Fill - Free fillable GUARDIANSHIP OF MINOR (Beaver County Information Technology) PDF form

Page 1 of 6

Form OC-04 eff. 09.01.16

GUARDIANSHIP OF MINOR

COURT OF COMMON PLEAS OF

ORPHANS’ COURT DIVISION

ESTATE OF

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.

Name of Counsel: _______________________________________________________________

Supreme Court I.D. No.: __________________________________________________________

Name of Law Firm: ______________________________________________________________

Address: ______________________________________________________________________

Telephone: ____________________________________________________________________

Fax: __________________________________________________________________________

Email: ________________________________________________________________________

______________________________________________________________________

, A MINOR

ACCOUNT OF ___________________________________________________, GUARDIAN

Estate of

,

A Minor

Form OC-04 eff. 09.01.16

Page 2 of 6

1

.

Name(s) and address(es) of Petitioner(s):

Petitioner:

Name:

Address:

2.

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

4.

A. Identify each unpaid claim against the minor or the minor's estate and describe in

detail (if none, so state):

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:

Judicial District or County Appointing Guardian:

Date of Appointment as Guardian:

Attach copy(ies) of Decree(s).

________________________________________________________________________

_____________________________________________________________________

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

adjudication of the prior accountings.

_____________________________________________________________________

__________________________________________________________________

_________________________

Estate of

, A Minor

Form OC-04 eff. 09.01.16

Page 3 of 6

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.

I

f 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 o

f

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.

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:

____________________________________________________________________

_____________________________________________________________________

Estate of

,

A Minor

Form OC-04 eff. 09.01.16 Page 4 of 6

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.

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

__________________________________________________________________

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

A. State each party’s relationship to the minor and the nature of each party's

interest(s):

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:

6.

C. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed

(see Pa. O.C. Rule 5.5).

__________________________________________________________________

Estate of ,

A Minor

Form OC-04 eff. 09.01.16

Page 5 of 6

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 pr

oportions, not amounts) are as follows:

A. In

come:

Proposed Distributee(s) Amount/Proportion

B. Principal:

Proposed Distributee(s) Amount/Proportion

Submitted By:

(

All petitioners must sign

. Place additional

sig

natures on attachment if necessary):

Corporate Fiduciary (if applicable)

__________________________________________ ____________________________________________

Name of Corporate Fiduciary Name of Petitioner

___________________________________________

____________________________________________

Name of Representative and Title

Signature of Petitioner

___________________________________________

____________________________________________

Signature of Officer/Representative

Name of Petitioner

____________________________________________

Signature of Petitioner

Estate of

Page 6 of

6

Form OC-04 eff.

09.01.16

(Verification must be by at least one petitioner.)

Verification for Individual Petitioner

The undersigned hereby verifies th

at the averment

of facts

set

forth

in

the

foregoing

Petition

for

Adjudication/Sta

tement

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).

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.

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).

Verification for Corporate Petitioner

, A Minor

__________________________________

Date

______________________________________

Signature of Petitioner

__________________________________

Date

__________________________________________

Signature of Representative for Corporate Petitioner

__________________________________

Date

______________________________________

Signature of Counsel for Petitioner

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