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-4 - Affidavit of service of mailing notice of application
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF ________
________X
ADMINISTRATION PROCEEDING AFFIDAVIT OF MAILING
Estate of ________ NOTICE OF APPLICATION FOR
LETTERS OF ADMINISTRATION
a/k/a (SCPA 1005)
________ Deceased. File No. ________
________X
STATE OF NEW YORK)
) ss.:
COUNTY OF ________)
________, residing at ________, New York, being duly sworn, deposes and says that deponent is over the age of eighteen years; that on ________, 19 ________, deponent mailed a copy of the foregoing Notice of Application for Letters of Administration, contained in a securely closed postpaid wrapper, directed to each of the persons named in paragraph 4(b), respectively, as follows:
whose post office address is ____________
whose post office address is ____________
whose post office address is ____________
whose post office address is ____________
whose post office address is ____________
whose post office address is ____________
whose post office address is ____________
whose post office address is ____________
by depositing the document in a letter box or other official depository under the exclusive care and custody of the United States Post Office, located at:
____________
______________
Signature
Sworn to before me this
________ day of ________, 19________.
_________
Notary Public
Commission Expires: ________
(Affix Stamp or Seal)
