Northum. Cnty. Pa 17.4
The statement of proposed distribution required by Rule NOC-6.9A shall be substantially in the following form:
IN RE: ESTATE OF | : | IN THE COURT OF COMMON PLEAS OF NORTHUMBERLAND COUNTY, PA. |
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: | ORPHANS' COURT DIVISION | |
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__________, Deceased | : | NO. OC- |
Statement of Proposed Distribution of the Estate Of ______________________________________________
filed by
___________________
(Fiduciary)
___________________
(Capacity)
1. Date of death:
2. Indicate whether the decedent died testate or intestate and the date of probate of the decedent's Last Will and Testament (if any):
3. Date of appointment of executor or administrator:
4. State names of newspapers and dates on which advertisement of granting of Letters was published:
5. Set forth the name and address of the decedent's spouse:
(a) Indicate whether the spouse has elected to take against the Will and if so, the date of the filing of the election:
(b) Indicate whether the decedent married after the execution of the Will or Codicils (if any) and which of the said Will or Codicils was executed prior to the marriage:
6. Set forth the names and addresses of the decedent's surviving issue or adopted children and indicate if any of them were born or adopted after the execution of the Will (if any):
7. Set forth in list form the names of all legatees or in the case of an intestacy, the names of the heirs-at-law and the addresses of the legatees and heirs (if not previously disclosed in 4 and 5 above). Also, set forth the relationship of the legatees or heirs to the decedent, the amount or percentage of the interest and the character of the interest. This information may be in summary form but should indicate whether any of the devises and bequests have been revoked, adeemed, lapsed or been assigned, attached or disclaimed:
8. Set forth the names of all parties in interest who are under any legal disability and the names and addresses of their guardians or committees and the circumstances of the disability:
9. Set forth the names and addresses of unpaid creditors from whom the fiduciary has received written notice or of whom the fiduciary has actual notice. Also, set forth which of the amounts claimed are admitted:
10. Indicate whether or not charitable bequests are involved and if so, if notice is required to be given to the Attorney General pursuant to Pa. O.C. Rule 5.5:
11. List any fiduciary capacity which the decedent held and indicate the present status and court docket number (if any) :
12. Indicate whether the Pennsylvania Transfer, Inheritance and Estate taxes have been paid in full. If so, in lieu of completing the schedule below, a copy of Notice of Inheritance Tax Appraisement, Allowance or Disallowance of Deductions and Assessments of tax received from the Pennsylvania Department of Revenue may be attached:
(a) State the Pennsylvania Department of Revenue appraisement value of the estate, the amount of the debts and deductions allowed by the Register of Wills, and the value of the taxable estate:
Appraisement Value______________________
Less Debts and Deductions _____________________________
Taxable Estate
_____________________________
(b) State the tax rate and the total amount of tax paid:
Tax Rate _______________%
Tax Paid ______________
13. Indicate whether the estate is subject to the Federal Estate Tax and the date of receipt of a Federal Estate Tax closing letter (if it has been received). If the letter has not been received, indicate that to the personal representative's information, knowledge and belief, the Federal Estate Taxes have been paid in full in accordance with the return filed:
14. Where the accountant is requesting that any issue be decided by an auditor or by the Court, set forth any such issues:
15. Indicate whether a reserve is requested and, if so, state the amount and purpose thereof:
16. State whether the account is partial or final and whether any partial accounts had previously been filed:
17. Set forth any other information concerning unusual circumstances not previously mentioned:
The accountants propose to distribute the assets as follows:
Name of Distributee | Asset to be Distributed | Inventory Value | Tax Basis Value |
Total Distribution Value: _______________________
_______________________
(Accountant)
_______________________
(Accountant)
IN RE: ESTATE OF | : | IN THE COURT OF COMMON PLEAS OF NORTHUMBERLAND COUNTY, PA. |
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: | ||
: | ORPHANS' COURT DIVISION | |
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__________, Deceased | : | NO. OC- |
AFFIDAVIT OF INDIVIDUAL FIDUCIARY(IES)
________________________________________ , the within named fiduciary(ies) verify(ies) that the facts set forth in the foregoing account and statement of proposed distribution, which are within the personal knowledge of the fiduciary(ies), are true, and as to facts based on information of the others, the fiduciary(ies), after diligent inquiry, believe(s) them to be true. I understand that false statements therein are made subject to the penalties of 18 Pa. C.S. Sec 4904 relating to unsworn falsification to authorities.
_______________________________
_______________________________
Signature(s) of Individual Fiduciary (ies)
Date: ____________________
IN RE: ESTATE OF | : | IN THE COURT OF COMMON PLEAS OF NORTHUMBERLAND COUNTY, PA. |
: | ||
: | ||
: | ORPHANS' COURT DIVISION | |
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__________, Deceased | : | NO. OC- |
AFFIDAVIT OF OFFICER OF CORPORATE FIDUCIARY
______________________________ verifies that he/she is the__________________ of the above-named ____________________________________________, and that the facts set forth in the foregoing account and statement of proposed distribution which are within the personal knowledge of the affiant are true, and as to facts based on the information of others, the affiant, after diligent inquiry, believes them to be true. I understand that false statements therein are subject to the penalties of 18 Pa. C.S. Sec 4904 relating to unsworn falsification to authorities.
_____________________________________
Signature of Officer of Corporate Fiduciary
Date: ______________________
IN RE: ESTATE OF | : | IN THE COURT OF COMMON PLEAS OF NORTHUMBERLAND COUNTY, PA. |
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: | ||
: | ORPHANS' COURT DIVISION | |
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__________, Deceased | : | NO. OC- |
AFFIDAVIT OF NOTICE
___________________
(Fiduciary)
___________________
(Capacity)
of the Estate of ______________________________________, verifies that written notice by _______________
(State Method of Service of Notice)
was given of the filing of the [Account and Statement of Proposed Distribution/Account and Request for the Appointment of an Auditor] to every unpaid claimant who has given written notice to his claim to the accountant and to every person known to the accountant to have or claim an interest in the estate as creditor, beneficiary, heir or next of kin. Copies of said written notices are attached. I understand that false statements herein are subject to the penalties of 13 Pa. C.S. Sec 4904 relating to unsworn falsification to authorities.
______________________________________
Fiduciary or Officer of Corporate Fiduciary
Date:__________________
Northum. Cnty. Pa 17.4