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 AA-1 - Petition for ancillary 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
ANCILLARY ADMINISTRATION PROCEEDING, PETITION FOR ANCILLARY
ESTATE OF LETTERS OF ADMINISTRATION
SCPA ARTICLE 16
a/k/a [ ] Ancillary Letters of Administration
[ ] Ancillary Letters of Administration d.b.n.
a domiciliary of the State of
Deceased. File No. ________
________X
TO THE SURROGATE'S COURT, COUNTY OF :
It is respectfully alleged:
1. The name, citizenship, domicile (or, in the case of a bank or trust company, its principal office) and interest in this proceeding of the petitioner(s), are as follows:
Name: ____________
Domicile or Principal Office: ____________
(Street and Number)
____________
(City, Village or Town) (State) (Zip Code)
Mailing Address: ____________
(if different from domicile)
Citizen of: ________
Name: ____________
Domicile or Principal Office: ____________
(Street and Number)
____________
(City, Village or Town) (State) (Zip Code)
Mailing Address: ____________
(if different from domicile)
Citizen of: ________
Interest(s) of Petitioner(s): [Check one]
[ ] Administrator [ ] Distributee of decedent [State relationship] ____________
[ ] Creditor
[ ] Other [Specify] ____________
2. The name, domicile, date and place of death, and national citizenship of the above-named decedent are as follow:
(a) Name: ____________
AA-1 (4/98)
(b) Date of Death: ____________
(c) Place of Death: ____________
(d) Domicile: Street ____________
City, Town, Village ____________
County ________ State ____________
(e) Citizen of: ____________
3. The decedent died INTESTATE, leaving no will.
On ____________, letters were issued to ________
by ________ Court, State of ____________, being a competent court of the state of the domicile of decedent having jurisdiction thereof, and the amount of the security given on the original appointment was $________.
[If additional space is needed in Paragraphs 4, 5 and 6, attach addendum.]
4. (a) The estimated gross value of the decedent's property in the State of New York, consisting of real property and personal property, is described and valued as follows: [list items and describe briefly, giving location. If space is insufficient, attach addendum.]
|
Personal Property |
$ |
|
Improved real property in New York State |
$ |
|
Unimproved real property in New York State |
$ |
|
Estimated gross rents for a period of 18 months |
$ |
|
Total $ |
4. (b) No other assets exist in New York State, nor does any cause of action exist on behalf of the estate, except as follows: [Enter "NONE" or specify]
____________
____________
Exemplified copies of the decree and the letters issued, if any, are submitted as part of this petition.
5. The names, addresses and interests of all persons entitled to process [(a) New York State Department of Taxation and Finance, (b) all domiciliary creditors or domiciliaries claiming to be creditors, and (c) such other persons entitled to letters pursuant to SCPA § 1607] are as follows:
|
Nature of Interest or |
||
|
Name |
Address |
Amount of Claim |
|
New York State Department of |
||
|
Taxation and Finance |
Albany, New York |
6. The name and address of each domiciliary distributee having an interest in the property in this state is as follows:
(a) Each distributee who is of full age and sound mind or which is a corporation or association:
AA-1 (4/98)
|
Name |
Address |
Interest |
(b) Each distributee who is an infant or otherwise under a disability: [State disability and see SCPA § 304(3)]
|
Name |
Address |
Interest |
Disability: ____________
TABULAR OR GRAPHIC MATERIAL SET FORTH AT THIS POINT IS NOT DISPLAYABLE
Disability: ____________
7. There are no persons interested in this proceeding other than those hereinbefore mentioned. No previous application for ancillary administration with or without ancillary letters has been made, except
____________
____________
WHEREFORE, petitioner(s) pray(s) (a) that process issue to all necessary parties and (b) that ancillary letters issue thereon as follows:
[ ] Ancillary Letters of Administration to: ____________
____________
[ ] Ancillary Letters of Administration d.b.n. to: ____________
____________
(d) [State any other relief requested]
Dated: ________
1.
____________
(Signature of Petitioner) 2.
____________
(Signature of Petitioner)
____________
(Print Name)
____________
(Print Name)
3.
(Name of Corporate Petitioner)
(Signature of Officer)
(Print Name and Title of Officer)
AA-1 (12/97)
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
________X
ANCILLARY ADMINISTRATION PROCEEDING COMBINED VERIFICATION,
ESTATE OF OATH AND DESIGNATION
a/k/a
a domiciliary of the State of File No. ________
Deceased.
________X
STATE OF)
COUNTY OF) ss:
The undersigned, the petitioner named in the foregoing petition, being duly sworn, says:
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 ANCILLARY [ ] Administrator [ ] Administrator d.b.n.: I am over eighteen (18) years of age and a citizen of the United States; I will well, faithfully and honestly discharge the duties of ancillary administrator/administrator d.b.n.. I am not ineligible to receive letters.
3. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I do hereby designate the Clerk of the Surrogate's Court of ________ County, and his or 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 within the State of New York after due diligence used.
My domicile is ____________
(Street Address) (City/Town/Village) (State) (Zip Code)
________
(Signature of Petitioner)
________
(Print Name)
On ____________, 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 New York Attorney: ____________
Print Name of New York Attorney: ____________
Firm Name: ____________ Tel. No.: ________
Address of New York Attorney: ____________
AA-1 (4/98)
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
________X
ANCILLARY ADMINISTRATION PROCEEDING COMBINED CORPORATE
VERIFICATION,
ESTATE OF CONSENT AND DESIGNATION
a/k/a
a domiciliary of the State of File No. ________
Deceased.
________X
STATE OF)
COUNTY OF) ss:
The undersigned, a ____________ of
(Title)
____________
(Name of Bank or Trust Company)
a corporation duly qualified to act in a fiduciary capacity without further security, being duly sworn, says:
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. CONSENT: I consent to accept the appointment as [ ] Ancillary Administrator [ ] Ancillary Administrator d.b.n. of the decedent described in the foregoing petition and consent to act as such fiduciary.
3. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I do hereby designate the Clerk of the Surrogate's Court of ________ County, and his or 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 within the State of New York after due diligence used.
_______________
(Name of Corporate Petitioner)
_______________
(Signature of Officer)
_______________
(Print Name and Title of Officer)
On ________, before me personally came ________ to me known, who duly swore to the foregoing instrument and who did say that he/she resides at ________ and that he/she is a ________ of ________ the corporation/national banking association described in and which executed such instrument, and that he/she signed his/her name thereto by order of the Board of Directors of the corporation.
________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Signature of New York Attorney: ____________
Print Name of New York Attorney: ____________
Firm Name: ____________ Tel. No.: ________
Address of New York Attorney: ____________
AA-1 (4/98)
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
________X
ANCILLARY ADMINISTRATION PROCEEDING, WILL OF COMBINED CORPORATE VERIFICATION,
ESTATE OF CONSENT AND DESIGNATION
a/k/a
a domiciliary of the State of File No. ________
Deceased.
________X
STATE OF)
COUNTY OF) ss:
The undersigned, a ____________ of
(Title)
____________
(Name of Bank or Trust Company)
a corporation duly qualified to act in a fiduciary capacity without further security, being duly sworn, says:
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. CONSENT: I consent to accept the appointment as [ ] Ancillary Administrator [ ] Ancillary Administrator d.b.n. of the decedent described in the foregoing petition and consent to act as such fiduciary.
3. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I do hereby designate the Clerk of the Surrogate's Court of ________ County, and his or 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 within the State of New York after due diligence used.
________
(Name of Corporate Petitioner)
________
(Signature of Officer)
________
(Print Name and Title of Officer)
On ________, before me personally came ________ to me known, who duly swore to the foregoing instrument and who did say that he/she resides at ________ and that he/she is a ________ of ________ the corporation/national banking association described in and which executed such instrument, and that he/she signed his/her name thereto by order of the Board of Directors of the corporation.
________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Name of New York Attorney: ____________ Tel. No.:________
Address of New York Attorney: ____________
AA-1 (12/97)
