Philadelphia Cnty. C.P. CP-Orphans' Division Rule 14.8A

(1) Guardian shall file all inventories, annual reports, and final reports in

accordance with 20 Pa. C.S. §5521(c), Pa. O.C. Rule 14.8, and Pa.R.J.A. No.

510(b). Reports and inventories may be filed in either an electronic format or

a physical paper format. Reports and inventories filed in an electronic format

shall use the Guardianship Tracking System.

See https://ujsportal.pacourts.us/Guardianship.aspx.

Probate Section Comment: The Clerk will provide a computer terminal in the

Clerk’s office and will assist those Guardians without a computer or internet access to

file these legal papers through the Guardianship Tracking System.

(2) The Guardianship Tracking System is designated by the Court to provide the

notices to the Guardian required by Pa. O.C. Rule 14.8(f).

APPENDIX

The Forms below were adopted or amended on May 1, 2019, effective June 1, 2019.

PHILADELPHIA COUNTY ORPHANS’ COURT FORMS

General Orphans’ Court Forms:

*Certificate of Compliance

*Orphans’ Court Subpoena

Orphans’ Court Cover Sheet

*Entry of Appearance

*Decedent’s Estate Proceeding Forms:

Account Filing Checklist – Decedent’s Estate

Appeal from Register of Wills

Excerpt from Schedule of Distribution

Incapacitated Person’s Proceeding Forms:

Account Filing Checklist – Guardian of Incapacitated Person

Consent of Guardian

Final Decree

Guardian Address Confirmation Form

Preliminary Decree

*Minor’s Proceedings Forms:

Account Filing Checklist - Guardian of Minor

*Minor’s and Incapacitated Person’s Compromises Forms:

Minors and Incapacitated Persons Checklist

Affidavit of Compliance

Petition to Settle Minor’s Compromise

*Power of Attorney Proceedings Forms:

Account Filing Checklist – Agent under Power of Attorney

*Trust Proceeding Forms:

Account Filing Checklist – Special Needs Trust

Account Filing Checklist – Trust (Testamentary/Inter Vivos)

*Wrongful Death and Survival Proceeding Forms:

Wrongful Death and Survival Actions Checklist

Affidavit of Compliance

Petition to Settle Wrongful Death and Survival Actions

*Register of Wills Forms:

Affidavit for Filing in Philadelphia County by Foreign Fiduciary

*The above-listed Forms are available on the Website of the

First Judicial District of Pennsylvania at: www.philacourts.us/forms

Orphans’ Court Cover Sheet

Account Filing Checklist - Guardian of Incapacitated Person

Consent of Guardian Form

COURT OF COMMON PLEAS OF PHILADELPHIA

ORPHANS’ COURT DIVISION

Estate of

O.C. # Control #

CONSENT OF GUARDIAN

I, accept and confirm my appointment as Guardian

of the Person / Estate (circle all that apply) of ("Ward").

I understand that as Guardian:

1. I must always act in the best interests of my Ward;

2. I have a fiduciary responsibility to my Ward and the Court;

3. I must act with reasonable prudence in all matters relating to the Estate;

4. I must not engage in self-dealing;

5. I am forbidden from expending principal of the Estate without prior Court

authorization;

6. I am forbidden from selling any real property owned by my Ward without prior Court

authorization;

7. I must file a Guardian's Inventory within ninety (90) days of my appointment as

Guardian of the Estate;

8. I must file an annual report as Guardian of the Person and an annual report

as Guardian of the Estate every year on the anniversary date of my appointment as

Guardian;

9. I understand the duties and responsibilities of being a Guardian, and have the knowledge,

skills and expertise to be a Guardian; and

10. I understand and agree that as a Guardian, I must act in accordance with the laws

governing guardians found in the statutes set forth in 20 Pa.C.S. §5501, et seq., and the

Pennsylvania and Philadelphia Orphans’ Court Rules concerning guardianships set forth

in Chapter XIV, particularly Pa. O.C. Rule 14.8 and Phila. O.C. Rule 14.8.A.

11. The primary language of the alleged incapacitated person is _. My

primary language is.

12. My failure to abide by the above will result in my removal as Guardian, and may

result in my being found in contempt of Court, surcharged for any losses to the

Estate, fined, and/or otherwise sanctioned.

Further, subject to penalty of law under 18 Pa.C.S. § 4904, relating to unsworn falsification

to authorities, I affirm that I have not been convicted of or pleaded guilty or no contest to any crime

involving fraud, deceit, and/or financial misconduct.

Name of Guardian

Signature Date

Decree Appointing Guardian of the Estate

COURT OF COMMON PLEAS OF PHILADELPHIA

ORPHANS’ COURT DIVISION

Estate of Ivan Smith,

An Alleged Incapacitated Person

O.C. No. XXX AI of 2019

Control No. XXXX

FINAL DECREE

AND Now, this day of June 2019, upon consideration of the Petition for Adjudication

of Incapacity and Appointment of a Guardian and after a hearing held following due service of a

copy of the Petition and Citation Notice upon Ivan Smith, this Court finds by clear and

convincing evidence that:

1. Ivan Smith is 77 years old and is a domiciliary of the City and County of Philadelphia.

2. Ivan Smith suffers from vascular dementia with psychosis, schizophrenia, chronic

obstructive pulmonary disease, and hypertension which totally impairs his capacity to

receive or evaluate information effectively and to make and communicate decisions

concerning management of his financial affairs.

Accordingly, it is hereby ORDERED and DECREED that Ivan Smith is adjudged a

totally/partially incapacitated person and that is appointed plenary/limited Guardian

of the Estate of Ivan Smith, an incapacitated person.

The Guardian of the Estate shall enter security with a corporate surety in the amount of

$ within days of this Decree.

The Guardian of the Estate is NOT permitted to expend the principal of the incapacitated

person’s estate without ADVANCE permission of the court in accordance with the provisions of

20 Pa.C.S. § 5536, however, income may be expended by the Guardian for the care of the

incapacitated person without court approval.

All financial institutions, including without limitation, banks, savings and loans, credit

unions, and brokerages, shall grant to the Guardian of the Estate access to any and all assets,

records, and accounts maintained for the benefit of the incapacitated person, and the Guardian of

the Estate shall be entitled to transfer, retitle, withdraw, or otherwise exercise dominion and

control over any and all of these assets, records and accounts. The failure of any financial

institution to honor this order may lead to contempt proceedings and the imposition of sanctions.

Pa. O.C. Rule 14.7(b)(2).

The health care agent or the agent appointed under a durable power of attorney

previously executed by the incapacitated person shall be accountable to the Guardian of the

Estate of the incapacitated person as well as to the Principal (Ivan Smith). This agent’s authority

shall remain in effect to the extent approved by the Guardian of the Estate. OR Any previously

executed powers of attorney or health care powers of attorney and the authority to act under

these documents is null and void.

The Guardian of the Estate is directed to file an Inventory within ninety (90) days of the

date of this Decree in accordance with the provisions of 20 Pa.C.S. § 5521(b) and § 5142. Pa.

O.C. Rule 14.8(a)(1). The Guardian of the Estate shall file an Annual Report one year after

appointment and annually thereafter in accordance with the provisions of 20 Pa.C.S. §

5521(c)(1)(i). A Final Report shall be filed by the Guardian of the Estate within sixty (60) days

of the death of the incapacitated person, an adjudication of capacity, a change of guardian or the

expiration of an order of limited duration pursuant to 20 Pa.C.S. § 5521(c)(2). A Final Report

shall also be filed upon receipt of the provisional order from another state’s court accepting

transfer of a guardianship. Pa. O.C. Rule 14.8(a)(4) & (5). The Guardian shall serve a notice of

the filing of any of these reports on all those persons, sui juris, who would be entitled to share in

the estate of the incapacitated person if he/she died intestate, and the person or institution

providing residential care services to the incapacitated person as well as to

within ten (10) days after filing a report using the attached form. Pa. O.C. Rule 14.8(b).

If the incapacitated person resides in a nursing facility and is the recipient of Medical

Assistance, the Guardian of the Estate shall be compensated out of income at the rate of $100 per

month. In all circumstances, compensation out of income shall not prejudice the right of the

Guardian to seek additional compensation by petition for allowance.

In the event the incapacitated person has a safe deposit box, an Official Examiner of this

court shall be in attendance when the safe deposit box is opened by the Guardian of the Estate.

The Certificate of the Official Examiner of his examination of the assets in the safe deposit box

shall be submitted to the Court, and, when approved by the hearing judge, shall be filed with the

record in this case. The amount and manner of compensation for these services of the Official

Examiner shall be determined by the hearing judge.

All evidence received at the hearing concerning the present matter, including but not

limited to medical depositions, expert reports, testimony and exhibits, shall be SEALED and not

made available except upon further Decree of this Court.

Ivan Smith was/was not present at the hearing and was/was not represented by counsel.

The court finds clear and convincing medical evidence that the physical and mental health of

Ivan Smith would have been harmed by requiring his/her presence at the hearing. Counsel for the

petitioner shall cause to be served upon and read to the incapacitated person a copy of this

Decree and the following Statement of Rights:

You, Ivan Smith, are hereby notified of your right to seek reconsideration of this

Decree pursuant to Rule 8.2 and the right to appeal this Decree within 30 days from

the date of this Decree by filing a Notice of Appeal with the Clerk of the Orphans’

Court. You may also petition the court at any time to review, modify, or terminate

the guardianship due to a change in circumstances. You have a right to be

represented by an attorney to file a motion for reconsideration, an appeal, or to seek

modification or termination of this guardianship. If the assistance of counsel is

needed and You cannot afford an attorney, an attorney will be appointed to

represent you free of charge. Pa. O.C. Rule 14.7(a)(2).

BY THE COURT:

, J.

Counsel

Guardian(s)

Decree Appointing Guardian of the Person

COURT OF COMMON PLEAS OF PHILADELPHIA

ORPHANS’ COURT DIVISION

Estate of Ivan Smith,

An Alleged Incapacitated Person

O.C. No. XXX AI of 2019

Control No. XXXX

FINAL DECREE

AND Now, this day of June 2019, upon consideration of the Petition for Adjudication

of Incapacity and Appointment of a Guardian and after a hearing held following due service of a

copy of the Petition and Citation Notice upon Ivan Smith, this Court finds by clear and

convincing evidence that:

1. Ivan Smith is 77 years old and is a domiciliary of the City and County of Philadelphia.

2. Ivan Smith suffers from vascular dementia with psychosis, schizophrenia, chronic

obstructive pulmonary disease, and hypertension which totally impairs his capacity to

receive or evaluate information effectively and to make and communicate decisions to

meet the essential requirements for his physical health and safety.

Accordingly, it is hereby ORDERED and DECREED that Ivan Smith is adjudged a

totally/partially incapacitated person and that is appointed plenary/limited Guardian

of the Person of Ivan Smith, an incapacitated person.

The health care agent or the agent appointed under a durable power of attorney

previously executed by the incapacitated person shall be accountable to the Guardian of the

Person of the incapacitated person as well as to the Principal (Ivan Smith). This agent’s authority

shall remain in effect to the extent approved by the Guardian of the Person. OR Any previously

executed powers of attorney or health care powers of attorney and the authority to act under

these documents is null and void.

The Guardian of the Person shall file an Annual Report one year after appointment and

annually thereafter in accordance with the provisions of 20 Pa.C.S. § 5521(c)(1)(ii). Pa. O.C.

Rule 14.8(a)(3). A Final Report shall be filed by the Guardian of the Person within sixty (60)

days of the death of the incapacitated person, an adjudication of capacity, a change of guardian

or the expiration of an order of limited duration pursuant to 20 Pa.C.S. § 5521(c)(2). A Final

Report shall also be filed upon receipt of the provisional order from another state’s court

accepting transfer of a guardianship. Pa. O.C. Rule 14.8(a)(4) & (5). The Guardian shall serve a

notice of the filing of any of these reports on all those persons, sui juris, who would be entitled to

share in the estate of the incapacitated person if he/she died intestate, and the person or

institution providing residential care services to the incapacitated person as well as to

within ten (10) days after filing a report using the attached form. Pa. O.C. Rule

14.8(b).

The Guardian of the Person, unless authorized after a subsequent hearing, shall not have

the power to:

1. Consent on behalf of the incapacitated person to psychosurgery, electroconvulsive

therapy or removal of a healthy body organ;

2. Prohibit the marriage or consent to the divorce of the incapacitated person; or

3. Consent on behalf of the incapacitated person to the performance of any

experimental biomedical or behavioral medical procedure or participation in any

biomedical or behavioral experiment.

All evidence received at the hearing concerning the present matter, including but not

limited to medical depositions, expert reports, testimony and exhibits, shall be SEALED and not

made available except upon further Decree of this Court.

Ivan Smith was/was not present at the hearing and was/was not represented by counsel.

The court finds clear and convincing medical evidence that the physical and mental health of

Ivan Smith would have been harmed by requiring his/her presence at the hearing. Accordingly,

counsel for the petitioner shall cause to be served upon and read to Ivan Smith a copy of this

Decree and the following Statement of Rights:

You, Ivan Smith, are hereby notified of your right to seek reconsideration of this

Decree pursuant to Rule 8.2 and the right to appeal this Decree within 30 days from

the date of this Decree by filing a Notice of Appeal with the Clerk of the Orphans’

Court. You may also petition the court at any time to review, modify, or terminate

the guardianship due to a change in circumstances. You have a right to be

represented by an attorney to file a motion for reconsideration, an appeal, or to seek

modification or termination of this guardianship. If the assistance of counsel is

needed and You cannot afford an attorney, an attorney will be appointed to

represent you free of charge. Pa. O.C. Rule 14.7(a)(2).

BY THE COURT:

, J.

Counsel

Guardian(s)

Decree Appointing Guardian of the Estate and Person

COURT OF COMMON PLEAS OF PHILADELPHIA

ORPHANS’ COURT DIVISION

Estate of Ivan Smith,

An Alleged Incapacitated Person

O.C. No. XXX AI of 2019

Control No. XXXX

FINAL DECREE

AND Now, this day of June 2019, upon consideration of the Petition for Adjudication

of Incapacity and Appointment of a Guardian and after a hearing held following due service of a

copy of the Petition and Citation Notice upon Ivan Smith, this Court finds by clear and

convincing evidence that:

1. Ivan Smith is 77 years old and is a domiciliary of the City and County of Philadelphia.

2. Ivan Smith suffers from vascular dementia with psychosis, schizophrenia, chronic

obstructive pulmonary disease, and hypertension which totally impairs his capacity to

receive or evaluate information effectively and to make and communicate decisions

concerning management of his financial affairs or to meet essential requirement of his

physical health and safety.

Accordingly, it is hereby ORDERED and DECREED that Ivan Smith is adjudged a

totally/partially incapacitated person and that is appointed plenary/limited Guardian

of the Estate of Ivan Smith, an incapacitated person. is appointed Guardian of

the Person of Ivan Smith, an incapacitated person.

The Guardian of the Estate shall enter security with a corporate surety in the amount of

$ within days of this Decree.

The Guardian of the Estate is NOT permitted to expend the principal of the incapacitated

person’s estate without ADVANCE permission of the court in accordance with the provisions of

20 Pa.C.S. § 5536, however, income may be expended by the guardian for the care of the

incapacitated person without court approval.

All financial institutions, including without limitation, banks, savings and loans, credit

unions, and brokerages, shall grant to the Guardian of the Estate access to any and all assets,

records, and accounts maintained for the benefit of the incapacitated person, and the Guardian of

the Estate shall be entitled to transfer, retitle, withdraw, or otherwise exercise dominion and

control over any and all of these assets, records and accounts. The failure of any financial

institution to honor this order may lead to contempt proceedings and the imposition of sanctions.

Pa.O.C .Rule 14.7(b)(2).

The health care agent or the agent appointed under a durable power of attorney

previously executed by the incapacitated person shall be accountable to the Guardian of the

Person and Estate of the incapacitated person as well as to the Principal (Ivan Smith). This

agent’s authority shall remain in effect to the extent approved by the Guardian of the Person and

Estate. OR Any previously executed powers of attorney or health care powers of attorney and

the authority to act under these documents is null and void.

The Guardian of the Estate is directed to file an Inventory within ninety (90) days of the

date of this Decree in accordance with the provisions of 20 Pa.C.S. § 5521(b) and § 5142. Pa.

O.C. Rule 14.8(a)(1). The Guardian of the Estate and Person shall each file an Annual Report

one year after appointment and annually thereafter in accordance with the provisions of 20

Pa.C.S. § 5521(c)(1)(i) and (ii). Pa. O.C. Rule 14.8(a)((2) & (3)). Final Reports shall be filed

by the Guardian of the Estate and Person within sixty (60) days of the death of the incapacitated

person, an adjudication of capacity, a change of guardian or the expiration of an order of limited

duration pursuant to 20 Pa.C.S. § 5521(c)(2). Final Reports shall also be filed upon receipt of

the provisional order from another state’s court accepting transfer of a guardianship. Pa. O.C.

Rule 14.8(a)(4) & (5). The Guardian shall serve a notice of the filing of any of these reports on

all those persons, sui juris, who would be entitled to share in the estate of the incapacitated

person if he/she died intestate, and the person or institution providing residential care services to

the incapacitated person as well as to within ten (10) days after filing a report

using the attached form. Pa. O.C. Rule 14.8(b).

If the incapacitated person resides in a nursing facility and is the recipient of Medical

Assistance, the Guardian of the Estate shall be compensated out of income at the rate of $100 per

month. In all circumstances, compensation out of income shall not prejudice the right of the

Guardian to seek additional compensation by petition for allowance.

In the event the incapacitated person has a safe deposit box, an Official Examiner of this

court shall be in attendance when the safe deposit box is opened by the Guardian of the Estate.

The Certificate of the Official Examiner of his examination of the assets in the safe deposit box

shall be submitted to the Court, and, when approved by the hearing judge, shall be filed with the

record in this case. The amount and manner of compensation for these services of the Official

Examiner shall be determined by the hearing judge.

The Guardian of the Person, unless authorized after a subsequent hearing, shall not have

the power to:

1. Consent on behalf of the incapacitated person to psychosurgery, electroconvulsive therapy

or removal of a healthy body organ;

2. Prohibit the marriage or consent to the divorce of the incapacitated person; or

3. Consent on behalf of the incapacitated person to the performance of any experimental

biomedical or behavioral medical procedure or participation in any biomedical or

behavioral experiment.

All evidence received at the hearing concerning the present matter, including but not

limited to medical depositions, expert reports, testimony and exhibits, shall be SEALED and not

made available except upon further Decree of this Court.

Ivan Smith was/was not present at the hearing and was/was not represented by counsel.

The court finds clear and convincing medical evidence that the physical and mental health of

Ivan Smith would have been harmed by requiring his/her presence at the hearing. Counsel for the

petitioner shall cause to be served upon and read to Ivan Smith a copy of this Decree and the

following Statement of Rights:

You, Ivan Smith, are hereby notified of your right to seek reconsideration of this

Decree pursuant to Rule 8.2 and the right to appeal this Decree within 30 days from

the date of this Decree by filing a Notice of Appeal with the Clerk of the Orphans’

Court. You may also petition the court at any time to review, modify, or terminate

the guardianship due to a change in circumstances. You have a right to be

represented by an attorney to file a motion for reconsideration, an appeal, or to seek

modification or termination of this guardianship. If the assistance of counsel is

needed and You cannot afford an attorney, an attorney will be appointed to

represent you free of charge. Pa. O.C. Rule 14.7(a)(2).

BY THE COURT:

, J.

Counsel

Guardian(s)

Guardian Address Confirmation Form

COURT OF COMMON PLEAS OF

PHILADELPHIA ORPHANS’ COURT DIVISION

Estate of

O.C. # Control #

GUARDIAN ADDRESS CONFIRMATION FORM

I am the (check one):

☐Guardian/Co-Guardian of Person and Estate

☐Guardian/Co-Guardian of the Estate

□ Guardian/Co-Guardian of Person

As the Guardian named in the above case, I affirm that my name, address, phone number, and

email address should be recorded as follows:

Name (Please Print):

Address:

City:

State: Zip Code:

Home Phone # Mobile Phone #

E-Mail:

Preferred contact method: (Phone, Mail or

Email)

I understand that it is my responsibility to update the Court of my current contact information if

any of it should change or become inaccurate, and I agree to do so immediately.

Signature Date

Preliminary Decree Awarding Citation for Guardianship Hearing

COURT OF COMMON PLEAS OF PHILADELPHIA

ORPHANS’ COURT DIVISION

Estate of X,

An Alleged Incapacitated Person

O.C. No. X AI of 2018

Control No. X

PRELIMINARY DECREE

AND NOW, this day of 2019, upon consideration of the

Petition for Adjudication of Incapacity and the Appointment of Plenary Guardian of the Person

and Estate, it is hereby ORDERED and DECREED that:

1. A citation is awarded, directed to X, to show cause why he should not be adjudged an

incapacitated person and why a plenary guardian of his person and estate should not be

appointed; the hearing thereon to be held in Courtroom 41, City Hall, Philadelphia,

PA, 19107 on, 2019 at.

2. Petitioner shall cause to be served (by personal service) the Citation with Notice and

Petition, pursuant to the provisions of 20 Pa.C.S. §5511(a) and Pa.O.C. Rule 14.2, upon

the alleged incapacitated person at least twenty (20) days prior to the court hearing.

The contents and terms of the Citation with Notice and Petition shall be read and

explained to the maximum extent possible in language and terms the alleged

incapacitated person is most likely to understand in accordance with the provisions of

20 Pa.C.S. §5511(a).

3. At least twenty (20) days prior notice of the court hearing, together with a copy of the

petition and citation, shall be given personally or by certified mail in accordance with

the provisions of 20 Pa.C.S. §5511(a) to all persons who are sui juris and who would

be entitled to share in the estate of the alleged incapacitated person if he died intestate,

and the Person or Institution providing residential services to the alleged incapacitated

person, and to ------------------.

Notice shall also be given to the Commonwealth of Pennsylvania, Office of Attorney

General, as a possible intestate heir to the estate of the alleged incapacitated person.

(Include this section only when AIP has no next of kin). Notice shall also be given

to the U.S. Department of Veterans Affairs as a result of the alleged incapacitated

person receiving veteran’s benefits (or survivor benefits). (Include this section only

when AIP is a veteran or receives survivor benefits)

4. An affidavit of service containing specific averments as to the above requirements in

the two preceding paragraphs shall be presented at the beginning of the court hearing.

5. Petitioner and/or counsel for the petitioner shall notify the court, in writing, at least

seven (7) days prior to the court hearing if counsel has not been retained by or on behalf

of the alleged incapacitated person in accordance with the provisions of 20 Pa.C.S.

§5511(a). This notice shall also contain all pertinent information which would indicate

to the court whether or not counsel should be appointed to represent the interests of the

alleged incapacitated person.

6. In accordance with Pa. O.C. Rule 14.2(c)(2), unless previously attached to the Petition,

Petitioner shall submit for each proposed guardian, at least seven (7) days prior to the

court hearing, the response to the Pennsylvania State Police criminal record check,

issued within six months of the date of filing of the Petition. If any proposed guardian

resided outside the Commonwealth of PA within the previous five (5) year period and

was 18 years of age or older at any time during that period, the criminal record check

from each state in which the proposed guardian resided within the five year period shall

be submitted.

For criminal history reports from PA, see https://epatch.state.pa.us/Home.jsp.

7. The alleged incapacitated person shall be present at the court hearing unless it is

established by clear and convincing medical evidence that his physical or mental

condition would be harmed by his presence in court in accordance with the provisions

of 20 Pa.C.S. §5511(a).

8. In accordance with 20 Pa.C.S. §5518, at the hearing on this matter the Petitioner must

present testimony, in person or by deposition, from a medical professional, who must

be qualified by training and experience to evaluate individuals with incapacities of the

type alleged by the Petitioner, that establishes the nature and extent of the alleged

incapacitated person’s incapacities and disabilities and his mental, emotional, and

physical condition, and adaptive behavior and social skills. The absence of such

testimony and/or depositions shall preclude a declaration of incapacity and

appointment of a guardian. Alternatively, the use of an Expert Report in lieu of

testimony in person or by deposition shall be in accordance with Pa. O.C. Rule 14.3.

9. The Consent of Guardian and Guardian Address Confirmation Form (substantially in

the forms annexed to this Preliminary Decree) shall be completed by the proposed

guardian and presented to the Court at the time of the hearing.

BY THE COURT:

, J.

X, Esquire