Fill and Sign the Small Estate Form

SURROGATE’S COURT OF THE STATE OF NEW YORK COUNTY _______________________________ ----------------------------------------------------------------------------- VOLUNTARY ADMINISTRATION, Estate of REPORT AND ACCOUNT IN SETTLEMENT OF ESTATE PURSUANT , TO ARTICLE 13, SCPA (as of 6/91) _______________________________ Deceased. File No. ----------------------------------------------------------------------------- The undersigned, authorized by this court to act as the voluntary administrator of the above entitled estate, reports and accounts as follows: 1. There has come into my possession the following personal property of the deceased, which is on hand or has been converted into cash in the amounts indicated: Item Value _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ [If more space is needed add a sheet of paper] Total value of personal property and cash: _______________________________ 2. All of this personal property and cash have been disbursed or distributed as follows: Item or Cash To Whom Item or Cash To Whom _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ Receipts or canceled checks showing the payment of expenses of administration, disbursements, or distributions are annexed. 3. No part of the estate of the decedent remains in my possession. Voluntary Administrator/rix _______________________________ Print Name of Voluntary Administrator/rix STATE OF NEW YORK ) ) ss.: COUNTY OF ) , , being duly sworn, desposes and says: I have read the foregoing Report and Account and know the contents thereof; the matters and things therein stated are true of my own knowledge; the foregoing Account is in all respects just and true and contains a full, particular and true account of all money and property of the deceased coming into my possession; and the administration expenses, disbursements and distribution shown have been actually made for the purposes and reasons therein stated. (Affiant) Sworn to before me on , 20 _ Notary Public My Commission expires:_____ SE-1D