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 I-1 - Inventory of assets
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF ________
________x
IN THE MATTER OF THE ESTATE OF LIST OF ASSETS - INVENTORY
[RULE § 207.20(c) ]
Deceased. File No. ________
________x
The undersigned, a fiduciary or an attorney for the above estate, certifies that the following recapitulation constitutes the gross estate (for tax purposes) of the above decedent. The following documents are attached: [ ] a detailed list of assets; or a copy of one of the following: [ ] Form ET-90; [ ] Form TT-385; [ ] Form 706; or, Form 706NA.
IF FORM ET-90 IS ATTACHED, ALL RIGHTS TO SECRECY UNDER TAX LAW § 994 ARE WAIVED
Date of Death: ____________ Date of Letters: ____________ Type of Letters: ____________
Name of Each Fiduciary: ____________
(I) [FN3] ( ____________ and I jointly and severally) undertake that defendant will appear in
RECAPITULATION OF Non-probate, Joint Individually owned
ATTACHED SCHEDULES: or Trust Property by Decedent or
Payable to Estate
A. Real Estate $ ________ $ ________
B. Stocks and Bonds ________ ________
C. Mortgages, Notes, Cash, etc. ________ ________
D. Insurance on Decedent's Life ________ ________
E. Jointly Owned Property ________ ________
F. Miscellaneous & Trust Property ________ ________
G. Transfers During Decedent's Life ________ ________
H. Powers of Appointment ________ ________
I. Annuities ________ ________
TOTALS $ ________ $ ________
Cause of Action Pending for Filing Fee under § 2402 (8) ________
Wrongful Death or Conscious Filing Fee Initially Paid ________
Pain and Suffering: Balance (Refund) Due ________
Amount Claimed $________
ATTORNEY Certified to be true on ____________, 19 ________
Name ________
Address ________
_______________
Signature
________
Telephone ________
_______________
Print Name
1-1 (12/91)
GROSS ASSETS
(Attach Additional Sheets If Necessary)
A. REAL ESTATE (Individually owned property)
Description Date of Death Value
________ ________
________ ________
________ ________
B. STOCKS AND BONDS (Individually owned)
Description, Including Face
Amount of Bonds and
Number of Shares Date of Death Value
________ ________
________ ________
________ ________
C. MORTGAGES, NOTES AND CASH (Including Bank Deposits)
(Jointly owned property should be reported at E and trust property at F)
Description Date of Death Value
________ ________
________ ________
________ ________
D. INSURANCE ON DECEDENT'S LIFE
(1) Payable to Estate
Description Date of Death Value
________ ________
________ ________
________ ________
(2) Payable to Named Beneficiary
Description Date of Death Value
________ ________
________ ________
________ ________
E. JOINTLY OWNED PROPERTY (Real and Personal Property)
(1) Real Estate
Description Joint Tenant Date of Death Value
________ ________ ________
________ ________ ________
________ ________ ________
(2) Stocks and Bonds
Description Joint Tenant Date of Death Value
________ ________ ________
________ ________ ________
________ ________ ________
(3) Mortgages, Notes and Cash
Description Joint Tenant Date of Death Value
________ ________ ________
________ ________ ________
________ ________ ________
F. OTHER MISCELLANEOUS PROPERTY
(1) Individually Owned
Description Date of Death Value
________ ________
________ ________
________ ________
(2) Assets Passing to the Estate from Employment
Description Date of Death Value
________ ________
________ ________
________ ________
(3) Trust Property
Description Date of Death Value
________ ________
________ ________
________ ________
G. TRANSFERS DURING DECEDENT'S LIFE
Description Date of Death Value
________ ________
________ ________
________ ________
H. POWERS OF APPOINTMENT
Description Date of Death Value
________ ________
________ ________
________ ________
I. ANNUITIES
Description Date of Death Value
________ ________
________ ________
________ ________
CAUSE OF ACTION for decedent's wrongful death and for conscious pain and suffering, as well as any other type of action.
Court in which Index Amount
Description Action Pending Number Demanded
________ ________ ________ ________
________ ________ ________ ________
________ ________ ________ ________
