York Cnty. C.P. Local Rules of Orphans' Court Procedure Rule 5.50.1

(b) Contents. In addition to the requirements outlined in Pa.R.O.C.P. 5.50, the

Petition shall be substantially in the form as set forth after this Rule.

(c) Exhibits. In addition to those exhibits required in Pa.R.O.C.P. 5.50:

(2) If the decedent died testate, then the Official Receipt from the Register of

Wills that the original Will has been lodged shall constitute adequate

proof.

(3) The inheritance tax voucher, or in lieu therefore a statement from the

Pennsylvania Department of Revenue that no tax is due.

(6) An itemized list of disbursements made prior to the filing of the petition,

indicating the date, name of the payee and whether the disbursements

were in payment of administration expenses, preferred or ordinary

debts, items of distribution or the family exemption; and

(7) A copy of the notice served pursuant to Pa.R.O.C.P. 3.5(b) and York

O.C. Rule 5.50.1(d), below.

(d) Notice.

(1) Contested matters.

(i) A Notice to Plead in the form set forth in Pa.R.O.C.P.

3.5(b)(1) shall endorse the Petition for Settlement of Small

Estate.

(ii) The Petitioner shall serve notice that the Petition and

proposed Order will be presented to the Court at the Call of

the Audit List to:

a. Every unpaid claimant who gave notice of the claim or

who acted in a manner equivalent to giving notice in

accordance with 20 Pa.C.S. § 3384; and

b. Any other individual or entity that asserted a claim that will

not be paid in full; and

c. Any other individual or entity known to Petitioner to have a

claim or an interest in the estate as beneficiary, heir, next

of kin, except for those legatees or claimants whose

legacies or claims were, or will be, satisfied in full as

proposed in the Petition; and

d. If a charity were involved, then, to refer to Pa.R.O.C.P.4.4.

for notice to the Attorney General; and

e. If counsel has entered an appearance in accordance with

Pa.R.O.C.P. 1.7., then, to the attorney.

(iv) Notice of presentation shall be in writing, served at least 20

days prior to the Call of the Audit List, and shall:

a. State the date of the Call of the Audit List; and

b. State the time and courtroom of the Call of the Audit

List;

c. State that any objections shall be filed in writing in

the above-captioned matter with the clerk of the

Orphans’ Court prior to, or stated on the record at,

the time of the Call of the Audit List; and

d. Include a copy of the Petition and every legal paper

filed therewith.

(v) If the Court continues the proceedings on the Petition, then,

additional notice of the continued proceeding shall be served

at least 20 days prior to the date to which the proceedings

were continued unless the Court issues an Order of which the

Clerk provides notice.

(2) Uncontested matters. In cases where all interested parties join in the

petition filed herein pursuant to Pa.R.O.C.P. 3.5(c), a cover sheet

shall be prepared and shall state that the matter is uncontested, all

joinders and consents are attached and shall accompany the

Petition for Settlement of Small Estate in the form set forth in York

County Civil Rule 205.2(b) and the example of the form that follows

that Rule.

Form 5.50.1 Petition for Settlement of Small Estate:

In the Court of Common Pleas of York County, Pennsylvania

Orphans’ Court Division

Estate of ___________

Also known as _________, Late of No.

York County, Pennsylvania

Petition for Settlement of Small Estate

(Gross Estate of $25,000 or less for decedents dying before

August 31, 2013) (Gross Estate of $50,000 or less for

decedents dying on or after August 31, 2013)

Pursuant to section 3102 of the Probate, Estates and Fiduciaries

Code, the undersigned Petitioner respectfully represents:

(1) Estate.

i. The name and address of each petitioner and relationship of

each petitioner to the decedent:

ii. The decedent’s name, date of death, and domicile in York

County, Pennsylvania, with a last family or principal residence:

iii. The decedent died:

intestate.

testate. If the decedent died testate:

The original will and any codicil(s) has / have been

lodged or probated with the Register of Wills. A copy

has been attached hereto.

The original will/codicil cannot be produced because:

The Register of Wills has issued a decree

accepting the photocopy as an original. A copy of

the will/codicil and decree has been attached

hereto.

iv. Letters of Administration granted?

(1) If yes, what is the date of Grant of Letters?

(2) The Personal Representative was/was not required to give

bond in the amount of _______, with _______________as

the surety.

v. The name, address, relationship, and interest of all beneficiaries or

heirs are: [Give details as to whether the decedent was survived by a spouse, children

or stepchildren. If a minor or incapacitated person, use Confidential Information Form

(CIF) and provide information of representative; the Court Self-Help Center may have

resource material on definitions of any unfamiliar legal terms.]

Name and Address Relationship Interest Sui

Juris

vi. Is the Family Exemption claimed?

(1) If claimant is not the surviving spouse, state relationship

to decedent:

(2) If claimant is surviving spouse, has spouse forfeited the right

claim exemption?

Yes No

(3) Did claimant reside with decedent at death? If not, state why

not.

vii. A spouse’s elective share:

has not been claimed.

has been claimed. [Give details.]

viii. If the decedent died testate, the decedent:

was not married or divorced after the date of execution of the

will.

was married or divorced after the date of execution of the

will. [Give

details.]

ix. If the decedent died testate, the decedent:

did not have a child or children born or adopted after the date

of execution of the will.

had a child or children born or adopted after the date of

execution of the will. [Give the name and date of birth or

adoption of each such child. If minors, use initials and

Confidential Information Form (CIF) for names and date of

birth.]

Name Date of Birth or Adoption

(2) Assets. All assets other than real estate.

The decedent died owning property (other than real estate and property

distributable

under section 3101 of the Probate, Estates and Fiduciaries Code) of a gross value not

exceeding

$50,000, (or $25,000.00 if prior to August 31, 2013) which is itemized below. [Include only

last four (4) digits of account numbers and registration numbers, etc.] A true and correct

copy of the inventory of the decedent’s estate filed with the Register of Wills is attached

hereto as Exhibit “B” and incorporated by reference herein.

Asset Amount

Total $

(3) Liabilities.

(i) Names and addresses of all known creditors, amounts claimed, if

satisfied, and to which objection is made or not:

Name and Address Amount Claimed Satisfied or not Objection

Total $

(ii) Itemized list of unpaid administrative expenses, unpaid taxes, unpaid

debts, and, if the estate were insolvent, are prioritized under 20 PA.C.S. §

3392:

Priority Description (Identify each) Amount

1. Administrative Expenses

2. Family Exemption

3. Funeral and Medical Expense within 6 months

4. Marker or Headstone

5. Rents and medical expenses more than 6 months before death

5.1 Commonwealth and other political subdivisions

6. All other claims

Total $

(iii) If the decedent was 55 years of age or older at the time of death, a request was

made to

Pennsylvania Department of Human Services pursuant to 65 P.S. § 1412 on

the following date:

(iv) The following persons claim reimbursement for debts, expenses, and other

claims (including

inheritance tax, if applicable) they have paid with own funds.

Person Claiming Date of Debt or

Reimbursement Payment Payee Expense Amount

Total $

(4) Distribution.

(i) Name of Distributees paid prior to filing the Petition:

Name Description Amount Paid

Total $

(ii) Name of each proposed Distributee and proposed Distribution

Name Description Amount

Total $

(iii) Name of each interested party who has consented to, or joined in, the

petition.

(iv) Name of each beneficiary or heir who has consented to, or joined in, the

petition.

(v) All holders of claims that are disputed, which in the case of this estate, all

holders of claims that will not be paid in full, have either:

Joined in this petition which is hereto attached & titled

Joinder(s)

or

been mailed at least twenty (20) days written notice of the

date, time, and place of the Orphans’ Court Audit session.

(5) Taxes.

(i) Tax Return

Pennsylvania Inheritance Tax Return has been filed.

Pennsylvania Inheritance Tax Return has not been filed

because:

A true and correct copy of the Department of Revenue

appraisement of the inheritance tax return filed on the

decedent’s estate, showing that no inheritance tax is due, is

attached hereto as Exhibit “C” and incorporated by reference

herein.

(ii) Payment

Pennsylvania Inheritance Tax has been paid. Proof of payment

attached.

Pennsylvania Inheritance Tax has not been paid. If inheritance

taxes due have not been paid, Petitioner should list the

Register of Wills, Agent, as a creditor. [Give details of why tax

has not been paid.]

I hereby certify that I am complying with the provision of the Case Record Public Access

Policy of the Unified Judicial System of Pennsylvania as outlined below:

CIF/CDF Forms are included with an attached to this filing.

-OR-

I certify that this filing complies with the provisions of the Case Records Public

Access

Policy of the Unified Judicial System of Pennsylvania that require filing

confidential information and documents differently than non-confidential information

and documents.

__________________________________

___________________________

Signature of Petitioner Signature of Attorney for Petitioner

Typed Name: Typed Name:

Telephone Number: Supreme Court No.:

Email Address: Office Address:

Telephone Number:

Email Address

Exhibits

The following are attached hereto:

Death Certificate:

Death certificate is already filed with the Register of Wills.

Death certificate is already filed with the Clerk of Orphans’ Court.

A photocopy of the decedent's Will and Codicil, along with:

the receipt of the will being lodged with the Register of

Wills.

the decree of the Register accepting a photocopy as the

original.

A true and correct copy of the Department of Revenue appraisement/tax

voucher, or proof of payment of all taxes, or a statement providing reasons why

the filing has not been made or payment has not occurred.

Original Consents, Joinders, and Letters of No Objections signed by

interested parties.

Copy of letter from Pennsylvania Department of Human Services (DHS) as

to the existence and amount of the estate recovery claim.

An itemized list of disbursements made prior to the filing of the petition,

indicating the date, name of the payee and whether the disbursements were in

payment of administration expenses, preferred or ordinary debts, items of

distribution or the family exemption;

A copy of the notice served and certificate of service in compliance with

Pa.R.O.C.P. 3.5(b) and York O.C. Rule 5.50.1 (d).

Verification

The undersigned Petitioner hereby verifies, subject to the penalties of

18 Pa.

C.S.A. §4904 (relating to unsworn falsification to authorities), that the facts set forth in

the foregoing petition which are within his (her) knowledge are true, and, as to the facts

based on information received, after diligent inquiry, he (she) believes them to be true.

Date:

Signature of Petitioner

Joinder(s)

I (we), the undersigned, being parties other than the petitioner

beneficially interested in the estate and/or surviving spouse, children or stepchildren

of the foregoing decedent, do hereby certify that I (we) have read the foregoing

petition and join in the prayer thereof.

Consent

I (we), the undersigned, being parties other than the Petitioner

beneficially interested in the estate and/or surviving spouse, children or stepchildren

of the foregoing decedent, do hereby certify that I (we) have read the foregoing

petition and consent to the prayer thereof.

[binding.law: PDF page 33 has no text layer (a scanned page) and is not served]

Form Order: Order Regarding Disbursement and Distribution of Property

In the Court of Common Pleas of York County, Pennsylvania

Orphans’ Court Division

Estate of:

: No.

also known as:

Late of:

York County, Pennsylvania, deceased:

ORDER

AND NOW, this day of, 20,

upon

consideration of the foregoing Petition, it is ORDERED and DECREED that the Petitioner

disburse and distribute the property of the decedent under section 3102 and section 3392, if

applicable, of the Probate, Estates and Fiduciaries Code, as follows, to:

Name Amount

Total $

This decree of distribution shall constitute sufficient authority to all transfer

agents, registrars and others dealing with the property of the estate to recognize the persons

named as entitled to receive such property without administration and shall in all respects

have the same effect as a decree of distribution after an accounting by a personal

representative.

BY THE COURT,

CHAPTER VII

RULES RELATING TO PRE-HEARING AND HEARING PROCEDURE