Fillable For Office Use Only PETITION FOR ANCILLARY Ancillary (NYS Unified Court System Division of Technology)

Fill Online, Printable, Fillable, Blank For Office Use Only PETITION FOR ANCILLARY Ancillary (NYS Unified Court System Division of Technology) Form

Use Fill to complete blank online NYS UNIFIED COURT SYSTEM DIVISION OF TECHNOLOGY (NY) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

For Office Use Only PETITION FOR ANCILLARY Ancillary (NYS Unified Court System Division of Technology)

On average this form takes 52 minutes to complete

The For Office Use Only PETITION FOR ANCILLARY Ancillary (NYS Unified Court System Division of Technology) form is 8 pages long and contains:

  • 0 signatures
  • 16 check-boxes
  • 199 other fields

Country of origin: US
File type: PDF

U.S.A. forms for NYS Unified Court System Division of Technology

BROWSE NYS UNIFIED COURT SYSTEM DIVISION OF TECHNOLOGY (NY) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
-1-
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
ANCILLARY ADMINISTRATION PROCEEDING,
ESTATE OF __________________________________
a/k/a ________________________________________
a domiciliary of the State of ______________________
Deceased.
------------------------------------------------------------------------------ X
PETITION FOR ANCILLARY
LETTERS OF ADMINISTRATION
SCPA ARTICLE 16
Ancillary Letters of Administration
Ancillary Letters of Administration d.b.n.
File No.___________________________
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 principal 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]
Administrator Distributee of decedent [State relationship] ____________________
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:_____________________________________________________________________
AA-1 (4/98)
-2-
3. The decedent died INTESTATE, leaving no will.
On the _____________________________________________, letters were issued to ____________________________
by _________________________________ Court, State of _________________________________________, being a
competent court of the state of the domicile of decedent having jurisdiction thereof, and the amount of the security given
on the original appointment was $________________________.
[If additional space is needed in Paragraph 4, 5 and 6, attach addendum.]
4. (a) The estimated gross value of decedent’s property in the State of New York, consisting of real property and
personal property, is described and valued as follows: [list items and described briefly, giving location. If space is
insufficient, attach 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 assets exits 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 decree and the letters issued, it any, are submitted as part of this petition.
5. The names, addresses and interests of all persons entitled [ (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 § 1607] are as follows:
Name Address
Nature of Interest
or Amount of Claim
New York State Department of
Taxation and Finance Albany, New York
AA-1 (4/98)
-3-
6. The name and address of each domiciliary distributee having an interest in the property in this state is as
follows:
(a) Each distributee who is of full age and sound mind or which is a corporation of association:
Name Address Interest
(b) Each distributee who is an infant or otherwise under a disability: [State disability and see
SCPA § 304 (3) ]
Name Address Interest
Disability:
Disability:
7. There are no persons interested in this proceeding other than those hereinbefore mentioned. No previous
application for ancillary administration with or without ancillary letters has been made, except _______________________
_________________________________________________________________________________________________
WHEREFORE, petitioner (s) pray (s) (a) that process issue to all necessary parties and (b) that ancillary letters
issue thereon as follows:
Ancillary Letters of Administration to:_____________________________________________________________
___________________________________________________________________________________________
Ancillary Letters of Administration d.b.n. to:________________________________________________________
___________________________________________________________________________________________
(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)
AA-1 (4/98)
-4-
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF ____________________________________
------------------------------------------------------------------------------ X
ANCILLARY ADMINISTRATION PROCEEDING,
ESTATE OF ____________________________________
a/k/a __________________________________________
a domiciliary of the State of ________________________
Deceased.
------------------------------------------------------------------------------ X
COMBINED VERIFICATION,
OATH AND DESIGNATION
File No._______________________________
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 ANCILLARY Administrator Administrator d.b.n.: 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
administrator/administrator d.b.n.. 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:________________________________________________________________________
AA-1 (4/98)
-5-
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF ___________________________________
------------------------------------------------------------------------------ X
ANCILLARY ADMINISTRATION PROCEEDING,
ESTATE OF ___________________________________
a/k/a _________________________________________
a domiciliary of the State of _______________________
Deceased.
------------------------------------------------------------------------------ X
COMBINED CORPORATE VERIFICATION,
CONSENT AND DESIGNATION
File No._______________________________
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 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 Ancillary Administrator
Ancillary Administrator d.b.n. 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 ___________________________________, before me personally came ________________________________
to me known, who duly swore to the foregoing instrument and who did say that he/she resides at ______________________
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 or Seal)
Signature of New York Attorney:_______________________________________________________________________
Print Name of New York Attorney:______________________________________________________________________
Firm Name:__________________________________________________________ Tel No.:_______________________
Address of New York Attorney: ________________________________________________________________________
AA-1 (4/98)
ANCILLARY ADMINISTRATION 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 on the __________________ noon of that day, why a decree should not be made in the estate
of __________________________________________________________________________________________________
lately domiciled at ___________________________________________________________________________________
granting ancillary administration and directing that
Ancillary Letters of Administration issue to:______________________________________________________
Ancillary Letters of Administration d.b.n. issue to: _________________________________________________
(State any further relief requested)
Dated, Attested and Sealed, Hon. ________________________________________________
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 request. You have a right to have an attorney appear for you.)
AA-2 (12/97)
-1-
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF____________________________________
------------------------------------------------------------------------------ X
ANCILLARY ADMINISTRATION PROCEEDING,
ESTATE OF ____________________________________
a/k/a __________________________________________
a domiciliary of the State of ________________________
Deceased.
------------------------------------------------------------------------------ X
NOTICE OF APPLICATION FOR
ANCILLARY LETTERS OF ADMINISTRATION
File No. __________________
Notice is hereby given that:
1. An application for ancillary letters of administration upon the estate of _____________________________________, deceased,
domiciled at _________________________________________________________________________________________________
State of______________________________ has been offered for ancillary administration in the Surrogate’s Court for the County of
___________________________________.
2. Each and every name of the intestate decedent know to the undersigned is as indicated in the above caption.
3. Petitioner prays that a decree be made directing the issuance of Ancillary Letters of Administration Ancillary Letters of
Administration d.b.n. to:
___________________________________________________________________________________________________________
4. The name and post office address of each and every distributee of the above-named decedent, as set forth in Paragraph 6 of the petition
and known to the undersigned, is/are as follows:
NAME OF DISTRIBUTEE DOMICILE AND POST OFFICE ADDRESS
(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: __________________________________________________________________________________
AA-3 (12/97)
-2-
NAME OF DISTRIBUTEE DOMICILE AND POST OFFICE ADDRESS
AFFIDAVIT OF MAILING NOTICE OF ANCILLARY ADMINISTRATION
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 Application for Ancillary
Letters of Administration contained in a securely closed postpaid wrapper directed to each of the persons named in said notice at the
places set opposite their respective names.
__________________________________________________
Sworn to before me this ____________________
day of __________________________________
Signature
_________________________________________________
Print Name
________________________________________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Name of New York Attorney: _________________________________________ Tel. No.:___________________________________
Address of New York Attorney: __________________________________________________________________________________
AA-3 (12/97)
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

For Office Use Only PETITION FOR ANCILLARY Ancillary (NYS Unified Court System Division of Technology)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 5 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document