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 SE1D - Report and account in settlement of estate
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF ________
________X
VOLUNTARY ADMINISTRATION, Estate of REPORT AND ACCOUNT IN
SETTLEMENT OF ESTATE
________, PURSUANT TO ARTICLE 13, SCPA
Deceased File No. ________
________X
The undersigned, authorized by this court to act as the voluntary administrator of the above entitled estate, reports and accounts as follows:
1. There has come into my possession the following personal property of the deceased, which is on hand or has been converted into cash in the amounts indicated:
Item Value
____________
____________
____________
[If more space in needed add a sheet of paper]
Total value of personal property and cash: $ ________
2. All of this personal property and cash have been disbursed or distributed as follows:
Item or Cash To Whom
____________
____________
____________
Receipts or cancelled checks showing the payment of expenses of administration, disbursements, or distributions are annexed.
3. No part of the estate of the decedent remains in my possession.
______________
Voluntary Administrator/trix
______________
Print Name of Voluntary Administrator/trix
STATE OF NEW YORK)
ss.:
COUNTY OF ________)
________ being duly sworn, deposes and says: I have read the foregoing Report and Account and know the contents thereof; the matters and things therein stated are true as of my own knowledge; the foregoing Account is in all respects just and true and contains a full, particular and true account of all money and property of the deceased coming into my possession; and the administration expenses, disbursements and distribution shown have been actually made for the purposes and reasons therein stated.
______________
Affiant
Sworn to before me on
________, 19________
______________
Notary Public
My commission expires:________
SE-1D (3/91)
