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 ADM/DBN-3 - Waiver of citation, renunciation and consent to appointment of administration d.b.n. (individual)
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
________X
LETTERS OF ADMINISTRATION d.b.n. WAIVER OF CITATION,
ESTATE OF RENUNCIATION AND CONSENT
TO APPOINTMENT OF
ADMINISTRATOR d.b.n.
a/k/a (INDIVIDUAL)
File No. ________
Deceased.
________X
The undersigned, a distributee or creditor of the above-named decedent, and being of full age and sound mind, hereby voluntarily appears in the Surrogate's Court of ________ County, New York, and waives the issuance and service of citation in this matter, renounces all rights to Letters of Administration d.b.n. of the above captioned estate and consents that
[ ] Letters of Administration d.b.n.
[ ] Letters of Administration d.b.n. with Limitations
[ ] Limited Letters of Administration d.b.n.
be issued to ____________
or any other person or persons entitled thereto without any notice whatsoever to the undersigned, and consents
[ ] that a bond be dispensed with
[ ] that a bond in the amount of $____________ be posted and hereby specifically releases any claim the undersigned might have under any bond that may be filed.
____
Date
_______
Signature
_______
Street Address
_______
Relationship
_______
Print Name
_______
Town/State/Zip
STATE OF NEW YORK
COUNTY OF ss.:
On ____________, ________, before me personally came
____________
to me known and 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)
Name of Attorney: ____________ Tel. No.:________
Address of Attorney: ____________
ADM/DBN-3 (7/98)
