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Petition For Adjudication-Statement Of Proposed Distribution (Guardian Of Estate Of Incapacitated Person) Form. This is a Pennsylvania form and can be use in Orphans Court Statewide.
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Tags: Petition For Adjudication-Statement Of Proposed Distribution (Guardian Of Estate Of Incapacitated Person), OC-03, Pennsylvania Statewide, Orphans Court
GUARDIANSHIP OF INCAPACITATED PERSON
COURT OF COMMON PLEAS OF
COUNTY, PENNSYLVANIA
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 6.9
This form may be used in all cases involving the Audit of the Account of a Guardian of the Estate
of an incapacitated person. If space is insufficient, riders may be attached.
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-03 rev. 10.13.06
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Estate of
1.
, An Incapacitated Person
Name(s) and address(es) of Petitioner(s):
Petitioner:
Petitioner:
Name:
Address:
2.
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. If Account is filed for any other reason,
state address of incapacitated person):
B. Have prior accountings been filed? . . . . . . . . . . . . . . . . . . . . . . . . . . . “ Yes
“ No
If yes, state accounting periods and dates of adjudication.
4.
Describe in detail any questions requiring adjudication and state the position of the
Petitioner(s) as to each question:
Form OC-03 rev. 10.13.06
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Estate of
5.
, An Incapacitated Person
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 6 below. In addition, notice of any questions
requiring adjudication 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
together with a statement executed by a Petitioner or counsel certifying that such
Notice has been given.
C. If any such party in interest 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.
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 Party in Interest
Form OC-03 rev. 10.13.06
Relationship and Comments, if any
Interest
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Estate of
, An Incapacitated Person
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.
7.
Is the Court being asked to direct
the filing of a Schedule of Distribution? . . . . . . . . . . . . . . . . . . . . . . . . . . “ Yes
Form OC-03 rev. 10.13.06
“ No
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Estate of
, An Incapacitated Person
Wherefore, your Petitioner(s) ask(s) that distribution be awarded to the parties entitled
and suggests 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):
___________________________________________
Name of Petitioner:
___________________________________________
Name of Petitioner:
Form OC-03 rev. 10.13.06
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Estate of
, An Incapacitated Person
Verification of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies * [that he/she
is title
of the above-named name of corporation
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-03 rev. 10.13.06
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