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 JA-3 - Waiver of citation and consent in accounting
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
________X
ACCOUNTING BY
as the WAIVER OF CITATION AND
CONSENT IN ACCOUNTING
of the ESTATE OF
a/k/a
Deceased. File No. ________
________X
The undersigned, being of full age and sound mind, residing at the address written below, having an interest in this proceeding, waives the issuance and service of citation in this proceeding, and consents to the submission of a decree settling the account as filed and adjusted without further notice. I acknowledge receipt of a copy of the summary statement of account.
________ ________ ________ ________
Date Signature Street Address Interest
________ ____________
Print Name City/Town/Village, State/Zip
STATE OF NEW YORK)
COUNTY OF) ss.:
On ________, 19 ________, before me personally appeared
[INDIVIDUAL]
________ to me known and known to me to be the person described in and who executed the foregoing waiver and consent and duly acknowledge the execution thereof.
[CORPORATION]
________ to me known, who duly swore to the foregoing instrument and who did say that he/she resides at ________ and that he/she is a ________ of ________ the corporation/national banking association described in and which executed such instrument; and that he/she signed his/her name thereto by order of the Board of Directors of the corporation.
______________
Notary Public
Commission Expires:
(Affix Notary Stamp of Seal)
Name of Attorney: ____________ Tel. No.: ________
Address of Attorney: ____________
[Note: You may request a copy of the full account from the petitioner or petitioner's attorney.]
JA-3 (12/96)
