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 G-11 - Release settling accounts
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF ________
________X
In the Matter of the Guardianship of RELEASE SETTLING ACCOUNTS
File No. ________
a Former Infant.
________X
TO THE SURROGATE'S COURT OF THE COUNTY OF ________:
WHEREAS,
(Name of Guardian) of
__________________
(I) [FN3] ( ____________ and I jointly and severally) undertake that defendant will appear in
was duly appointed guardian of the (person and) property of ________, an infant, on ________, ________, by the Surrogate's Court of ________ County, and thereupon duly qualified as guardian; and
WHEREAS, the former infant attained the age of eighteen on ________, ________; and
WHEREAS, the guardian has settled with the former infant all matters relating to the guardianship and to the property of the former infant, in which settlement the guardian is charged:
With amount of personal property and income thereof received $ ________
With amount of income from infant's real estate received $ ________
Total $ ________
And is credited:
With amount expended in care of infant $ ________
With amount applied to support, maintenance and education of infant $ ________
Total $ ________
Leaving a balance of $ ________
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G-11 (9/00)
NOW, THEREFORE, in consideration of the payment and delivery to me,
____________
(Name of Former Infant) of
____________
(I) [FN3] ( ____________ and I jointly and severally) undertake that defendant will appear in
$ ________ in cash and property, the receipt of which is hereby acknowledged, being the balance in the hands of the guardian and also in consideration of a mutual agreement to waive a judicial accounting, I do for myself, my executors and administrators, release and forever discharge
__________
(Name of Guardian) and
(Names of Depositories)
[ ] Clerk of the Court, [ ] Guardianship Clerk of the Court, from any and every claim, demand, action and cause of action, account, liability or reckoning of every name and nature for and on account of any and every matter and thing whatsoever arising from or in any manner relating to or connected with my estate and guardianship.
IN WITNESS WHEREOF, we, the guardian and former infant, have set our hands and seals this ________ day of ________, ________.
______________
Signature of Guardian
______________
Signature of Former Infant
______________
Print Name
______________
Print Name
On this ________ day of ________, ________, before me personally came ________ and ________ known to me to be the individual(s) described in and who executed the foregoing instrument. Such person(s) duly swore to such instrument before me and duly acknowledged that he/she/they executed the same.
________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Signature of Attorney: ____________
Print Name: ____________
Firm Name: ________ Tel. No.: ____________
Address of Attorney: ____________
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