Fill and Sign the Summary Administration Package Not More Than 50000 Small Estates Pennsylvania Form

© 2016 - U.S. Legal Forms, Inc.       PENNSYLVANIA PETITION FOR SETTLEMENT OF SMALL ESTATE AND ORDER/DECREE OF DISTRIBUTION (20 Pa. C.S.A. § 3102) Control Number: PA-ET20 I. TIPS ON COMPLETING THE FORMS The form(s) in this packet may contain “form fields” created using Microsoft Word or Adobe Acrobat (“.pdf” format). “Form fields” facilitate completion of the forms using your computer. They do not limit your ability to print the form “in blank” and complete with a typewriter or by hand. It is also helpful to be able to see the location of the form fields. Go to the View menu, click on Toolbars, and then select Forms. This will open the Forms toolbar. Look for the button on the Forms toolbar that resembles a shaded letter “a”. Click this button and the form fields will be visible. By clicking on the appropriate form field, you will be able to enter the needed information. In some instances, the form field and the line will disappear after information is entered. In other cases, it will not. The form was created to function in this manner. II. DISCLAIMER These materials were developed by U.S. Legal Forms, Inc. based upon statutes and forms for the State of Pennsylvania. All information and Forms are subject to this Disclaimer: All forms in this package are provided without any warranty, express or implied, as to their legal effect and completeness. Please use at your own risk. If you have a serious legal problem, we suggest that you consult an attorney in your state. U.S. Legal Forms, Inc. does not provide legal advice. The products offered by U.S. Legal Forms (USLF) are not a substitute for the advice of an attorney. THESE MATERIALS ARE PROVIDED “AS IS” WITHOUT ANY EXPRESS OR IMPLIED WARRANTY OF ANY KIND INCLUDING WARRANTIES OF MERCHANTABILITY, NONINFRINGEMENT OF INTELLECTUAL PROPERTY, OR FITNESS FOR ANY PARTICULAR PURPOSE. IN NO EVENT SHALL U.S. LEGAL FORMS, INC. OR ITS AGENTS OR OFFICERS BE LIABLE FOR ANY DAMAGES WHATSOEVER (INCLUDING WITHOUT LIMITATION DAMAGES FOR LOSS OR PROFITS, BUSINESS INTERRUPTION, LOSS OF INFORMATION) ARISING OUT OF THE USE OF OR INABILITY TO USE THE MATERIALS, EVEN IF U.S. LEGAL FORMS, INC. HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. In the Court of Common Pleas of ____________ County, Pennsylvania Estate of             Also known as             , Deceased : : : : No.       : : PETITION FOR SETTLEMENT OF SMALL ESTATE AND NOW, comes the Petitioner,       , as a Pro Se Petitioner, and files the following Petition for Settlement of the Estate of ________________________ pursuant to 20 Pa. Code § 3102 , and states: 1. Petitioner is an adult individual eighteen years of age or older. Petitioner presently resides at ____________________________________________________________ ; 2. ______________________________ died at the age of ____________ on ____________ , 20 ______ ; and at the time of his/her death resided at: ____________________________________ , City of __________________ , County of __________________ , State of __________________ , having a Social Security Number of ________________________ ; 3. Petitioner’s relationship to the decedent is: ____________________________________ 4. Decedent died: a. Intestate b. Testate (1) The Will was Probated on the ______ day of __________________ , 20 ______ and Letters of Administration were granted on the ______ day of __________________ , 20 ______ . The Personal Representative ______________________________ , was required to give bond in the amount of $ __________________ and the surety is __________________ . A Copy of the Will is attached hereto. 1 (2) The Will has not been probated. The original Will is attached hereto. 5. The following are beneficiaries of the estate either under the Will or the laws of intestacy: Name: Relationship to Decedent: Describe Interest in Estate: Beneficiary: Has not received or retained any property of the decedent by payment of wages or other items under Section 3101 of the Probate, Estates, and Fiduciaries Code, or otherwise. Has received or retained the following property of the decedent by payment of wages or other items under Section 3101 of the Probate, Estates, and Fiduciaries Code, or otherwise: ____________________________________________________________ Is deceased (attach supporting documentation) Is incompetent (attach supporting documentation) and his/her fiduciary is ____________________________________________________________ whose address and telephone number is: ____________________________________________________________ Is a minor whose date of birth is __________________ and and his/her fiduciary is ____________________________________ whose address and telephone number is: ____________________________________________________________ . Name: Relationship to Decedent: Describe Interest in Estate: 2 Beneficiary: Has not received or retained any property of the decedent by payment of wages or other items under Section 3101 of the Probate, Estates, and Fiduciaries Code, or otherwise. Has received or retained the following property of the decedent by payment of wages or other items under Section 3101 of the Probate, Estates, and Fiduciaries Code, or otherwise: ____________________________________________________________ Is deceased (attach supporting documentation) Is incompetent (attach supporting documentation) and his/her fiduciary is ____________________________________________________________ whose address and telephone number is: ____________________________________________________________ Is a minor whose date of birth is __________________ and and his/her fiduciary is ____________________________________ whose address and telephone number is: ____________________________________________________________ . Name: Relationship to Decedent: Describe Interest in Estate: Beneficiary: Has not received or retained any property of the decedent by payment of wages or other items under Section 3101 of the Probate, Estates, and Fiduciaries Code, or otherwise. Has received or retained the following property of the decedent by payment of wages or other items under Section 3101 of the Probate, Estates, and Fiduciaries Code, or otherwise: ____________________________________________________________ Is deceased (attach supporting documentation) Is incompetent (attach supporting documentation) and his/her fiduciary is 3 ____________________________________________________________ whose address and telephone number is: ____________________________________________________________ Is a minor whose date of birth is __________________ and and his/her fiduciary is ____________________________________ whose address and telephone number is: ____________________________________________________________ . Name: Relationship to Decedent: Describe Interest in Estate: Beneficiary: Has not received or retained any property of the decedent by payment of wages or other items under Section 3101 of the Probate, Estates, and Fiduciaries Code, or otherwise. Has received or retained the following property of the decedent by payment of wages or other items under Section 3101 of the Probate, Estates, and Fiduciaries Code, or otherwise: ____________________________________________________________ Is deceased (attach supporting documentation) Is incompetent (attach supporting documentation) and his/her fiduciary is ____________________________________________________________ whose address and telephone number is: ____________________________________________________________ Is a minor whose date of birth is __________________ and and his/her fiduciary is ____________________________________ whose address and telephone number is: ____________________________________________________________ . Name: 4 Relationship to Decedent: Describe Interest in Estate: Beneficiary: Has not received or retained any property of the decedent by payment of wages or other items under Section 3101 of the Probate, Estates, and Fiduciaries Code, or otherwise. Has received or retained the following property of the decedent by payment of wages or other items under Section 3101 of the Probate, Estates, and Fiduciaries Code, or otherwise: ____________________________________________________________ Is deceased (attach supporting documentation) Is incompetent (attach supporting documentation) and his/her fiduciary is ____________________________________________________________ whose address and telephone number is: ____________________________________________________________ Is a minor whose date of birth is __________________ and and his/her fiduciary is ____________________________________ whose address and telephone number is: ____________________________________________________________ . Name: Relationship to Decedent: Describe Interest in Estate: Beneficiary: Has not received or retained any property of the decedent by payment of wages or other items under Section 3101 of the Probate, Estates, and Fiduciaries Code, or otherwise. 5 Has received or retained the following property of the decedent by payment of wages or other items under Section 3101 of the Probate, Estates, and Fiduciaries Code, or otherwise: ____________________________________________________________ Is deceased (attach supporting documentation) Is incompetent (attach supporting documentation) and his/her fiduciary is ____________________________________________________________ whose address and telephone number is: ____________________________________________________________ Is a minor whose date of birth is __________________ and and his/her fiduciary is ____________________________________ whose address and telephone number is: ____________________________________________________________ . (If there are additional beneficiaries, attach additional sheets) 6. The following individuals are entitled to the family exemption: Name       Address:       City:       State and Zip:       Relationship:       DOB: (minors only)       Name       Address:       City:       State and Zip:       Relationship:       DOB: (minors only)       Name       Address:       City:       State and Zip:       Relationship:       DOB: (minors only)       6 Name       Address:       City:       State and Zip:       Relationship:       DOB: (minors only)       Name       Address:       City:       State and Zip:       Relationship:       DOB: (minors only)       Name       Address:       City:       State and Zip:       Relationship:       DOB: (minors only)       Name       Address:       City:       State and Zip:       Relationship:       DOB: (minors only)       Name       Address:       City:       State and Zip:       Relationship:       DOB: (minors only)       7. Real and Personal Property assets of the estate and their estimated values: ASSET DESCRIPTION COMPLETE ASSET ADDRESS DOLLAR VALUE                                     7                                                                         8. Debts and Claims against the Estate: Funeral and burial expenses (attach statement and/or receipts): Type of service:       Services by:       Address:       Amount:       Paid/Due:       Type of service:       Services by:       Address:       Amount:       Paid/Due:       Type of service:       Services by:       Address:       Amount:       Paid/Due:       Last illness expenses (attach statement and/or receipts): Type of service:       Services by:       Address:       Amount:       Paid/Due:       Type of service:       Services by:       Address:       Amount:       Paid/Due:       8 Type of service:       Services by:       Address:       Amount:       Paid/Due:       Other claims or expenses that are unpaid: CLAIMANT ADDRESS TYPE OF AMOUNT CHARGE                                                                         9. The following exhibits are attached hereto: An itemized list of disbursements made prior to the filing of the petition, indicating the payor and whether the disbursements were in payment of administration expenses, preferred or ordinary debts, items of distribution, or the family exemption; A certificate of the Register of Wills or the equivalent thereof, satisfactory to the Court, showing payment or other status of the inheritance tax, unless the estate be valued at less than the family exemption and petitioner be claiming the same as such; and A certification on valuation of assets by one or more appraisers competent to give an opinion as to the value thereof, accompanied by a brief statement of the qualifications of such appraiser, except for cash or listed securities, for which no certification of value is required. Therefore, Petitioner requests payment or distribution to of the property of the estate to those entitled and such other a further relief as the Court deems just and proper. Respectfully submitted, Date: ____________ 9 Signature of Party       Printed Name       Address       City, State, and Zip       Telephone Number 10 VERIFICATION A. PETITIONER STATE OF __________________ COUNTY __________________ I, the undersigned Petitioner, being sworn, state that I have read and understood the Petition in the above styled case; that the petition was filed at my request and direction; and that the allegations in the above petition are true and correct, to the best of my knowledge, information and belief. Given on this the ______ day of __________________ , 20 ______ . ____________________________________ Name Of Petitioner ACKNOWLEDGED, SWORN TO AND SUBSCRIBED before me on this the ______ day of __________________ , 20 ______ . __________________________________ Notary Public My commission expires: _____________ 11 B. STATE OF __________________ COUNTY __________________ I, the undersigned Surviving Spouse Heir Beneficiary Creditor (other, specify) __________________ being sworn, state that I have read and understood the Petition in the above styled case; that the allegations in the above petition are true and correct, to the best of my knowledge, information and belief; and that I join in the Petition. Given on this the ______ day of __________________ , 20 ______ . ____________________________________ Name Of Petitioner ACKNOWLEDGED, SWORN TO AND SUBSCRIBED before me on this the _______ day of _____________________, _________. __________________________________ Notary Public My commission expires: _____________ C. STATE OF __________________ COUNTY __________________ I, the undersigned Surviving Spouse Heir Beneficiary Creditor, (other, specify) ______________________________ , being sworn, state that I have read and understood the Petition in the above styled case; that the allegations in the above petition are true and correct, to the best of my knowledge, information and belief; and that I join in the Petition. Given on this the ______ day of __________________ , 20 ______ . ____________________________________ Name Of Petitioner 12 ACKNOWLEDGED, SWORN TO AND SUBSCRIBED before me on this the _______ day of _____________________, _________. __________________________________ Notary Public My commission expires: _____________ D. STATE OF __________________ COUNTY __________________ I, the undersigned Surviving Spouse Heir Beneficiary Creditor, (other, specify) ______________________________ , being sworn, state that I have read and understood the Petition in the above styled case; that the allegations in the above petition are true and correct, to the best of my knowledge, information and belief; and that I join in the Petition. Given on this the ______ day of __________________ , 20 ______ . ____________________________________ Name Of Petitioner ACKNOWLEDGED, SWORN TO AND SUBSCRIBED before me on this the _______ day of _____________________, _________. __________________________________ Notary Public My commission expires: _____________ 13 E. STATE OF __________________ COUNTY __________________ I, the undersigned Surviving Spouse Heir Beneficiary Creditor, (other, specify) ______________________________ , being sworn, state that I have read and understood the Petition in the above styled case; that the allegations in the above petition are true and correct, to the best of my knowledge, information and belief; and that I join in the Petition. Given on this the ______ day of __________________ , 20 ______ . ____________________________________ Name Of Petitioner ACKNOWLEDGED, SWORN TO AND SUBSCRIBED before me on this the _______ day of _____________________, _________. __________________________________ Notary Public My commission expires: _____________ F. Parent or Guardian STATE OF __________________ COUNTY __________________ I, the undersigned, acting as Parent Legal Guardian Natural Guardian, by and on behalf of the minor or incompetent Surviving Spouse Heir Beneficiary Creditor, (other, specify) ______________________________ , being sworn, state that I have read and understood the Petition in the above styled case; and that the allegations in the above petition are true and correct, to the best of my knowledge, information and belief. Given on this the ______ day of __________________ , 20 ______ . ____________________________________ Name Of Petitioner 14 ACKNOWLEDGED, SWORN TO AND SUBSCRIBED before me on this the _______ day of _____________________, _________. __________________________________ Notary Public My commission expires: _____________ NOTE: If any unpaid beneficiary, heir or claimant or the surety of a personal representative, if any, has not joined in the petition, the Court may require notice thereof by citation or otherwise as circumstances may require to be served upon him or them before the Court acts upon the petition. 15 ORDER And now, this ______ day of __________________ , 20 ______ , upon consideration of the foregoing petition and on motion of attorney for petitioner or on motion of petitioner, it is ordered that the petitioner distribute the property of the decedent under section 3102 (and section 3392, if applicable) of the Probate, Estate and Fiduciaries Code as follows: 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, Judge 16