __________, (Name or Corporate Name) in the capacity/relationship as __________ of the above Decedent, hereby renounces the right to administer the Estate of the Decedent and, to the extent permitted by law pursuant to 20 Pa.C.S. § 3155, respectfully requests that Letters be issued to __________. __________
(Date) Name or Corporate Fiduciary (if applicable) /s/_________
Signature of Officer/Representative /s/_________
Title of Officer/Representative /s/_________
Address /s/_________
Telephone /s/_________
Email /s/_________
Signature of Person /s/_________
Address /s/_________
Telephone /s/_________
Email

Executed in Register's Office

Sworn to or affirmed and subscribed before me this __________ day of __________, __________.

Executed out of Register's Office

Before the undersigned personally appeared the party executing this Renunciation and certified that he or she executed the Renunciation for the purposes stated within on this__________day of __________,__________. /s/_________
Deputy for Register of Wills /s/_________
Notary Public My Commission Expires:
(Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.)

IMPORTANT NOTICE

NOTICE OF ESTATE ADMINISTRATION

PURSUANT TO Pa. O.C. Rule 10.5

THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY

MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE

Whether you will receive any money or property will be determined wholly or partly by

the decedent's will. If the decedent died without a will, whether you will receive any

money or property will be determined by the intestacy laws of Pennsylvania.

BEFORE THE REGISTER OF WILLS,

IN RE: ESTATE OF__________, Deceased

File Number __________

TO: __________(Beneficiary)

__________(Address)

Please take notice of the death of the Decedent and the grant of Letters to the personal representative(s) named below, The Decedent died on __________, a resident of The Decedent died: __________ [ ] testate (with a Will) or [ ] intestate (without a Will). You may have a beneficial interest in the estate as follows: __________ (If additional space is needed, use separate sheet) The name(s), address(es) and telephone number(s) of all personal representatives appointed are:

NAME	ADDRESS	TELEPHONE
__________	__________	__________
__________	__________	__________

If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of The Register's address is __________, and telephone number is __________. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date __________ Capacity: [ ] Personal Representative [ ] Counsel Corporate Fiduciary (if applicable) /s/_________
Name of Corporate Fiduciary /s/_________
Name of Representative and Title /s/_________
Address /s/_________
Telephone /s/_________
Email /s/_________
Signature of Officer/Representative /s/_________
Name of Person /s/_________
Address /s/_________
Telephone /s/_________
Email /s/_________
Signature of Person

CERTIFICATION OF NOTICE UNDER Pa. O.C. Rule 10.5

REGISTER OF WILLS

Name of Decedent:__________ Date of Death:__________ File Number:__________ Date Letters Granted:__________ To the Register: I certify that Notice of Estate Administration required by Pa. O.C. Rule 10.5 of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on __________, __________ :

Name:	Address:
__________	__________
__________	__________
__________	__________
__________	__________
__________	__________
__________	__________
__________	__________

(If more space is needed, attach separate sheet.) Notice has now been given to all persons entitled thereto under Pa. O.C. Rule 10.5 except: __________ Date __________ Capacity: [ ] Personal Representative [ ] Counsel Corporate Fiduciary (if applicable) /s/_________
Name of Corporate Fiduciary /s/_________
Name of Representative and Title /s/_________
Address /s/_________
Telephone /s/_________
Email /s/_________
Signature of Officer/Representative /s/_________
Name of Person /s/_________
Address /s/_________
Telephone /s/_________
Email /s/_________
Signature of Person

INVENTORY

REGISTER OF WILLS OF

COMMONWEALTH OF PENNSYLVANIA
ss
County of File Number__________ The undersigned, __________, Personal Representative(s) of the Estate of __________ deceased, depose(s) and say(s) that the items appearing in the following Inventory include all of the personal assets wherever situated and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of Decedent's death, and that Decedent owned no real estate outside of the Commowealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory.

I verify that the statements made in this Inventory are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities.

Corporate Fiduciary (if applicable)

/s/_________

Name of Corporate Fiduciary

/s/_________

Name of Representative and Title

/s/_________

Signature of Officer/Representative

/s/_________

Signature of Personal Representative

/s/_________

Signature of Personal Representative

__________

Date Attorney -- (Name)__________ (Supreme Court I.D. No.) __________

(Name of Law Firm) __________

(Address)__________

(Telephone) __________

(Email) __________

DATE OF DEATH	LAST RESIDENCE	DECEDENT'S SOC. SEC. NO.
FIGURES MUST BE TOTALED(Attach additional sheets as needed)
TOTAL:	$0.00

NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory, (See 20 Pa . C.S. § 3301(b))

Pa. O.C. Rule 10.6 STATUS REPORT

REGISTER OF WILLS OF

Name of Decedent:__________ Date of Death:__________ File Number:__________ Pursuant to Pa. O.C. Rule 10.6, I report the following with respect to completion of the administration of the above-captioned estate:

1. State whether administration of the estate is complete: ....................... [ ] Yes [ ] No

2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete:

__________

3. If the answer to No. 1 is YES, state the following:

a. Did the personal representative file a final account with the Court? ......... [ ] Yes [ ] No

b. The separate Orphans' Court No. (if any) for the personal representative's account is:
__________

c. Did the personal representative state an account informally to the parties in interest? ................................. [ ] Yes [ ] No

d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court or may be attached to this report.

Date __________

Capacity: [ ] Personal Representative [ ] Counsel Corporate Fiduciary (if applicable) /s/_________
Name of Corporate Fiduciary /s/_________
Name of Representative and Title /s/_________
Address /s/_________
Telephone /s/_________
Email /s/_________
Signature of Officer/Representative /s/_________
Name of Person /s/_________
Address /s/_________
Telephone /s/_________
Email /s/_________
Signature of Person