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Filling Fee Paid $ Certs $ Certs $ SURROGATE’S COURT OF THE STATE OF NEW YORK $ Bond, Fee: $ COUNTY OF Receipt No: No: X PROBATE PROCEEDING, PETITION FOR PROBATE AND: WILL OF: □ Letters Testamentary a/k/a □ Letters of Trusteeship □ Letters of Administration c.t.a. □ Temporary Administration Deceased X 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 are as follows: Name: (First) (Middle) (Last) 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 □ Other (Specify) 1. (b) The proposed Executor □ is □ is not an attorney. [NOTE: A sole Executor-Attorney must comply with 22 NYCRR 207.16(e)] 1. (c) The proposed Executor □ is □ is not the attorney-draftsperson, a then-affiliated attorney or employee thereof. [NOTE: An attorney-draftsperson, a then-affiliated attorney or employee thereof must comply with SCPA 2307-a] 1. (d) The proposed Executor □ is □ is not a convicted felon nor is he/she otherwise ineligible, pursuant t\ o SCPA 707 to receive letters.If the proposed Executor is a convicted felon, submit a copy of the Certificate of Relief from Civil Disabilities. 2. The name, domicile, date and place of death, and national citizenship of\ the above-named decedent as follows: (a) Name: (b) Date of death (c) Place of death (d) Domicile: Street City, Town, Village County State (e) Citizen of: 3. The Last Will, herewith presented, relates to both real and personal pro\ perty and consists of an instrument or instruments dated as shown below and signed at the end the\ reof by the decedent and the following attesting witnesses: (Date of Will) (Names of All Witnesses to Will) (Date of Codicil) (Names of All Witnesses to Codicil) (Date of Codicil) (Names of All Witnesses to Codicil) 4. No other will or codicil of the decedent is on file in this Surrogate’s Court, and upon information and belief, after a diligent search and inquiry, including a search of any safe deposit box, there exists no will, codi\ cil or other testamentary instrument of the decedent later in date to any of the inst\ ruments mentioned in Paragraph 3 except as follows: [Enter “NONE” or specify] 5. The decedent was survived by distributees classified as follows: [Information is required only as to those classes of surviving relatives who would take the property of dece\ dent pursuant to EPTL 4-1.1 and 4-1.2. State the number of survivors in each class. Insert “ NO ” in all prior classes. Insert “ X” in all subsequent classes]. a. □ Spouse (husband/wife). b. □ Child or children and/or issue of predeceased child or children. [Must include marital, nonmarital, adopted, or adopted-out of child unde\ r DRL Section 117] c. □ Mother/Father. d. □ Sisters and/or brothers, either of the whole or half blood, and issue of\ predeceased sisters and/or brothers (nieces/nephews, etc.) e. □ Grandparents. [Include maternal and paternal] f. □ Aunts and/or uncles, and children of predeceased aunts and/or uncles (first cousins). [Include maternal and paternal] g. □ First cousins once removed (children of predeceased first cousins). [Include maternal and paternal] 6. The names, relationships, domicile and addresses of all distributees (u\ nder EPTL 4-1.1 and 4-1.2), of each person designated in the Will herewith presented as primary executo\ r, of all persons adversely affected by the purported exercise by such Will of any power of appointment, of all pers\ ons adversely affected by any codicil and of all persons having an interest under any other will of the decedent on file in the Surrogate’s Court, are hereinafter set forth in subdivisions (a) and (b). [If the propounded will purports to revoke or modify an inter vivos trus\ t or any other testamentary substitute, list the names, relationships, domicile and addresses of the trustee and beneficiaries affected by the will in subparagraphs (a) and (b) below. Submit trust agreement ] (a) All persons and parties so interested who are of full age and sound mind\ or which are corporations or associations, are as follows: Name and Relationship Domicile Address and Mailing Address Description of Legacy, Devise or Other Interest, or Nature of Fiduciary Status (b) All persons so interested who are persons under disability, are as follows: [Furnish all information specified in NOTE following 7b] Name and Relationship Domicile Address and Mailing Address Description of Legacy, Devise or Other Interest, or Nature of Fiduciary Status 7. (a) The names and domiciliary of all substitute or successor executors and o\ f all trustees, guardians, legatees, devisees, and other beneficiaries named in the Will and/or trustees and beneficiaries of any inter vivos trust designated in the propounded Will other than those named in Paragraph 6 \ herewith are as follows: Name and Relationship Domicile Address and Mailing Address Description of Legacy, Devise or Other Interest, or Nature of Fiduciary Status (b) All such legatees, devisees and other beneficiaries who are persons under disability are as follows: [Furnish all information specified in NOTE below] Name and Relationship Domicile Address and Mailing Address Description of Legacy, Devise or Other Interest, or Nature of Fiduciary Status [NOTE: In the case of each infant, state (a) name, birth date, relatio\ nship 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 nam\ e 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 regar\ ding his 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 c\ ommittee, person or institution having care and custody of him/her, conservator, guardian, and any relative or friend having an interest in his/her wel\ fare. 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. In the case of unknowns, describe such person in the same language as will be u\ sed in the process.] 8. (a) No beneficiary under the propounded will, listed in Paragraph 6 or 7 above, had a confidential relationship to the decedent, such as attorney, accountant, doctor, or clergyperson, except: [Enter “NONE” or indicate the nature of the confidential relationship] . (b) No persons, corporations or associations are interested in this proceedi\ ng other than those mentioned above. 9. (a) To the best of the knowledge of the undersigned, the approximate total va\ lue of all property constituting the decedent’s gross testamentary estate is greater than $ but less than $ 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, except as follows: [Enter “NONE” or specify] 10. Upon information and belief, no other petition for the probate of any wi\ ll of the decedent or for letters of administration of the decedent’s estate has heretofore been filed in any court. WHEREFORE your petitioner (s) pray (s) that process be issued to all\ necessary parties to show cause why the Will and the Codicil (s) set forth in Paragraph 3 and presented herewi\ th should not be admitted to probate; (b) that an order be granted directing the service of process, pursuant to the provi\ sions of Article 3 of the S.C.P.A., upon the persons named in Paragraph (6) hereof whose names or whereabouts are unknown a\ nd cannot be ascertained, or who may be persons on whom service by personal delivery cannot be made; and (c) t\ hat such Will and Codicil (s) be admitted to probate as a Will of real and personal property and that letters issue t\ hereon as follows: [Check and complete all relief requested.] □ Letters Testamentary to □ Letters of Trusteeship to f/b/o f/b/o f/b/o □ Letters of Administration c.t.a. to and that petitioner (s) have such other relief as may be proper. 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) COMBINED VERIFICATION, OATH AND DESIGNATION [For use when petitioner is an individual] STATE OF NEW YORK ) COUNTY OF ) ss.: The undersigned, the petitioner named in the foregoing petition, being d\ uly sworn, says: 1. VERIFICATION: I have read the foregoing petition subscribed by me and know the c\ ontents thereof, and the same is true of my own knowledge, except as to the matters there\ in stated to be alleged upon information and belief, and as to those matters I believe it to be true. 2. OATH OF □ EXECUTOR □ ADMINISTRATOR c.t.a. □ TRUSTEE as indicated above: I am over eighteen (18) years of age, and I will well, faithfully and honestly d\ ischarge the duties of Fiduciary of the goods, chattels and credits of said decedent according to law. I am not ineligible, pursuant to SCPA 707, to receive letters and will duly account for all moneys and other property that will come into my hands. 3. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I hereby designate the Clerk of the Surrogate’s Court of County, and his/her successor in office, as a person on whom service of any process, issuing from such Court may be ma\ de in like manner and with like effect as if it were served personally upon me, whenever I cannot be found and served wi\ thin the State of New York after due diligence used. My domicile is : (Street Address) (City/Town/Village) (State) (Zip) (Signature of Petitioner) (Print Name) On ___________________________________________________ , 20 _________, b\ efore 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 Attorney: Print Name: Firm Name: Tel No.: Email: Address of Attorney: P-1 (03/18) COMBINED CORPORATE VERIFICATION, CONSENT AND DESIGNATION [For use when a petitioner to be appointed is a bank or trust company] STATE OF NEW YORK ) COUNTY OF ) ss.: I, 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 c\ ontents thereof, and the same is true of my own knowledge, except as to the matters there\ in 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 □ Executor □ Administrator c.t.a □ Trustee under the Last Will and Testament of the decedent described in the foregoing petition and consent to act as such fiduciary. 3. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I designate the Chief Clerk of the Surrogate’s Court of County, and his/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 whenever one of its proper officers cannot be found and served within the State of New York after due diligence used. _______________________________________ (Name of Bank or Trust Company) BY____________________________________ (Signature) ______________________________________ (Print Name and Title) On , 20 , 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 exe\ cuted 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 Attorney: Print Name: Firm Name: Tel No.: Email: Address of Attorney: P-1 (03/18) SURROGATE’S COURT OF THE STATE OF NEW YORK COUNTY OF X PROBATE PROCEEDING, APPLICATION FOR WILL OF PRELIMINARY LETTERS TESTAMENTARY (See SCPA 1412) a/k/a File # Deceased. X 1. The proposed preliminary executor (s) is/are and is/are designated as executor (s) in the Will of the above named decedent dated (together with Codicil (s) dated ) and duly filed with the court. 2. The person (s) who would have a right to letters testamentary pursuant\ to Section 1412.1 is/are: [Enter “NONE” or specify name and interest] 3. Preliminary letters are requested for the following reasons: 4. Probate is expected to be completed by: 5. A contest □ is □ is not expected. 6. The testamentary assets of decedent’s estate are estimated as follows: [describe and state value; annex schedule if space is insufficient] Personal Property: Total Personal Property: $ Real Property: Total Real Property: $ 18 months rent, if applicable: Total of 18 month’s rent: $ 7. The liabilities of this estate are: 8. By provision in the propounded will, the applicant(s) [is/are] [are not] required to file a bond or other security for the performance of his/her/their duties. Your applicant (s) respectfully request the issuance to of preliminary letters testamentary upon qualifying. Dated: (ApplicantF (ApplicantF OATH & DESIGNATION OF PRELIMINARY EXECUTOR STATE OF NEW YORK ) COUNTY OF ) ss.: I, the undersigned, being duly sworn say: 1. OATH OF PRELIMINARY EXECUTOR: I am over eighteen (18) years of age and a citizen of the United States; I am an executor named in the Will described in the foregoing pe\ tition and will well, faithfully and honestly discharge the duties of preliminary executor and duly account for all mo\ ney or property which may come into my hands. I am not ineligible to receive letters. 2. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I hereby designate the Clerk of the Surrogate’s Court of County, and his/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 \ and served within the State of New York after due diligence used. My domicile is : (Street Address) (City/Town/Village) (State) (Zip) (Signature of Petitioner) (Print Name) On , 20 , 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 in\ strument before me and duly acknowledged that he/she executed the same. Notary Public: Commission Expires: (Affix Notary Stamp or Seal) Signature of Attorney: Print Name: Firm Name: Tel No.: Email: Address of Attorney: NOTE: Each Preliminary Executor must complete a combined Oath & Designat\ ion of Preliminary Executor. CONSENT AND DESIGNATION OF CORPORATE PRELIMINARY EXECUTOR STATE OF NEW YORK ) COUNTY OF ) ss.: I, 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. CONSENT: I consent to accept the appointment as Preliminary Executor under the \ Last Will and Testament of the decedent described in this application and consent to act as such fiduciary. 2. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I designate the Chief Clerk of the Surrogate’s Court of County, and his/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 whenever one of its proper officers cannot be found and served within the State of New York after due diligence used. (Name of Bank or Trust Company) BY (Signature) (Print Name and Title) On , 20 , 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 exec\ uted such instrument, and that he/she signed his/her name thereto by order of the Board of Directors of the corporati\ on. Notary Public: Commission ExpiresW (Affix Notary Stamp or Seal) Signature of Attorney: Print Name: Firm Name: Tel No.: Email: Address of Attorney: SURROGATE’S COURT OF THE STATE OF NEW YORK COUNTY OF X PROBATE PROCEEDING, AFFIDAVIT OF ATTESTING WITNESS WILL OF (After Death) Pursuant to SCPA 1406 a/k/a Deceased. File # X STATE OF NEW YORK ) COUNTY OF ) ss.: The undersigned witness, being duly sworn, deposes and says: (1) I have been shown [check one] □ the original instrument dated , □ a court-certified photographic reproduction of the original instrument dated , purporting to be the last Will and Testament/Codicil of the above-named decedent. (2) On the date indicated in such instrument (under the supervision of an a\ ttorney), I saw the decedent subscribe the same at the place where decedent’s signature appears, and I heard the decedent declare such instrument to be his/her last Will and Testament/Codicil. (3) I thereafter signed my name to such instrument as a witness thereto at t\ he request of the decedent, and I saw the other witness (es) sign his/her/their names (s) at the end of such instrument as a witness the\ reto. (4) At the time the decedent subscribed and executed such instrument, the de\ cedent was to the best of my knowledge and belief upwards of 18 years of age, and in all respects app\ eared to be of sound and disposing mind, memory and understanding, competent to make a will, and not under any re\ straint. (5) The decedent could read, write and converse in the English language, and\ was not suffering from defects of sight, hearing or speech, or any other physical or mental imp\ airment, which would affect his/her capacity to make a valid will. The purported instrument was the only copy of said Will/Codicil executed\ on that occasion, and was not executed in counterparts. (6) I am making this affidavit at the request of . (Witness Signature) (Print Name) (Street Address) (Town/State/Zip) Sworn before me this day of , 20 Notary Public: Commission Expires: (Affix Notary Stamp or Seal) [Note: Each witness must be shown either the Original Will or a Court-Certified Reproduction thereof. The Notary Public subscribing to this affidavit may Not be a party or witness to the W ill.] P-3 (10/96) SURROGATE’S COURT OF THE STATE OF NEW YORK COUNTY OF X PROBATE PROCEEDING, WAIVER OF PROCESS: WILL OF CONSENT TO PROBATE a/k/a File # Deceased. X To the Surrogate’s Court, County of The undersigned, being of full age and sound mind, residing at the address written below and interested in this proceeding as set forth in paragraph 6a of the petition, hereby waives the issuance\ and service of citation, in this matter and consents that the court admit to probate the decedent’s Last Will and Testament dated ,20 (and codicils, if any, dated ), a copy of each of which testamentary instrument had been received by me, and that □ Letters Testamentary issue to □ Letters of Trusteeship issue to of the following trusts: Dated Signature Street Address Relationship Print Name Town/State/Zip STATE OF NEW YORK ) COUNTY OF ) ss.: On , 20 , before me personally appeared to me known and known to me to be the person described in and who execut\ ed the foregoing waiver and consent and duly acknowledged the execution thereof. Notary Public: Commission ExpiresW (Affix Notary Stamp or Seal) Signature of Attorney: Print Name: Firm Name: Tel No.: Email: Address of Attorney: P-4 (10/96) 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 20 at o