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 be 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. Name of Counsel: ________________________________________________________________ Supreme Court I.D. No.: ___________________________________________________________ Name of Law Firm: _______________________________________________________________ Address: ________________________________________________________________________ ________________________________________________________________________ Telephone: ______________________________________________________________________ Fax: ___________________________________________________________________________ Email: __________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Form OC-02 eff. 09.01.16 Page 1 of 11 Name of Trust: 1. Name(s) and address(es) of Petitioner(s): Petitioner: Name: _________________________________________ Petitioner: ________________________________________________________ ________________________________________________________ ________________________________________________________ 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 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. 3. Check if any of the following issues are involved in this case: 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: ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Form OC-02 eff. 09.01.16 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 11 Name of Trust: 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: _____________________ or 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: _________________________________________________________________________ ______