Court of Common Pleas of Carbon County Orphans’ Court Division Case Initiation Cover Sheet Interested Parties For Clerk of Orphans’ Court Use Only (Docket Number) Estate of: ____________________________________________________________ Name __________________________________________ Type of Estate NAME OF INTERESTED PARTY O.C. No. __________________ of __________________ NAME OF INTERESTED PARTY RELATIONSHIP TO ESTATE: ADDRESS: RELATIONSHIP TO ESTATE: ADDRESS: NAME OF INTERESTED PARTY NAME OF INTERESTED PARTY RELATIONSHIP TO ESTATE: ADDRESS: RELATIONSHIP TO ESTATE: ADDRESS: NAME OF INTERESTED PARTY NAME OF INTERESTED PARTY RELATIONSHIP TO ESTATE: ADDRESS: RELATIONSHIP TO ESTATE: ADDRESS: NAME OF INTERESTED PARTY NAME OF INTERESTED PARTY RELATIONSHIP TO ESTATE: ADDRESS: RELATIONSHIP TO ESTATE: ADDRESS: NAME OF INTERESTED PARTY NAME OF INTERESTED PARTY RELATIONSHIP TO ESTATE: ADDRESS: RELATIONSHIP TO ESTATE: ADDRESS: Prepared By: __________________________________ Signature: ____________________________________ Address: _____________________________________________________ Date: ___________________________ 2002 © American LegalNet, Inc.