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-6 - Affidavit of mailing
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
________X
LETTERS OF ADMINISTRATION d.b.n. AFFIDAVIT OF MAILING
ESTATE OF NOTICE OF APPLICATION FOR
LETTERS OF ADMINISTRATION d.b.n.
a/k/a (SCPA 1005)
File No. ________
Deceased.
________X
STATE OF NEW YORK
COUNTY OF ss.:
________, residing at ____________, New York, being duly sworn, deposes and says that deponent is over the age of eighteen years; that on ________, ________, deponent mailed a copy of the foregoing Notice of Application for Letters of Administration d.b.n., 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 letters 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 ____________, ________
______________
Notary Public
Commission Expires:
(Affix Stamp or Seal)
ADM/DBN-6 (7/98)
