New York Codes, Rules and Regulations
Title 22 - JUDICIARY
Subtitle D - Forms
Chapter VII - Surrogate's Court Forms
Subchapter A - Forms Authorized By Section 207.52
Surrogate's Forms
Form A-1 - Petition for letters of administration
For Office Use Only
(Filing Fee Paid $ ____________)
( ____________ Certs: $ ____________)
($ ____________ Bond, Fee: $ ____________)
(Receipt No: ____________ No: ____________)
DO NOT LEAVE ANY ITEMS BLANK
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
________X
ADMINISTRATION PROCEEDING, PETITION FOR LETTERS OF:
Estate of ________ [ ] Administration
[ ] Limited Administration
a/k/a [ ] Administration with Limitations
[ ] Temporary Administration
________ Deceased. File No. ________
________X
TO THE SURROGATE'S COURT, County of :
It is respectfully alleged:
1. The name, domicile and interest in this proceeding of the petitioner, who is of full age, is as follows:
Name: ____________
Domicile: ____________
(Street Address) (City/Town/Village)
____________
(County) (State) (Zip) (Telephone Number)
Mailing address is: ____________
(if different from domicile)
Citizenship (check one): [ ] U.S.A. [ ] Other (specify) ____________
Interest of Petitioner (check one):
[ ] Distributee of decedent (state relationship) ____________
[ ] Other (specify) ____________
Is proposed Administrator an attorney? [ ] Yes [ ] No [If yes, submit statement pursuant to 22 NYCRR 207.16(e); see also 207.52 (Accounting of attorney-fiduciary).]
2. The name, domicile, date and place of death, and national citizenship of the above-named decedent are as follows: [The Death Certificate must be filed with this proceeding. If the decedent's domicile is different from that shown on the death certificate, check box [ ] and attach an affidavit explaining the reason for this inconsistency.]
Name: ____________
Domicile: ____________
(Street Number) (City/Village/Town)
A-1 (12/98)
____________
(State) (Zip Code)
Township of: ____________ County of: ____________
Date of Death: ____________ Place of Death: ____________
Citizenship (check one): [ ] U.S.A. [ ] Other (specify)
[Note: For Items 3a through c: Do not include any assets that are jointly held, held in trust for another, or have a named beneficiary.]
3. (a) The estimated gross value of the decedent's personal property passing by intestacy is less than $ ________.
(b) The estimated gross value of the decedent's real property, in this state, which is [ ] improved, [ ] unimproved, passing by intestacy is less than $ ________.
A brief description of each parcel is as follows:
____________
____________
(c) The estimated gross rent for a period of eighteen (18) months is the sum of $ ________.
(d) In addition to the value of the personal property stated in paragraph (3) the following right of action existed on behalf of the decedent and survived his/her death, or is granted to the administrator of the decedent by special provision of law, and it is impractical to give a bond sufficient to cover the probable amount to be recovered therein: [Write "NONE" or state briefly the cause of action and the person against whom it exists, including names and carrier.]
____________
____________
(e) If decedent is survived by a spouse and a parent, or parents but no issue, and there is a claim for wrongful death, check here [ ] and furnish name(s) and address(es) of parent(s) in Paragraph 7. See E PTL 5-4.4.
4. A diligent search and inquiry, including a search of any safe deposit box, has been made for a will of the decedent and none has been found. Petitioner(s) (has) (have) been unable to obtain any information concerning any will of the decedent and therefore allege(s), upon information and belief, that the decedent died without leaving any last will.
5. A search of the records of this Court shows that no application has ever been made for letters of administration upon the estate of the decedent or for the probate of a will of the decedent, and your petitioner is informed and verily believes that no such application ever has been made to the Surrogate's Court of any other county of this state.
6. The decedent left surviving the following who would inherit his/her estate pursuant to E PTL 4-1.1 and 4-1.2:
a. [ ] Spouse (husband/wife).
b. [ ] Child or children or descendants of predeceased child or children. [Must include marital, nonmarital, and adopted].
c. [ ] Any issue of the decedent adopted by persons related to the decedent (DRL Section 117).
d. [ ] Mother/Father.
e. [ ] Sisters or brothers, either of whole or half blood, and issue of predeceased sisters or brothers.
f. [ ] Grandmother/Grandfather.
g. [ ] Aunts or uncles, and children of predeceased aunts and uncles (first cousins).
h. [ ] First cousins once removed (children of first cousins).
[Information is required only as to those classes of surviving relatives who would take the property of decedent pursuant to E PTL 4-1.1. State "number" of survivors in each class. Insert "No" in all prior classes. Insert "X" in all subsequent classes].
7. The decedent left surviving the following distributees, or other necessary parties, whose names, degrees of relationship, domiciles, post office addresses and citizenship are as follows:
[Note: Show clearly how each person is related to decedent. If relationship is through an ancestor who is deceased, give name, date of death, and relationship of the ancestor to the decedent. Use rider sheet if space in paragraph (7) is not sufficient. See Uniform Rules 207.16(b).
If any person listed in paragraph (7) is a nonmarital person, or descended from a nonmarital person, attach a copy of the order of filiation or Schedule A. If any person listed in paragraph (7) was adopted by any persons related by blood or marriage to decedent or descended from such persons, attach Schedule B.]
7a. The following are of full age and under no disability: [If nonmarital or adopted-out person, so indicate by attaching Schedule A and/or B]
Domicile and
Name Relationship Mailing Address Citizenship
________ ________ ________ ________
________ ________ ________ ________
________ ________ ________ ________
7b. The following are infants and/or persons under disability: [Attach applicable Schedule A, B, C and/or D]
Domicile and
Name Relationship Mailing Address Citizenship
________ ________ ________ ________
________ ________ ________ ________
________ ________ ________ ________
8. There are no outstanding debts or funeral expenses, except: [Write "NONE" or state same]
9. There are no other persons interested in this proceeding other than those hereinbefore mentioned.
WHEREFORE, your petitioner respectfully prays that: [Check and complete all relief requested]
() a. process issue to all necessary parties to show cause why letters should not be issued as requested;
() b. an order be granted dispensing with service of process upon those persons named in Paragraph (7) who have a right to letters prior or equal to that of the person nominated, and who are non-domiciliaries or whose names or whereabouts are unknown and cannot be ascertained;
() c. a decree award Letters of:
[ ] Administration to ____________
[ ] Limited Administration to ____________
[ ] Administration with Limitation to ____________
[ ] Temporary Administration to ____________
or to such other person or persons having a prior right as may be entitled thereto, and;
() d. That the authority of the representative under the foregoing Letters be limited with respect to the prosecution or enforcement of a cause of action on behalf of the estate, as follows: the administrator(s) may not enforce a judgment or receive any funds without further order of the Surrogate.
() e. That the authority of the representative under the foregoing Letters be limited as follows:
____________
____________
____________
() f. [State any other relief requested].
____________
____________
Dated: ________
1.
(Signature of Petitioner) 2.
(Signature of Petitioner)
______________
(Print Name)
(Print Name)
STATE OF NEW YORK)
) ss:
COUNTY OF)
COMBINED VERIFICATION, OATH AND DESIGNATION
[For use when petitioner is to be appointed administrator]
I, the undersigned, the petitioner named in the foregoing petition, being duly sworn, say:
1. VERIFICATION: I have read the foregoing petition subscribed by me and know the contents thereof, and the same is true of my own knowledge, except as to the matters therein stated to be alleged upon information and belief, and as to those matters I believe it to be true.
2. OATH OF ADMINISTRATOR as indicated above: I am over eighteen (18) years of age and a citizen of the United States; and I will well, faithfully and honestly discharge the duties of Administrator of the goods, chattels and credits of said decedent according to law. I am not ineligible to receive letters and will duly account for all moneys and other property that will come into my hands.
3. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I do hereby designate the Clerk of the Surrogate's Court of ________ County, and his/her successor in office, as a person on whom service of any process, issuing from such Surrogate's Court may be made in like manner and with like effect as if it were served personally upon me, whenever I cannot be found and served within the State of New York after due diligence is used.
My domicile is:
(Street/Number) (City/Village/Town) (State) (Zip)
______________
Signature of Petitioner
On the ________ day of ________, 19 ________, before me personally came ____________
to me known to be the person described in and who executed the foregoing instrument. Such person duly swore to such instrument before me and duly acknowledged that he/she executed the same.
______________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Signature of Attorney: ____________
Print Name: ____________
Firm Name: ____________ Tel. No.: ________
Address of Attorney: ____________
File # ________
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
________X
PROCEEDING FOR SCHEDULE A
Estate of NONMARITAL PERSONS
(PERSONS BORN OUT OF WEDLOCK)
a/k/a
Deceased.
________X
[NOTE: Nonmarital children (or their issue) who would be distributees if they (or their ancestors) were born in wedlock will not be regarded as distributees unless satisfactory proof is submitted establishing paternity]. See E PTL 4-1.2 which sets forth methods of establishing paternity.
Name of alleged distributee: ____________
Date of birth: ________ Relationship to decedent: ____________
Name of father: ____________
Name of mother: ____________
Does the birth certificate contain the father's name? Yes [ ] No [ ]
If yes, attach copy of birth certificate.
Has an order of filiation establishing paternity been entered? Yes [ ] No [ ]
If yes, attach copy of order.
Did the nonmarital person live with his or her father? Yes [ ] No [ ]
If yes, give dates and places of residence: ____________
____________
____________
File # ________
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
________X
PROCEEDING FOR SCHEDULE B
Estate of ISSUE OF THE DECEDENT
WHO WERE THE SUBJECT
a/k/a OF AN ADOPTION
Deceased.
________X
Name of child: ____________
Relationship to decedent prior to adoption: ____________
Date of adoption: ________
Was this a step-parent adoption? (i.e., was the child adopted by the spouse of the decedent's former spouse?) Yes [ ] No [ ]
If yes, name of adoptive father or mother: ____________
If not a step-parent adoption, indicate below the biological relationship of the adoptive parent to the child:
[ ] grandparent(s)
[ ] brother or sister
[ ] aunt or uncle
[ ] first cousin
[ ] nephew or niece
Name of the adoptive parent: ____________
File # ________
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
________X
PROCEEDING FOR SCHEDULE C
Estate of INFANTS
a/k/a
Deceased.
________X
[NOTE: Please furnish all of the information requested, otherwise the petition may be rejected.]
Name: ________ Date of birth: ____________
Relationship to the decedent: ____________
With whom does the infant reside? ____________
Name of mother: ________ Is she alive? ____________
Name of father: ________ Is he alive? ____________
Does infant have a court-appointed guardian? Yes [ ] No [ ]
If yes, name and address of guardian: ____________
____________
Name: ________ Date of birth: ____________
Relationship to the decedent: ____________
With whom does the infant reside? ____________
Name of mother: ________ Is she alive? ____________
Name of father: ________ Is he alive? ____________
Does infant have a court-appointed guardian? Yes [ ] No [ ]
If yes, name and address of guardian: ____________
____________
File # ________
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
________X
PROCEEDING FOR SCHEDULE D
Estate of PERSONS UNDER DISABILITY
OTHER THAN INFANTS
a/k/a
Deceased.
________X
[use additional sheets if more than one]
1. Name: ________ Relationship: ____________
Residence: ____________
With whom does this person reside? ____________
If this person is in prison, name of prison: ____________
Does this person have a court-appointed fiduciary? Yes [ ] No [ ]
If yes, give name, title and address: ____________
____________
If no, describe nature of disability: ____________
____________
If no, give name and address of relative or friend interested in his or her welfare: ____________
____________
2. Whereabouts unknown/Unknowns [persons whose addresses or names are unknown to petitioner; if known, give name and relationship to decedent]
