New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter A - Forms Authorized By Section 207.52 › Surrogate's Forms › Form SE1A - Affidavit in relation to settlement of estate

Current through Register Vol. 46, No. 28, July
					 10, 2024
THE CERTIFIED COPY MUST BE RETAINED BY THE
						VOLUNTARY
ADMINISTRATOR/TRIX FOR FILING WITH THE
						REPORT AND ACCOUNT
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF ________
________X
VOLUNTARY ADMINISTRATION, Estate of
						AFFIDAVIT IN RELATION
TO SETTLEMENT OF
________, ESTATE UNDER
ARTICLE 13, SCPA
Deceased File No. ________
________X
STATE OF NEW YORK) [INSTRUCTIONS: In
						completing this form, answer
ss.: each question. This may be done in
						some instances
COUNTY OF ________) by crossing out words
						in parentheses, and in other
instances by inserting the required
						information.]
I, ____________, being duly sworn, depose
						and say:
(1) My domicile is ____________
(Street address)
						(City/Town/Village)
____________
(County) (State) (Zip) (Telephone
						Number)
My mailing address is ____________
(if different from domicile)
(2) My interest is: [ ] Distributee of
						decedent ____________
(Relationship)
[ ] Other (Specify) ____________
(3) The name, domicile, date, place of
						death, and citizenship of the decedent, to whose estate this proceeding
						relates, are as follows:
Name of Decedent (a/k/a, if
						applicable):____________
Domicile of Decedent: ____________
(Street address) (City/Town/Village)
						(County) (State)
Date of Death:____________ Place of Death:
						____________
(City/Town/Village) (State)
Citizenship:________
(4) Decedent died: [ ] Intestate (without
						a will)
[ ] Testate (the original will is
						attached)
(5) A search of the records of the Court
						shows that no application has been made in the estate of the decedent for
						voluntary administration, letters of administration or for probate of a will,
						and your affiant is informed and verily believes that no such application ever
						has been made to any other Surrogate's Court of this state.
(6) The names and addresses of the
						decedent's distributees under New York law, including non-marital children, and
						decendants of predeceased non-marital children, and their relationship to the
						decedent, are as follows: [If more space is needed, add a sheet of
						paper]
Post Office Relationship
Name Address(including Zip) (Indicate if
						non-marital)
____________
____________
____________
____________
____________
(7) (If decedent had a will) The names and
						addresses of all beneficiaries in the will of the decedent filed herewith are
						as follows: [If more space is needed, add a sheet of paper]
Post Office
Name Address (including Zip)
						Bequest
____________
____________
____________
____________
____________
(I) [FN3] ( ____________ and I jointly and
						severally) undertake that defendant will appear in§5-3.1, does not exceed
						$10,000.00.
(I) [FN3] ( ____________ and I jointly and
						severally) undertake that defendant will appear in§5-3.1, is a complete
						list of all personal property owned by the decedent, either standing in his/her
						own name or owned by him/her beneficially and including items of value in any
						safe deposit box: (If more space is needed, add a sheet of paper]
Items of Personal Property Space for
						Endorsements
Separately Listed Value of Each Item By
						Transferors
____________
____________
____________
____________
____________
________
TOTAL: $
(10) All the liabilities of the decedent
						known to me are as follows: (If more space is needed, add a sheet of
						paper)
Name of Creditor Amount Owed
____________
____________
____________
____________
____________
(11) I undertake to act as voluntary
						administrator/trix of the decedent's estate, and to administer it pursuant to
						Article 13 of the Surrogate's Court Procedure Act. I agree to reduce all of the
						decedent's assets to possession; to liquidate such assets to the extent
						necessary; to open an estate bank account in a bank of deposit or savings bank
						in this state, in which I shall deposit all money received; to sign all checks
						drawn on or withdrawls from such account in the name of the estate by myself,
						as voluntary administrator/trix; to pay the expenses of administration, the
						decedent's reasonable funeral expenses and his/her debts in the order provided
						by law; and to distribute the balance to the person or persons and in the
						amount or amounts provided by law. As voluntary administrator/trix, I shall
						file in this court an account of all receipts and of disbursements made.
(I) [FN3] ( ____________ and I jointly and
						severally) undertake that defendant will appear in
(13) If letters testamentary or of
						administration are later granted, I acknowledge that my powers as voluntary
						administrator/trix shall cease, and I shall deliver to the court appointed
						fiduciary a complete statement of my account and all assets and funds of the
						estate in my possession.
______________
Signature of Affiant
______________
Print Name
Sworn to before me on
________, 19________.
______________
Notary Public
My Commission Expires: ________
NAME OF ATTORNEY: ____________
ADDRESS: ____________
TELEPHONE NUMBER:
						________