Court of Common Pleas of Carbon County Orphans’ Court Division Case Initiation Cover Sheet For Clerk of Orphans’ Court Use Only (Orphans’ Court Number) NAME OF ESTATE NAME OF FILING PARTY ADDRESS FILING PARTY’S RELATIONSHIP TO ESTATE TYPE OF ESTATE (SEE INSTRUCTIONS) DOCUMENT FILED (SEE INSTRUCTIONS) RELATED CASES RELIEF REQUESTED TOTAL NUMBER OF INTERESTED PARTIES NUMBER OF INTERESTED PARTIES FORM(S) ATTACHED TO THE CLERK OF ORPHANS’ COURT: Kindly enter my appearance on behalf of the _____ estate _____ interested party _______________________ Papers may be served at the addresses set forth below. NAME OF FILING ATTORNEY OR PARTY PHONE NUMBER ADDRESS (SEE INSTRUCTIONS) FAX NUMBER SUPREME COURT IDENTIFICATION NO. E-MAIL ADDRESS SIGNATURE OF FILING ATTORNEY OR PARTY DATE INFORMATION FOR USE BY THE CLERK OF ORPHANS’ COURT -- NOT TO BE RELEASED DATE OF BIRTH DATE OF DEATH SOCIAL SECURITY NO. REGISTER OF WILLS NO. 2002 © American LegalNet, Inc. Instructions for Completing Case Initiation Cover Sheet Rules of Court require that a Case Initiation Cover Sheet be attached to any document commencing an action. The information requested is necessary to allow the Court to properly monitor, control, and dispose cases filed. A copy of the Case Initiation Cover Sheet must be attached to service copies of the document commencing the action. The attorney or non-represented party filing a case shall complete the form as follows: A. Parties. i. ii. iii. B. Name of Estate. Enter the full name of the Estate. The Type of Estate will be identified hereunder. Name and Address of Filing Party. Enter the name of the filing party as well as his/her address at the time of filing of the action. List additional parties on the Interested Parties Form. Set forth the relationship of the filing party to the Estate. (i.e. guardian, administrator, executor, debtor, etc.) Type of Estate. Insert the Estate Type by consulting the list set forth hereunder: Minor Alleged Incapacitated Person Incapacitated Person Other: C. Decedent's Estate Testamentary Trust Inter Vivos Trust Cemetery Trust Document Filed. Indicate the type of document filed to commence the action by consulting the list set forth hereunder: Petition for Appointment of Guardian of Minor Petition for Appointment of Guardian of Alleged Incapacitated Person Petition for Appointment of Guardian Ad Litem Petition for Allowance Petition for Sale of Real Estate Other: Account Inheritance Tax Matter Report of ___________________ Marriage License Schedule of Distribution Petition for __________________ D. Related Pending Cases. All previously filed related cases must be identified. E. Relief Requested. Set forth a brief statement of the nature of the request. F. Filing Attorney or Party The name of the filing attorney must be inserted herein together with other required information. In the event the filing party is not represented by an attorney, the name of the filing party, address, the phone number, and signature is required. The Filing Party shall complete the Statistical Information Block at the bottom of the form only on the ORIGINAL Case Initiation Cover Sheet filed with the Clerk, and not the service copies. The information will only be used by the Clerk. The Clerk shall not release this information to the general public. PLEASE NOTE An Interested Parties Form must be attached to the Case Initiation Cover Sheet if the filing party is aware of the existence of parties interested in the Estate. A Petition/Pleading Cover Sheet shall be utilized for each document filed, including the initial document filed to commence the case. 2002 © American LegalNet, Inc.