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For Office Use Only a/k/a File No. of (NYS Unified Court System Division of Technology)

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For Office Use Only
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DO NOT LEAVE ANY ITEMS BLANK
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF
-------------------------------------------------------------------------------X
ACCOUNTING BY
as the
of the ESTATE OF
a/k/a
Deceased.
-------------------------------------------------------------------------------X
PETITION FOR JUDICIAL
SETTLEMENT OF ACCOUNT OF
[ ] Executor
[ ] Adm inistrator
[ ] Trustee
[ ] Other [specify]
File No.
TO THE SURROGATE’S COURT, COUNTY OF
It is respectfully alleged:
1. The name(s), and address(es) of the petitioner(s), the type and date of letters issued, and the
amount and surety of petitioner’s (s’) bond, if any, are as follows:
Name:
Address:
(Street Address) (City/Town/Village)
(County) (State) (Zip) (Telephone Number)
Mailing address:
(if different from above)
Type of letters issued: Date letters issued:
Amount of bond: $ Name of surety:
Name:
Address:
(Street Address) (City/Town/Village)
(County) (State) (Zip) (Telephone Number)
Mailing address:
(if different from above)
Type of letters issued: Date letters issued:
JA-1 (4/98)
-1-
2. The decedent’s nam e, date of death and dom icile are as follows:
Name: Date of death:
Domicile:
(Street Address) (City/Town/Village)
(State) (Zip Code)
Township of: County of:
3. The petitioner(s) present (s) and render (s) herewith, a verified account of petitioner’s (s’) proceedings in this
estate or trust, for the period from to , showing the gross value
of assets, including principal and incom e, to be the sum of $ .
4. [ ] (a) An order was entered in this Court on , 20 .
[ ] Exempting the estate from tax
[ ] Fixing and assessing the tax due
[Attach a copy of the tax order and receipt]
[ ] (b) The following return (s) (was) (were) filed:
[ ] ET-90 [For decedent’s dying on or after May 25, 1990].
A copy was filed with the Surrogate’s Court [ ] Yes [ ] No
[ ] TT-385 [For decedent’s dying before May 25, 1990]
[ ] 706 or 706NA
The estate taxes with respect to this estate were paid in full.
[Attach a copy of letter of discharge.]
[ ] (c.) No tax proceeding or return was required for this estate.
5. The rendering of such account at this tim e is proper because
check appropriate reason]
[ ] seven months have elapsed since letters were issued to petitioner(s);
[ ] letters issued to the petitioner(s) have been revoked,
[ ] more than one year has elapsed since the preceding account of the petitioner(s)
was settled;
[ ] other reason [specify]:
6. The names and post-office addresses of all persons and parties interested in this proceeding who are required to
be cited under the provisions of Surrogate’s Court Procedure Act §2210, or otherwise, or concerning whom or
which the Court is required to have information, are set forth in subdivision (a) or (b):
(a) All persons and parties so interested herein who are of full age and sound m ind, or which are
corporations or associations, are as follows:
-2-
Name Nature of Interest P.O. Address
____________________________ _____________________________ _____________________________
____________________________ _____________________________ _____________________________
____________________________ _____________________________ _____________________________
____________________________ _____________________________ _____________________________
____________________________ _____________________________ _____________________________
(b) All persons so interested herein who are infants or incompetents or persons believed to be
mentally incapable to adequately protect their rights, or persons whose existence, identity, or
whereabouts are unknown (including persons who are virtually represented under SCPA §315)
are as follows:
[Furnish all information specified in NOTE at bottom of page]
Name Nature of Interest P.O. Address
____________________________ _________________________ __________________________
____________________________ _________________________ __________________________
____________________________ _________________________ __________________________
____________________________ _________________________ __________________________
____________________________ _________________________ __________________________
[NOTE: In the case of each infant, state (a) name, birth date, age, nature of interest, domicile, residence address,
and the person with whom he/she resides; (b) whether or not he/she has a guardian or testamentary guardian,
and whether or not his/her father, or if he/she be dead, his/her mother is living; and (c) the nam e and post office
address of any guardian and any living parent. In the case of each incompetent or person incapable of adequately
protecting his/her rights, state (a) name, nature of interest, and post office address; (b) facts regarding his/her
incompetency, including whether or not a committee has been appointed and whether or not he/she has been
committed at any institution; (c) the nam es and post office addresses of any committee, conservator, guardian,
and person or institution having care and custody of him/her, and any relative or friend having an interest in his/her
welfare. In the case of unknow ns, describe in identical language to be used in citation for publication. In the case
of a person confined as a prisoner, state place of incarceration. W ith respect to virtual representation see Uniform
Court Rule, §207.18.]
7. There are no persons interested in this proceeding other than those herein about mentioned.
8. No prior application has been m ade to this or any other court for the relief requested in this
petition.
W HEREFORE the petitioner(s) pray (s) that the account of proceedings be judicially settled
-3-
[specify any other relief requested.]
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
and that process be issued to all necessary parties who have not appeared to show cause why the relief requested should
not be granted; and that an order be granted directing the service of process pursuant to the provisions of SCPA Article 3
upon such persons nam ed in Paragraph (6) whose nam es or whereabouts are unknown and cannot be ascertained or
who m ay be persons on whom service by personal delivery cannot be made.
Dated:
1.
(Signature of Petitioner)
2.
(Signature of Petitioner)
(Print Nam e)
(Print Name)
3.
(Nam e of Corporate Petitioner)
(Signature of Officer)
(Print Nam e and Title of Officer)
-4-
VERIFICATION
[For use when petitioner is an individual]
STATE OF NEW YORK )
COUNTY OF ) ss.:
The undersigned, the petitioner (s), named in the foregoing petition, being duly sworn, say (s): (I) (W e) have read the
foregoing petition subscribed by m e (us) and know the contents thereof, and the sam e is true of (m y) (our) own knowledge,
except as to the m atters therein stated to be alleged upon information and belief, and as to those matters (I) (we) believe it
to be true.
(Signature of Petitioner)
(Print Nam e)
(Signature of Petitioner)
(Print Nam e)
Sworn to before m e on
, 20
Notary Public
Commission Expires:
(Affix Notary Stam p or Seal)
Signature of Attorney:
Print Nam e:
Name of Attorney: Tel. No.:
Address of Attorney:
-5-
VERIFICATION
[For use when petitioner is a bank or trust com pany]
STATE OF NEW YORK )
COUNTY OF ) ss.:
I, the undersigned, a of
(Title)
(Name of Bank or Trust Com pany)
being duly sworn, say (s),
I have read the foregoing petition subscribed by me and know the contents thereof, and the sam e is true of my own
knowledge, except as to the m atters stated to be alleged upon information and belief, and as to those matters I believe it to
be true.
(Name of Bank or Trust)
BY
(Signature of Officer)
(Print Nam e and Title)
Sworn to before m e on
, 20
Notary Public
Commission Expires:
(Affix Notary Stam p or Seal)
Signature of Attorney:
Print Nam e:
Name of Attorney: Tel. No.:
Address of Attorney:
-6-
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF
------------------------------------------------------------------------------X
ACCOUNTING BY ________________________________ RECEIPT AND RELEASE
File No.
as the
of the ESTATE OF ________________________________
a/k/a ___________________________________________
Deceased.
------------------------------------------------------------------------------X
The undersigned, being of full age, sound m ind and under no disability, and entitled to share in the estate of the above
nam ed decedent as a [check one] [ ] legatee under a will, [ ] distributee of an intestate share, [ ] trust beneficiary,
[ ] creditor of the estate, [ ] other [specify]
(a) Acknowledges that each fiduciary named above has fully and satisfactorily accounted for all assets of the
estate;
(b) Approves the written account verified on , 20 as
submitted to the undersigned;
[Delete paragraphs (a) and (b) if the undersigned is not interested in or affected by the am ount of the residuary
estate or trust, or if being m ade pursuant to a decree of the court.]
(c) Acknowledges receipt of m oney paid or property transferred or delivered as follows:
money (cash or check): $
the following property: valued at $
The following payment and/or transfer is in full payment or distribution of :
[ ] a legacy under Paragraph/Article of the will or trust;
[ ] a claim against the estate;
[ ] the am ount directed to be paid by a decree of this court dated:
[ ] other [specify]:
(d) Releases and discharges each fiduciary named above from all liability to the undersigned for any and all
matters relating to or derived from the adm inistration of the estate; waives the issuance and service of a
citation to attend any and all proceedings for the judicial settlement of the account; and authorizes the
Surrogate to m ake and enter a decree settling the account and fully releasing and discharging each fiduciary
nam ed above as to all matters embraced therein.
Dated:
(Signature) (Corporate Name)
(Print Nam e) (Signature of Officer)
JA-2 (12/96)
-7-
STATE OF NEW YORK )
COUNTY OF_____________________ ) ss.:
On , 20 , before m e personally appeared
[INDIVIDUAL]
[ ] to m e known and known to me to be the person
described in and who executed the foregoing receipt and release and duly acknowledged the execution thereof.
[CORPORATION]
[ ] to me known, who duly swore to the foregoing instrum ent 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 instrum ent; and that he/she signed his/her
nam e thereto by order of the Board of Directors of the corporation.
Notary Public
Commission Expires:
(Affix Notary Stam p or Seal)
Name of Attorney: Tel. No.:
Address of Attorney:
-8-
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF
------------------------------------------------------------------------------X
ACCOUNTING BY _______________________________
W AIVER OF CITATION AND CONSENT
IN ACCOUNTING
as the _________________________________________
File No.
of the ESTATE OF _______________________________
a/k/a __________________________________________
Deceased.
------------------------------------------------------------------------------X
The undersigned, being of full age, and sound m ind, 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 subm ission 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 , 20 , before m e personally appeared
[INDIVIDUAL]
to m e known and known to me to be the person described in and who executed
the foregoing waiver and consent and duly acknowledged the execution thereof.
[CORPORATION]
to m e 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 instrum ent; and that he/she signed his/her
nam e by order of the Board of Directors of the corporation.
Notary Public
Commission Expires:
(Affix Notary Stam p or 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)
-9-
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF
----------------------------------------------------------------------------X
ACCOUNTING BY _______________________________ ACCOUNTING BY:
as the ________________________________________ [ ] Executor with Trust
[ ] Trustee
of the ESTATE OF _______________________________ [ ] Other [Specify]
a/k/a __________________________________________ File No.
Deceased.
-----------------------------------------------------------------------------X
TO THE SURROGATE’S COURT OF THE COUNTY OF
The undersigned does hereby render the account of proceedings as follows:
Period of account from to . This is a
[ ] (final) [ ] (interm ediate) account.
[The instructions concerning the schedules need not be stated at the head of each schedule. It will be sufficient to
set forth only the schedule letter and heading. For convenience of reference, the schedule letter and page number of the
schedule should be shown at the bottom of each sheet of the account.]
PRINCIPAL
Schedule A - Principal Received, page
Schedule A - 1 - Realized Increases, page
Schedule B - Realized Decreases, page
Schedule C - Funeral and Administration Expenses and Taxes, page
Schedule C - 1 - Unpaid Administration Expenses, page
Schedule D
- Creditor’s Claim s, page [Does not apply in a trustee’s account]
Schedule E - Distributions of Principal, page
Schedule F - New Investm ents, Exchanges and Stock Distribution, page
Schedule G - Principal remaining on Hand, page
Schedule A-2
INCOME
- Income Collected, page
Schedule C-2 - Adm inistration, Expenses Chargeable to Incom e, page
Schedule E-1 - Distributions of Incom e, page
Schedule G-1 - Incom e Remaining on Hand, page
Schedule H - Interested Parties, page
Schedule I - Com putation of Commissions, page
Schedule J - Other Pertinent Facts and Cash Reconciliation, page
Schedule K - Estate Taxes Paid and Allocation of Estate Taxes, page
JA-4 (6/98)
-10-
SUM M ARY
PRINCIPAL ACCOUNT
CHARGES:
Schedule “A” - (Principal received) $
Schedule “A - 1” - (Realized increases in principal) $
Total principal charges $
CREDITS:
Schedule “B” - (Realized decreases in principal) $
Schedule “C” - (Funeral and adm inistration expenses) $
Schedule “D" - (Creditor’s claims actually paid)
[Does not apply in trustee’s account]
$
Schedule “E” - (Distributions of principal) $
Total principal credits $
Principal balance on hand shown by Schedule “G” $
INCOME ACCOUNT
CHARGES:
Schedule “A-2" - (Income collected) $
Total incom e charges $
CREDITS
Schedule “C-2" - (Administration expenses) $
Schedule “E-1" - (Distributions of Income) $
Total incom e credits $
Balance of undistributed income rem aining on hand as shown in Schedule “G-1" $
-11-
COMBINED ACCOUNTS
Principal on hand Cash $
Other Property $
Total $
Income on hand: Cash $
Other Property $
Total $
Total on hand as of ___________________, 20____ $
The foregoing principal balance of $ consists of $ in cash and
$ in other property on hand as of the day of ______________, 20 . It is subject to
deduction of estimated principal commissions amounting to $ as shown in Schedule I, and to the proper
charge to principal of expenses of this accounting.
The foregoing incom e balance of $ consists of $ in cash and
$ in other property on hand as of the day of ____________, 20 . It is subject to
deduction of estim ated income com m issions am ounting to $ as shown in Schedule I, and to the proper
charge to income expenses of this accounting.
The attached schedules are part of this account.
(Name of Corporate Fiduciary)
(Signature of Fiduciary)
(Signature of Officer)
(Signature of Fiduciary)
-12-
AFFIDAVIT OF ACCOUNTING PARTY
STATE OF NEW YORK )
COUNTY OF ) ss.:
being duly sworn, says: that the schedules of assets of the estate
reported herein are true and complete and include all money and property of any kind, and all increment thereon, which have
com e into the hands of any of the accounting parties or have been received by any other persons for the use of any accounting
party by order of authority of such accounting party, and include all indebtedness due by any accounting party to the estate
whether discharged or not; that the m oneys stated in the account as collected were all that could be collected; that all claim s
for credit for losses or decreases of value of assets are correctly reported; that the reported payments out of estate assets for
funeral and administration expenses were actually m ade and m ade in the am ounts scheduled; that the reported payments to
creditors and beneficiaries were actually made at the dates and in the amounts scheduled; that no paym ents have been made
by any accounting party on any fiduciary’s claim s against the estate except after prior approval and allowance by the Surrogate;
that all receipts and disbursements are correctly and fully reported and scheduled; that the accounting parties do not know of
any error in the account or in any schedule thereof or of any matter or thing relating to the estate om itted therefrom to the
prejudice of rights of any creditor or of any person interested in the estate; and that the schedule of commissions has been
com puted in conformity with the statute regulating commissions and the Rules of the Surrogate’s Court applicable thereto.
Sworn to before m e on
, 20
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Signature
Print Name
Signature of Attorney: Tel. No.:
Address of Attorney:
-13-
INSTRUCTIONS
PRINCIPAL
Schedule A
Statement of Principal Received
This schedule m ust contain an itemized statement of all the moneys and other personal property constituting principal
for which each accounting party is charged, together with the date of receipt or acquisition of such money or property. If real
property has been sold by the fiduciary, this schedule m ust set forth the proceeds of sale of such property, including a copy
of the closing statem ent.
Schedule A-1
Statement of Increases on Sales, Liquidation or Distribution
This schedule must contain a full and complete statement of all realized increases derived from principal assets
whether due to sale, liquidation, or distribution or any other reason. It should also show realized increases on new investments
or exchanges. In each instance, the date of realization of the increase must be shown and the property from which the
increase was derived must be identified.
Schedule B
Statement of Decreases Due to Sales, Liquidation, Collection, Distribution or
Uncollectibility
This schedule must contain a full and com plete statem ent of all realized decreases on principal assets whether due
to sale, liquidation, collection or distribution, or any other reason. It should show decreases on new investm ents or exchanges
and also sales, liquidations or distributions that result in neither gain nor loss. In each instance, the date of realization of the
decrease must be shown and the property from which the decrease was incurred must be identified. It should also report any
asset which the fiduciary intends to abandon as worthless, together with a full statem ent of the reasons for abandoning it.
Schedule C
Statement of Funeral and Administration Expenses and Taxes Charged to Principal
This schedule must contain an item ized statement of all moneys chargeable and paid for funeral, adm inistration and
other necessary expenses, together with the date and the reason for each expenditure. Consolidate all similar expenditures;
i.e. funeral expenses, taxes, accountant fees, legal fees, filing fees, commissions, other. W here the will directs that all
inheritance and death taxes are to be paid out of the estate, credit for paym ent of the same should be taken in this schedule.
Schedule C-1
Statement of Unpaid Administration Expenses
This schedule must contain an itemized statement of all unpaid claim s for adm inistration and other necessary
expenses, together with a statement of the basis for each such claim .
Schedule D
Statement of All Creditor’s Claim s
This schedule must contain an itemized statement of all creditor’s claims subdivided to show:
1. Claims presented, allowed, paid and credited and appearing in the Summary Statement together with the date
of payment.
2. Claims presented and allowed but not paid.
3. Claims presented but rejected, and the date of and the reason for such rejection.
4. Contingent and possible claim s.
5. Personal claim s requiring approval by the court pursuant to SCPA §1805.
In the event of insolvency, preference of various claims should be stated, with the order of their priority.
-14-
Schedule E
Statement of Distributions of Principal
This schedule must contain an itemized statement of all m oneys paid and all property delivered from principal to the
beneficiaries, legatees, trustees, surviving spouse or distributees of the deceased, the date of paym ent or delivery thereof, and
the name of the person to whom paym ent or delivery was actually made.
W here estate taxes are required to be apportioned and paym ents have been m ade on account of the taxes, the
amounts apportioned in Schedule K against beneficiaries of the estate shall be charged against the respective individuals
share.
Schedule F
Statement of New Investm ents, Exchanges and Stock Distributions
This schedule m ust contain an itemized statem ent of (a) all new investments m ade by the fiduciary with the date of
acquisition and cost of all property purchased, (b) all exchanges m ade by the fiduciary, specifying dates and items received
and items surrendered, and (c) all stock dividends, stock splits, right and warrants received by the fiduciary, showing the
securities to which each relates and their allocation as between principal and incom e.
Schedule G
Statement of Principal Rem aining on Hand
This schedule m ust contain an itemized statement showing all property constituting principal remaining on hand
including a statement of all uncollected receivables and property rights due to the estate. Show the date and cost of all
such property that was acquired by purchase, exchange or transfers m ade or received, together with the date of
acquisition and the cost thereof and indicate such sums in the appropriate lines of the summary schedule. Show all
unrealized increases and decreases relating to assets on hand, and report the sam e in the appropriate places in the
sum m ary schedule.
INCOME
Schedule A-2
Statement of All Incom e Collected
This schedule m ust contain a full and com plete statement of all interest, dividends, rents and other incom e
received, and the date of each receipt. Each receipt must be separately accounted for and identified, except that where a
security had been held for an entire year, the interest or ordinary dividends may be reported on a calendar year basis.
Schedule C-2
Statement of Adm inistration Expenses Charged to Incom e
This schedule m ust contain an itemized statement of all m oneys chargeable to income and paid for administration,
maintenance and other expenses, together with the date and reason for each such expenditure.
Schedule E-1
Statement of Distribution of Incom e
This schedule m ust contain an itemized statement of all m oneys paid and of property delivered out of incom e to
the beneficiaries, the date of payment or delivery thereof and the name of the person to whom paym ent or delivery was
actually m ade. If convenient, distributions of incom e to any one beneficiary may be reported by the calendar year.
-15-
Schedule G-1
Statement of Incom e on Hand
This schedule m ust contain a statem ent showing all undistributed income.
Schedule H
Statement of Interested Parties
This schedule must contain the names of all persons entitled as beneficiary, legatee, devisee, trustee, surviving
spouse, distributee, unpaid creditor or otherwise to a share of the estate or fund, with their post office addresses and the
degree of relationship, if any, of each to the deceased, and a statement showing the nature of and the value or approxim ate
value of the interest of each such person.
This schedule also m ust contain a statement that the records of this court have been searched for powers of attorney
and assignments and encum brances made and executed by any of the persons interested in or entitled to a share of the estate
and a list detailing each power of attorney, assignment and encumbrance, disclosed by such search, with the date of its
recording and the name and address of each attorney in fact and of each assignee and of each person beneficially interested
under the encum brance to in the respective instrum ents, and also whether the accounting party had any knowledge of the
execution of any such power of attorney or assignm ent not so filed and recorded.
Schedule I
Statement of Computation of Com m issions
This schedule m ust contain a computation of the amount of commissions due upon this accounting. See Uniform
Court Rule, §207.40 (d).
Schedule J
Statement of Other Pertinent Facts, and Cash Reconciliation
This schedule must contain a statement of all other pertinent facts affecting the administration of the estate and the
rights of those interested therein. It must also contain a statement of any real property left by the decedent that it is not
necessary to include as an estate asset to be accounted for, a brief description thereof, its gross value, and the am ount of
mortgages or liens thereon at the date of death of the deceased. A cash reconciliation must also be set forth in this schedule
so that verification with bank statements and cash on hand m ay be readily m ade.
Schedule K
Statement of Estate Taxes Paid and Allocation Thereof
This schedule m ust contain a statement showing all estate taxes assessed and paid with respect to any property
required to be included in the gross estate of the decedent under the provisions of the Tax Law or under the laws of the United
States. This schedule must also contain a com putation setting forth the proposed allocation of taxes paid and to be paid and
the am ounts due the estate from each person in whose behalf a tax payment has been made and also the proportionate
amount of the tax paid by each of the nam ed persons interested in this estate or charged against their respective interest, as
provided in §2-1.8 of the Estates, Powers and Trusts Law.
W here an allocation of taxes is required, the m ethod of computing the allocation of said taxes m ust be shown in
this schedule.
-16-
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF
----------------------------------------------------------------------------X
ACCOUNTING BY _______________________________
FINAL/INTERMEDIATE
as the _________________________________________ DECREE OF JUDICIAL SETTLEMENT
EXECUTOR W ITH TRUST OR TRUSTEE
of the ESTATE OF _____________________________
File No.
a/k/a __________________________________________
Deceased.
----------------------------------------------------------------------------X
A petition praying for a decree judicially settling the final/intermediate account having been presented and filed in this
court and the tim e to present claims against the estate having expired, and a citation having been issued directed to all persons
interested in this proceeding requiring them to show cause why a decree should not be granted judicially settling the account
prayed for in the petition, and the citation having been returned with proof of due service thereof on the following:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
and duly executed waivers of the service of citation or receipts and releases having been filed for the following:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
and the following parties having appeared in answer to the citation:
_________________________________________________________________________________________________
and attorneys, having appeared for the petitioner, and there being no
other appearances; and the Surrogate having appointed as guardian ad litem for the following
persons under a disability:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
and each guardian ad litem having filed a report recommending that the account be judicially settled and no objection having
been filed to the account;
and it appearing that all tax returns required by law have been filed and all New York State estate taxes have been fully paid,
provision m ade therefore, or the estate is exem pt from tax; and the Surrogate having examined the account and having found
that each petitioner has fully accounted for all of the monies and property of the estate that have com e into the petitioner’s
hands for the period of the account, as adjusted, it is
ORDERED, ADJUDGED AND DECREED, that the final/interm ediate account be and the same hereby is judicially
settled and allowed as filed (and adjusted), and that the following is a summary thereof as settled:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________
JA-5 (12/96)
-17-
SUM M ARY
PRINCIPAL ACCOUNT
CHARGES:
Schedule “A” - (Principal received) $
Schedule “A - 1” - (Realized increases in principal) $
Total Principal Charges $
CREDITS:
Schedule “B” - (Realized decreases in principal) $
Schedule “C” - (Funeral and adm inistration expenses) $
Schedule “D" - (Creditor’s claims actually paid)
[Does not apply in a trustee’s account]
$
Schedule “E” - (Distributions of principal) $
Total Principal Credits $
Principal balance on hand shown by Schedule “G” $
INCOME ACCOUNT
CHARGES:
Schedule “A-2" - (Income collected) $
Total incom e charges $ _____________ ____
CREDITS
Schedule “C-2" - (Administration expenses) $
Schedule “E-1" - (Distributions of Income) $
Total incom e credits $
Balance of undistributed income rem aining on hand as shown in Schedule “G-1" $
COMBINED ACCOUNTS
Principal on hand Cash $
Other Property $
Total
-18-
$
Income on hand: Cash $
Other Property $
Total $
Total on hand as of ___________________, 20____ $
and it is further
ORDERED, ADJUDGED AND DECREED, that petitioner(s) pay the rem aining cash and transfer, assign and deliver
the other rem aining assets as shown in the account as follows:
To the petitioner:
as and for commissions the sum of $
To the petitioner:
as and for commissions the sum of $
To the attorney:
for legal services rendered for
the benefit of the estate the sum of $
and for costs and disbursem ents
(which sums are in addition to any paym ents
made on account and allowed by the court) $
To the guardian ad litem:
for services as guardian ad litem $
and it is further
ORDERED, ADJUDGED AND DECREED, that the balance rem aining on hand in the amount
of $ be paid as follows:
To $
To $
To $
ORDERED, ADJUDGED AND DECREED, that upon com plying with the directions of this decree and the filing of
the receipts for the paym ents herein directed, the petitioner (s) hereby shall be discharged as to all m atters and things
contained in this accounting and decree.
Dated:
Judge of the Surrogate’s Court
-19-
ACCOUNTING 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 and an account having been duly filed by , whose address is
YOU ARE HEREBY CITED TO SHOW CAUSE before the Surrogate’s Court, County,
at , New York, on __________________________20 , at o’clock in the
noon of that day, why the account of _____________________________, a sum m ary of which has been served herewith,
as , of the estate of _____________________________should not be judicially settled.
[State any further relief requested]
HON.
Dated, Attested and Sealed, Surrogate
, 20
(Seal) Chief Clerk
Name of Attorney: Tel. No.:
Address of Attorney:
[Note: This citation is served upon you as required by law. You are not required to appear; however, 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, and you or your
attorney m ay request a copy of the full account from the petitioner or petitioner’s attorney.]
JA-6 (12/96) -20-
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Completed 14 December 2020

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