Fill and Sign the Petition Ancillary Form

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