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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: _______________________________________________________________
Form OC-02 rev.01.01.20
Page 1 of 11
Name of Trust:
1. Name(s) and address(es) of Petitioner(s):
Petitioner:
Petitioner:
Name: _________________________________________
________________________________________________________
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.
B.
Appointment of Trustee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 rev. 01.01.20
Page 2 of 11
Name of Trust:
4. Testamentary Trust:
Please note:
A detailed explanation of issues checked should be set forth at item 14 below.
Decedents' date of death: _____________________________________________
Date of Decedents' 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:
B.
Is this the first accounting of this Trust? . . . . . . . . . . . . . . . . . . . Yes No
Form OC-02 rev.01.01.20
Page 3 of 11
Name of Trust:
C.
If not, identify prior accountings, the accounting periods covered, and the dates of
adjudication of the prior accountings.
7. A. State how each Trustee was appointed:
. If a Petitioner is not a Trustee (e.g., executor or administrator of deceased trustee,
B
agent, or guardian of an incapacitated trustee), explain:
8. State how and when the present fund was awarded to Trustee(s):
9.
Period covered by this Account:
to
.
10.
Current fair market value of the Trust principal is $______________________
(see page of Account.)
11.
State concisely the dispositive provisions of the Trust:
Form OC-02 rev. 01.01.20
Page 4 of 11
Name of Trust:
12. Explain the reason for filing this Account (if filed because of the death of a party, state
name of person, relationship to Trust, and date of death):
13. A. State the amount of Pennsylvania Transfer Inheritance Tax paid (including postponed
tax on remainder interests), the dates of payment and the interests upon
which such amounts were paid:
Date
Payment
Interest
B.
If any such taxes remain unpaid or are in dispute, explain:
14. Describe any questions requiring adjudication, state the position of Petitioner(s) as
to each question, and give details of any issues identified in item 3:
15. 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 16 below. If any person is
being asked to represent the interests of another interested party (whether sui
juris or not), the person asked to serve as a representative has been so
notified and given an opportunity to decline pursuant to 20 Pa.C.S. § 7725.
In addition, notice of any questions requiring adjudication as discussed in item
14 above has been or will be given to all persons affected thereby. If one of the
beneficiaries is a trust or estate and any of the accountants is also a fiduciary of
the receiving trust or estate, provide written notice of the Account's filing to the
beneficiaries of the receiving trust or estate, as applicable, if known.
Form OC-02 rev. 01.01.20
Page 5 of 11
Name of Trust:
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. Unless contained
in the attached Notice, attach a copy of the written notice provided to any
person who is being asked to represent another or attach such person’s
consent to serve.
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 of the last day for filing objections in counties
without separate Orphans' Court Divisions together with a statement executed
by Petitioner(s) or counsel certifying that such Notice has been given. Unless
contained in the Notice or previously attached, a copy of the written notice
provided to any person who is being asked to represent another or such
person’s consent to serve shall be submitted at the Audit or filed before the
date of the last day for filing objections in counties without separate Orphans'
Court Divisions.
C. If any such interested party is not sui juris (e.g., minors or incapacitated
persons), Notice has been or will be given to the appropriate representative on
such party’s behalf as required by Pa. O.C. Rule 4.2.
D. If any charitable interest is involved, Notice has been or will also be given to
the Attorney General as required under Pa. O.C. Rule 4.4. In addition, the
Attorney General’s clearance certificate (or proof of service of Notice and a
copy of such Notice) must be submitted herewith or at the Audit or filed before
the date of the last day for filing objections in counties without separate
Orphans' Court Divisions.
E. If the Account before the Court is a Special Needs Trust established under 42
U.S.C. § 1396p(d)(4), Notice has been or will also be given to the
Pennsylvania Department of Human Services, Special Needs Trust Depository
and to the applicable department of any other state that has provided the
special needs beneficiary with medical care under a state medical assistance
program ("Department"). In addition, the Department's letter of no objection
(or proof of service of Notice and a copy of such Notice) must be submitted
herewith or at the Audit or filed before the date of the last day for filing
objections in counties without separate Orphans' Court Divisions.
16. List all parties of whom Petitioner(s) has/have notice or knowledge, having or claiming
any interest in the Trust (if beneficiary is a trust, name the trust and trustee as the
Interested Party), whether such interest is vested or contingent, charitable or non-
charitable. This list shall:
A. State each party’s relationship to the Settlor/Decedent and the nature of each
party’s interest(s);
Name and Address of Each Interested Party Relationship and Comments, if any Interest
Form OC-02 rev.01.01.20
Page 6 of 11
Name of Trust:
Name and Address of Each Interested Party
Relationship and Comments if Any
Interest
B.
If any interested party (whether sui juris or not) is not receiving Notice of
the filing of the Account and the Petition for Adjudication/Statement of
Proposed Distribution because another individual is proposed to
represent such interested party pursuant to 20 Pa.C.S. §§ 7721-7726,
provide the information below for each proposed representative. If there is
more than one proposed representative, attach a rider setting forth the
information below for each additional proposed representative:
(i)
Name of Proposed Representative:
Describe Proposed Representative's Interest(s) in Trust:
Name of the interested parties or description of the class of interested
parties whom the person named above is to represent and describe such
persons' interest in Trust:
(ii) Has any person who is proposed to be represented as identified
in the question above notified a Trustee in writing that he or
she objects to such representation? . . . . . . . . . . . . . . . . . Yes
If yes, provide Name(s) of Person(s) objecting to being represented:
No
(iii) Specify the subparagraph(s) under 20 Pa. C.S. § 7723 authorizing representation:
__________________________________________________________________
(iv) Is there any conflict of interest? . . . . . . . . . . . . . . . . . . . . Yes No
If yes, explain conflict and why representation should be permitted:
Form OC-02 rev. 01.01.20
Page 7 of 11
Name of Trust:
(v) Has Proposed Representative provided written consent? Yes No
If no, has Proposed Representative declined in writing to
act in the representative capacity as requested? . . . . . . Yes No
If Proposed Representative has neither consented to act in writing nor
declined in writing to act, provide date of the letter in which Proposed
Representative was notified that he or she is to represent another
person or class of interested parties:______________________________
C.
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.
D. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed
(see Pa. O.C. Rule 5.5).
E. If distribution is to be made to the personal representative of a deceased party,
state date of death, date and place of grant of Letters, and type of Letters granted.
Form OC-02 rev. 01.01.20
Page 8 of 11
Name of Trust:
17. If Petitioner(s) has/have knowledge that a Trust share has been assigned,
renounced, disclaimed, or attached, provide a copy of the assignment,
renunciation, disclaimer, or attachment, together with any relevant
supporting documentation and list the attached documents below.
18. If a Trustee’s principal commission is claimed:
A. If based on a written agreement, attach a copy thereof.
B. If a principal commission is claimed, state amount.$____________________
C. If a principal commission is claimed, state the amounts and dates of any
principal commissions previously paid in prior accounting periods.
19. If a reserve is requested, state amount and purpose.
Amount:
_________________________________________________________________
Purpose:
________________________________________________________________
_________________________________________________________________
________________________________________________________________
_________________________________________________________________
If a reserve is requested for counsel fees, has notice of the
amount of fees to be paid from the reserve been given to the
interested parties? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If so, attach a copy of the notice.
20. 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
Form OC-02 rev. 01.01.20
Page 9 of 11
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 proportions, not amounts) are as follows:
Proposed Distributee(s)
Amount/Proportion
Name of Trust:
A. Income:
B. Principal:
Proposed Distributee(s)
Amount/Proportion
Corporate Fiduciary (if applicable)
Submitted By:
(All petitioners must sign. Place additional
signatures on attachment if necessary):
_______________________________________
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
Form OC-02 rev. 01.01.20
Page 10 of 11
Name of Trust:
(Verification must be by at least one petitioner.)
Verification for Individual Petitioner
The undersigned hereby verifies 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).
________________________
Date
____________________________________
Signature of Petitioner
Verification for Corporate Petitioner
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).
________________________
Date
___________________________________
Signature of Representative for Corporate
Petitioner
Certification of Counsel
The undersigned counsel hereby certifies
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.
foregoing Petition
that
the
________________________
Date
__________________________________
Signature of Counsel for Petitioner
Form OC-02 rev. 01.01.20
Page 11 of 11
