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ANCILLARY PROBATE PROCEEDING, WILL OF PETITION FOR ANCILLARY (NYS Unified Court System Division of Technology)

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SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF____________________________
----------------------------------------------------------------------------------X
ANCILLARY PROBATE PROCEEDING, WILL OF PETITION FOR ANCILLARY PROBATE
__________________________________________ SCPA ARTICLE 16
Ancillary Letters Testamentary
a/k/a_______________________________________ Ancillary Letters of Administration c. t. a.
Without Ancillary Letters
a domiciliary of the State of _____________________
Deceased. File No.________________________
----------------------------------------------------------------------------------X
TO THE SURROGATE’S COURT, COUNTY OF__________________
It is respectfully alleged:
1. The name, citizenship, domicile (or, in the case of a bank or trust company, its principle office) and interest in this
proceeding of the petitioner(s) are as follows:
Name:
Domicile or Principal Office:
(Street and Number)
__________________________________________________________________________________________________
(City, Village or Town) (State) (Zip Code)
Mailing address:__________________________________________________________________________
(If different from domicile)
Citizen of:_____________________________
Name:____________________________________________________________________________________________
Domicile or Principal Office:
(Street and Number)
__________________________________________________________________________________________________
(City, Village or Town) (State) (Zip Code)
Mailing address:________________________________________________________________________
(If different from domicile)
Citizen of:
Interest (s) of Petitioner (s): [Check one]
Executor(s) named in decedent’s will Creditor
Other (Specify)______________________________________________________________________
2. The name, domicile, date and place of death, and national citizenship of the above-named decedent are as follows:
(a) Name:_________________________________________________________________________
(b) Date of Death:___________________________________________________________________
(c) Place of Death:__________________________________________________________________
(d) Domicile: Street__________________________________________________________________
City, Town, Village________________________________________________________________
County__________________________State __________________________________________
(e) Citizen of:______________________________________________________________________
AP-1 (4/99) -1-
3. Decedent left a will in writing dated _____________________________________________________ (and
codicil dated ), which was duly admitted to probate on
by the ________________ Court, County of ________________________, State of _______________________________
being a competent court of the state of the domicile of decedent having jurisdiction thereof, and the will/codicil is not subject
to contest under the laws of that state.
On ________________________________, letters were issued by the court to _________________________________,
and the amount of the security given on the original appointment was $_________________. Under the will/codicil a
bond is is not dispensed with.
[If additional space is needed in Paragraphs 4, 5 and 6, attach addendum.]
4. (a) The will/codicil upon ancillary probate may operate upon property in the State of New York consisting of real
property and personal property described and valued as follows: [list items and describe briefly, giving location. If space is
insufficient, attached addendum].
Personal Property $__________________________
Improved real property in New York State $__________________________
Unimproved real property in New York State $__________________________
Estimated gross rents for a period of 18 months $__________________________
Total $__________________________
4. (b) No other testamentary assets exist in New York State, nor does any cause of action exist on behalf of the estate,
except as follows: [Enter “NONE” or specify]
_________________________________________________________________________________________________
__________________________________________________________________________________________________
Exemplified copies of the will/codicil, the decree admitting the will/codicil to probate, and the letters issued, if any are submitted
as part of this petition.
5. The names, addresses and interests of all persons entitled to process [(a) New York State Department of Taxation
and Finance, (b) all domiciliary creditors or domiciliaries claiming to be creditors, and (c) such other persons entitled to letters
pursuant to SCPA §1604] are as follows:
Name Address Nature of Interest
New York State Department of Or Amount of Claim
Taxation and Finance Albany, New York
________________________ ____________________ ______________________
________________________ ____________________ ________________________
________________________
AP-1 (4/98) -2-
6. The name and address of each domiciliary beneficiary under the will/codicil having an interest in the property in this
state is as follows:
(a) Each beneficiary who is of full age and sound mind or which is a corporation or association:
Name Address Interest
[Refer to Paragraph of W ill]
______________________ _________________________ ___________________________
______________________ _________________________ ___________________________
(b) Each beneficiary who is an infant or otherwise under a disability: [State disability and see SCPA §304(3)]
Name Address Interest
[Refer to Paragraph of W ill]
______________________
Disability:__________________________________________________________________________________________
__________________________________________________________________________________________________
Disability: __________________________________________________________________________________________
7. There are no persons interested in this proceeding other than those herein before mentioned. No previous
application for ancillary probate with or without ancillary letters has been made, except ____________________________
_________________________________________________________________________________________________
__________________________________________________________________________________________________
W HEREFORE, petitioner(s) pray(s) (a) that process issue to all necessary parties (b) that the W ill/Codicil be admitted to
ancillary probate and (c) that ancillary letters issue thereon as follows:
Ancillary Letters Testamentary to:_ __________________________________________________________________
_________________________________________________________________________________________________
Ancillary Letters of administration c.t.a. to:____________________________________________________________
__________________________________________________________________________________________________
No Ancillary Letters to be issued
(d) [State any other relief requested] ____________________________________________________________________
Dated:______________________________
1. _________________________________ 2. _____________________________________
(Signature of Petitioner) (Signature of Petitioner)
_________________________________ _______________________________________
(Print Name) (Print Name)
3. _________________________________
(Name of Corporate Petitioner)
_________________________________
(Signature of Officer)
_________________________________
(Print Name and Title of Officer)
AP-1 (4/98) -3-
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF _____________________________
----------------------------------------------------------------------------------X
ANCILLARY PROBATE PROCEEDING, WILL OF COMBINED VERIFICATION
__________________________________________________ OATH AND DESIGNATION
a/k/a ______________________________________________
File No. _________________________
a domiciliary of the State of ____________________________
Deceased
----------------------------------------------------------------------------------X
STATE OF _______________________)
COUNTY OF______________________) ss:
The undersigned, the petitioner named in the foregoing petition, being duly sworn, says:
1. VERIFICATION: I have read the forgoing petition subscribed by me and know the contents thereof, and the same
is true of my own knowledge, except as to the matters therein stated to be alleged upon information and belief, and as to those
matters I believe it to be true.
2. OATH OF ANCILLARY Executor Administrator c.t.a.: I am over eighteen (18) years of age and a citizen
of the United States; I will well, faithfully and honestly discharge the duties of ancillary executor/administrator c.t.a. under the
will. I am not ineligible to receive letters.
3. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I do hereby designate the clerk of the Surrogate’s Court
of _________________________________ County, and his or her successor in office as a person on whom service of any
process issuing from such Surrogate’s Court may be made, in like manner and with like effect as if it were served personally
upon me, whenever I cannot be found within the State of New York after due diligence used.
My domicile is_____________________________________________________________________________________
(Street Address) (City/Town/Village) (State) (Zip Code)
_______________________________________
(Signature Of Petitioner)
_______________________________________
(Print Name)
On ___________________________________________________________________, before me personally came
______________________________________________________________________________________________
to me known to be the person described in and who executed the foregoing instrument. Such person duly swore to such
instrument before me and duly acknowledged that he/she executed the same.
_____________________________________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Signature of New York Attorney:________________________________________________________________________
Print Name of New York Attorney:_______________________________________________________________________
Firm Name: _________________________________________________Tel. No.:________________________________
Address of New York Attorney:_________________________________________________________________________
__________________________________________________________________________________________________
AP-1 (4/98) -4-
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF _____________________________
----------------------------------------------------------------------------------X
ANCILLARY PROBATE PROCEEDING, WILL OF COMBINED CORPORATE VERIFICATION
CONSENT AND DESIGNATION
a/k/a ______________________________________________
File No. _____________________________
a domiciliary of the State of_____________________________
Deceased.
----------------------------------------------------------------------------------X
STATE OF________________________)
COUNTY OF______________________) ss:
The undersigned, a _____________________________________________________________________of
(Title)___________________________________________________________________________________________
___________________________________________________________________________________________
(Name of Bank or Trust Company)
a corporation duly qualified to act in a fiduciary capacity without further security, being duly sworn, says:
1. VERIFICATION: I have read the forgoing petition subscribed by me and know the contents thereof, and the same
is true of my own knowledge, except as to the matters therein stated to be alleged upon information and belief, and as to those
matters I believe it to be true.
2. CONSENT: I consent to accept the appointment as [ ] Ancillary Executor [ ] Ancillary Administrator c.t.a. under
the will of the decedent described in the foregoing petition and consent to act as fiduciary.
3. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I do hereby designate the clerk of the Surrogate’s Court
of _______________________________ County, and his or her successor in office as a person on whom service of any
process issuing from such Surrogate’s Court may be made, in like manner and with like effect as if it were served personally
upon me, whenever I cannot be found within the State of New York after due diligence used.
_______________________________________
(Name of Corporate Petitioner)
_______________________________________
(Signature of Officer)
_______________________________________
(Print Name and Title of Officer)
On____________________________ , before me personally came____________________________________
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 singed his/her
name thereto by order of the Board of Directors.
____________________________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Signature of New York Attorney:________________________________________________________________________
Print Name of New York Attorney:_______________________________________________________________________
Firm Name:___________________________________ Tel. No.:_____________________________________________
Address of New York Attorney: _________________________________________________________________________
AP-1 (4/98) -5-
ANCILLARY PROBATE CITATION File No._____________________
SURROGATE’S COURT- COUNTY
CITATION
THE PEOPLE OF THE STATE OF NEW YORK,
By the Grace of God Free and Independent
TO
A petition having been duly filed by , who is
domiciled at _______________________________________________________________________________________
YOU ARE HEREBY CITED TO SHOW CAUSE before the Surrogate’s Court,_______________________County,
at , New York, on ,
at_____o’clock in the______noon of that day, why a decree should not be made in the estate of ____________________
_________________________________________________________________________________________________
lately domiciled at
admitting to ancillary probate an exemplified copy of the Will dated ___________________________________________,
(A Codicil dated ), as the Will of ____________________________________________________
deceased,
relating to real and personal property, and directing that
Ancillary Letters Testamentary issue to:_________________________________________________
Ancillary Letters of Administration c.t.a. issue to:__________________________________________
No Ancillary Letters to be issued
(State any further relief requested)
HON. ______________________________________________
Dated, Attested and Sealed, Surrogate
__________________________ _____________________________________________
(Seal)
Chief Clerk
__________________________________________________________________________________________________
Attorney for Petitioner Telephone Number
__________________________________________________________________________________________________
Address of Attorney
[Note: This is served upon you as required by law. You are not required to appear. If you fail to appear it will be assumed you do not object to
the relief requested. You have a right to have an attorney appear for you.]
AP-2 (12/97)
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF ____________________________
----------------------------------------------------------------------------------X
ANCILLARY PROBATE PROCEEDING, WILL OF NOTICE OF ANCILLARY PROBATE
___________________________________________________
a/k/a_______________________________________________
File No._______________________
a domiciliary of the State of_____________________________
Deceased
----------------------------------------------------------------------------------X
Notice is hereby given that:
1. An exemplified copy of the Will dated (and Codicil dated )
of the above named decedent, domiciled at ______________________________________________________________
State of______________________________has been offered for ancillary probate in the Surrogate’s Court for the County
of_____________________________________.
2. The name(s) of proponent(s) of said Will/Codicil is/are ___________________________________________________
_________________________________________________________________________________________ whose
address(es) is/are
_________________________________________________________________________________________________
3. The name and post office address of each and every domiciliary beneficiary of the above named decedent as set forth in
Paragraph 6 of the petition is/are as follows:
NAME MAILING ADDRESS NATURE OF INTEREST
OR STATUS
(USE ADDITIONAL SHEETS IF NECESSARY)
Date ___________________________________
[Note: Complete Affidavit of Mailing. If serving infant 14 years of age or older, list and mail to infant as well as parent
or guardian.]
Name of New York Attorney: Tel. No.:
Address of New York Attorney:
AP-3 (12/97) -1-
NAME MAILING ADDRESS NATURE OF INTEREST
OR STATUS
_________________________ ___________________________ ______________________________
AFFIDAVIT OF MAILING NOTICE OF ANCILLARY PROBATE
STATE OF NEW YORK )
)ss.:
COUNTY OF______________________)
, residing at
being duly sworn, says that he/she is over the age of 18 years, that on the ___________day of ,
he/she deposited in the post office or in a post office box regularly maintained by the government of the United States in the
________________________________of_____________________, State of New York, a copy of the foregoing Notice of
Ancillary Probate contained in a securely closed postpaid wrapper directed to each of the persons named in said notice at the
place set opposite their respective names.
Sworn to before me this ________________ _____________________________________
Signature
day of ______________________________ ______________________________________
Print Name
___________________________________
Notary Public
Commission Expires:______________
(Affix Notary Stamp or Seal)
Name of New York Attorney:___________________________________Tel. No.____________________________
Address of New York Attorney:____________________________________________________________________
AP-3 (12/97) -2-
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