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DO NOT LEAVE ANY ITEMS BLANK (NYS Unified Court System Division of Technology)

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For Office Use Only
Filing Fee Paid $__________________
___________ Certs: ______________
$__________ Bond, Fee: ___________
Receipt No:_________ No:___________
DO NOT LEAVE ANY ITEMS BLANK
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF ______________________________
_______________________________________________X
LETTERS OF ADMINISTRATION c.t.a.,
WILL OF _____________________________________________
a/k/a _____________________________________________
Deceased.
__________________________________________X
PETITION FOR
LETTERS OF ADMINISTRATION c.t.a
AFTER PROBATE
SCPA 1418 AND 1419
File No.
TO THE SURROGATE’S COURT, COUNTY OF ____________________ :
It is respectfully alleged:
1. (a) The name, citizenship, domicile (or, in the case of a bank or trust company, its principal office)
and interest in this proceeding of the petitioner(s) is/are as follows:__________________________________________
Name: _________________________________________________________________________________________
Domicile or Principal Office: ________________________________________________________________________
(Street and Number) (City, Village or Town)
_______________________________________________________________________________________________
(County) (State) (Zip) (Telephone Number)
Mailing Address: _________________________________________________________________________________
(If different from domicile)
Citizenship (check one): USA
Other (specify) __________________________
Name:__________________________________________________________________________________________
Domicile or Principal Office: ________________________________________________________________________
(Street and Number) (City, Village or Town)
_______________________________________________________________________________________________
(County) (State) (Zip) (Telephone Number)
Mailing Address: _________________________________________________________________________________
(If different from domicile)
Citizenship (check one): U.S.A.
Other (specify) __________________________
Interest (s) of Petitioner (s): [Check one]
Sole Beneficiary Residuary Beneficiary
Other [Specify] _____________________________________________________________________
1.(b) The proposed Administrator c.t.a. is is not an attorney.
[NOTE: An Administrator c.t.a. - Attorney must comply with Uniform Court Rule 207.16 (e). (See also
207.52)]
2. The will of the above-named decedent was admitted to probate by the Surrogate’s Court
of ___________________County on ______________________ and Letters Testamentary were issued to
_________________________________ , who on____________________________________________,
died resigned was removed.
CTA-1
-2-
3. The names and addresses of all persons and parties interested in this proceeding having a right
to letters of administration c.t.a. (with the will annexed) prior or equal to the petitioner under the provisions of SCPA §1418
and 1419, are as follows: [Furnish all information specified in NOTE below, if required]
Name_________________________ Domicile Address and______________________Description of Legacy, Devisee
Relationship______________________Mailing Address____________________________ or Other Interest, or Nature
of Fiduciary Status: _________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. The names and addresses of all persons and parties who are beneficiaries named in the will other than
those named in paragraph 3 above are as follows: [Furnish all information specified in NOTE below, if required]
Name_________________________ Domicile Address and______________________Description of Legacy, Devisee
Relationship______________________Mailing Address____________________________ or Other Interest, or Nature
of Fiduciary Status:__________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. There are no persons other than those hereinbefore mentioned interested in this proceeding.
6. There are no outstanding debts or funeral expenses, except: [If “NONE” so state]
7. (a) To the best of the knowledge of the undersigned, property of the estate remains unadministered as
follows:
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 $ _________________________________________________
(b) No other testamentary assets exist in New York State, nor does any cause of action exist on behalf of
the estate as follows: [Enter “NONE” or specify] _______________________________________________________
[NOTE: In the case of each infant, state (a) name, birth date, relationship to decedent, domicile and residence address,
and the person with whom he/she resides, (b) whether or not he/she has a court-appointed guardian (if not, so state), and
whether or not his/her father and/or mother is living, and (c) the name and residence address of any court-appointed guardian
and the information regarding such appointment. In the case of each other person under a disability, state (a) name,
relationship to decedent, and residence address, (b) facts regarding this disability including whether or not a committee,
conservator, guardian, or any other fiduciary has been appointed and whether or not he/she has been committed to any
institution, and (c) the names and addresses of any committee, person or institution having care and custody of him/her;
conservator; guardian; and any relative or friend having an interest in his/her welfare. In the case of a person confined as a
prisoner, state place of incarceration and list any person having an interest in his/her welfare.
Wherefore, petitioner (s) pray (s) (a) that process issue to all necessary parties and
(b) that letters issue as follows:
Letters of Administration c.t.a. to: ______________________________________________________
(c) [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)
-3-
COMBINED VERIFICATION, OATH & DESIGNATION
[For use when petitioner is to be appointed administrator c.t.a.]
STATE OF _________________ )
COUNTY OF _______________) SS.:
The undersigned, the petitioner named in the foregoing petition, being duly sworn says:
1. VERIFICATION: I have read the foregoing 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 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 the administrator c.t.a.. 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)
___________________________________
(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 sworn to such
instrument before me and duly acknowledge that he/she executed the same.
_______________________________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Signature of Attorney: ___________________________________________________________________________
Print Name: ___________________________________________________________________________________
Firm Name: ______________________________________________________ Tel. No.: __________________
Address of Attorney: ____________________________________________________________________________
-4-
COMBINED CORPORATE VERIFICATION, CONSENT AND DESIGNATION
[For use when a petitioner to be appointed is a bank or trust company]
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, say:
1. VERIFICATION: I have read the foregoing 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 Administrator c.t.a. of the decedent described in the
foregoing petition and consent to act as such 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 the ____________________________________________ , _________________ , 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 the he/she signed his/her name thereto by order of the Board of Directors of the corporation.
Notary Public ____________________________________________
Commission Expires:
(Affix Notary Stamp or Seal)
Signature of Attorney: _______________________________________________
Print Name: _______________________________________________
Firm Name: _______________________________________________ Tel. No.: ____________________
Address of Attorney: ______________________________________________________________________________
-5-
LETTERS OF ADMINISTRATION c.t.a. 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 ________________________________________________________________________
granting administration c.t.a. and directing that Letters of Administration c.t.a. issue to ___________________
_______________________________________________________________________________(State any
further relief requested)_____________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
HON. ______________________________
Dated, Attested and Sealed, Surrogate
, ___________ ___________________________________
(Seal Chief Clerk
________________________________________________________________________________________
Attorney for Petitioner Telephone Number
________________________________________________________________________________________
Address of Attorney
[Note: This citation 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.]
-6-
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF _______________________________
X
LETTERS OF ADMINISTRATION c.t.a.
WILL OF___________________________________________
a/k/a_______________________________________________
Deceased.
X
RENUNCIATION OF LETTERS OF
ADMINISTRATION c.t.a.
WAIVER OF PROCESS AND
CONSENT TO DISPENSE WITH BOND
File No. _______________________
The undersigned, ___________________________________ , a person interested in this estate as
a beneficiary with equal or prior right to receive letters
a beneficiary of the estate
a creditor
other (specify) _______________________________________________________
hereby personally appears in this proceeding in the Surrogate’s Court of __________________________
County and
1. Renounces all rights to Letters of Administration c.t.a.
2. Waives the issuance and service of citation in the above entitled proceeding.
3. Consents that Letters of Administration c.t.a. be granted by the Court
to_____________________ or any other person or persons entitled there to without any notice
whatsoever to the undersigned.
4. Consents to dispense with bond of the Administrator c.t.a. and if such consent be filed by some
but not all of the persons interested in the estate, specifically releases any claim under any bond that may be
required of such Administrator c.t.a.
________
Date
________________________________
Signature
____________________________
Street Address
____________________
Relationship
__________________________________________
Print Name
__________________________________________________
Town/State/Zip
STATE OF NEW YORK
COUNTY OF ______________________ ss.: ____________________________________________
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)
Name of Attorney: _______________________________________ Tel. No.:___________________
Address of Attorney: ____________________________________
CTA-3 (7/98)
-7-
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF ___________________________
________________________________________X
PROBATE PROCEEDING,
WILL OF _______________________________
a/k/a ___________________________________
Deceased.
________________________________________X
AFFIDAVIT OF NO DEBT
(For use with Letters of
Administration c.t.a.)
File No. ____________________________
STATE OF NEW YORK )
) ss.:
COUNTY OF ___________________________ )
___________________________________________________________________, being duly sworn, deposes and says that
he/she resides at ___________________________________________________, County of ___________________,
State of ___________________________________; that he/she is the person seeking appointment as administrator c.t.a. in the
above entitled proceeding; that the value of all personal property receivable by the fiduciary of the estate of the above-named
decedent plus estimated gross rents receivable by said fiduciary for 18 months will not exceed the sum of
$________________________; that deponent has made a diligent search to ascertain whether or nor there are any debts or claims
against the estate of said decedent and that there are no claims, including unpaid funeral and medical bills, except as follows:
[If “none”, write “NONE”] _______________
NAME ADDRESS NATURE OF CLAIM AMOUNT
______________________________________________________________________________________________________
______________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________
Sworn to be fore me this ____________ Signature
day of _________________, 20_______
____________________________
Print Name
________________________________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Name of Attorney____________________________________________ Tel. No.:______________________
Address of Attorney________________________________________________________________________
P-12 (10/96)
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Completed 22 October 2020

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