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-5 - Notice of application for letters of administration
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
________X
LETTERS OF ADMINISTRATION d.b.n.
ESTATE OF NOTICE OF APPLICATION FOR
LETTERS OF ADMINISTRATION d.b.n.
a/k/a (SCPA 1005)
File No. ________
Deceased.
________X
Notice is Hereby Given That:
1. An application for Letters of Administration d.b.n. upon the estate of the above-named decedent, has been made by ____________
petitioner, whose post office address is: ____________
2. Each and every name of the intestate decedent known to the undersigned is as indicated in the above caption.
3. Petitioner prays that a decree be made directing the issuance of Letters of Administration d.b.n.
to ____________
4. The name and post office address of each and every distributee of the above-named decedent, as set forth in the petition and known to the undersigned, are as follows:
(a) Distributees who have been duly cited or have waived citation or have appeared in this proceeding:
Name of Distributee Domicile and Post Office Address
________ ________
________ ________
________ ________
(b) Other Distributees:
Name of Distributee Domicile and Post Office Address
________ ________
________ ________
________ ________
[IF MORE SPACE IS NEEDED ADD RIDER]
5. The undersigned does not know of any other distributees of the said decedent.
6. Letters of Administration d.b.n. will issue on or after ____________, ________
Dated ________, ________
______________
Signature of Petitioner or Attorney
______________
Print Name
______________
Address
Name of Attorney: ____________ Tel. No.: ________
Address of Attorney: ____________
ADM/DBN-5 (7/98)
