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 WD-7 - Decree

Current through Register Vol. 46, No. 28, July
					 10, 2024
Form WD-7
(Decree)
At a Surrogate's Court of the State of New
						York held in and for the County of ________, at ________ New York on ________,
						19________.
P R E S E N T:
HON.
______
Surrogate
________x
In the Matter of the Application of
________ as Administrat________ of the
						Goods,
Chattels and Credits which were of
________ DECREE
Deceased, File No. ________
For leave to compromise and settle a
						certain cause of action for wrongful death of the decedent to render and have
						judicially settled an account of the proceedings as such
						Administrat________.
________x
Upon the Petition of ________ as
						Administrat________ of the Estate of ________, deceased, duly verified the
						________ day of ________, 19 ________, and the accounting sworn to the ________
						day of ________, 19________, in which application was made for an Order
						permitting the said, as Administrat________, to compromise and settle for the
						sum of $ ________ the cause of action against ________ for the wrongful death
						of the decedent,
And to discontinue the action for
						conscious pain and suffering and to discharge and release said defendant and
						insurance company from all suits and claims upon the payment of the said $
						________ in settlement of the cause of action herein,
And that the entire recovery of said
						action should be allocated to the cause of action for decedent's wrongful
						death, to modify the Letters of Administration to permit said compromise,
						dispense with the filing of a bond, judicially settle the account, pay to
						________, Esqs., their fee for services rendered, reject the claim of the
						Department of Social Services, and reject the claims of ________ and
						________
And more than seven months having elapsed
						since the granting of Letters of Administration to ________and the Surrogate
						having issued a Citation to all persons interested in the estate of said
						deceased to attend such judicial settlement on the ________ day of ________,
						19________, at 9:30 a.m., at the Surrogate's Court, ________ County,
And the said Citation having been duly
						returned with proof of due service thereof, or the due appearance and waiver of
						notice, by the following named person or corporations, to wit:
[List names of distributees, and, if
						applicable, New York City Department of Social Services New York State Tax
						Commission, Defendant, and Defendant's Insurance Company]
And the said ________, petitioner herein,
						having appeared by ________, his/her attorney,
And the said ________ having appeared by
						________, his/her attorneys, and having filed objections to said
						account,
And the said ________ having appeared by
						________, his/her attorney, and having filed objections to said account,
And said New York City Department of
						Social Services having appeared by ________, its attorney, and having filed
						objections to said account,
And said New York State Tax Commission
						having appeared by ________, its attorney, and having filed objections to said
						account,
And the Court having appointed ________,
						as Guardian ad Litem for ________,
And the Court having appointed ________,
						as Guardian ad Litem for ________,
And ________ having filed objections on
						behalf of his/her ward ________,
And ________ having filed a report as such
						guardian,
And a hearing having been held, and the
						Court having rendered a decision dated ________, granting the petition to
						compromise the cause of action for wrongful death and to judicially settle the
						account,
And the Court having examined the said
						account and having found the state and condition of said account to be as set
						forth in the following statement recorded with the Court:
SUMMARY STATEMENT OF THE SETTLEMENT
						PROCEEDS
The Administrat________ is charged with
						the proceeds of the action of wrongful death to be distributed. $
						________
TOTAL CHARGES $ ________
The Administrat________ is credited with
						the following amounts $ ________
TOTAL CREDITS $ ________
BALANCE OF THE SETTLEMENT PROCEEDS
TO BE DISTRIBUTED $ ________
And it appearing the said Administrat
						________ has fully accounted for all monies and properties of the estate in
						said summary statement, and the Administrat ________ having waived any claim to
						statutory commissions, it is hereby
ORDERED, ADJUDGED AND DECREED that the
						petitioner's application for leave to compromise and settle the cause of action
						for wrongful death and to allocate the entire amount of the proceeds to the
						cause of action for wrongful death and to grant leave to discontinue the cause
						of action for conscious pain and suffering is granted; and it is further
ORDERED, ADJUDGED AND DECREED that the
						petitioner as Administrat ________ of the decedent's estate is authorized to
						settle and discontinue the claims and causes of action for conscious pain and
						suffering and wrongful death against the defendant, ________, and petitioner is
						authorized to deliver general releases and discontinuances and any other papers
						or documents that may be required to effectuate a settlement and
						discontinuances or withdrawals of the said claims and causes of actions for
						conscious pain and suffering and wrongful death; and it is further
ORDERED, ADJUDGED AND DECREED that the
						entire settlement sum of $ ________ is allocated to the cause of action for
						wrongful death, and the personal injury action is discontinued with prejudice
						and without interest, costs or disbursements; and it is further
ORDERED, ADJUDGED AND DECREED that the
						entire settlement sum of $ ________ be paid by the defendant, or defendant's
						insurance company ________ as follows:
To ________, as fee for services $
						________ as Guardian ad Litem
To ________, as fee for $ ________services
						as Guardian ad Litem
To ________, as fee for $ ________
						services as attorney for the Administrat________ herein
To ________, in reimbursement of $
						________ disbursements as attorney for the Administrat ________ herein
To ________, as and for his/her share as
						surviving spouse and beneficiary of said decedent pursuant to section
						5-4.4 of the Estates, Powers and Trusts
						Law, equal to ________ % $ ________
To ________, child and next of kin by
						payment to ________, Guardian of the property of ________, jointly with the
						Guardianship Clerk of Surrogate's Court, as and for his/her share as next of
						kin of said decedent pursuant to section
						5-4.4 of the Estates, Powers and Trusts
						Law, equal to ________ % $ ________
and it is further
ORDERED, ADJUDGED AND DECREED that the
						claims of the Department of Social Services, the New York State Tax Commission,
						and ________ hereby are disallowed and objections filed by these parties are
						dismissed; and it is further
ORDERED, ADJUDGED AND DECREED that upon
						the defendant, ________, or defendant's insurance company, making payments as
						aforesaid, ________, as Administrat________ of the estate of ________,
						deceased, be and hereby is discharged from any and all further liability as to
						all matters and things embraced in the aforesaid account and determined by this
						decree; and it is further
ORDERED, ADJUDGED AND DECREED that the
						giving of a bond or other security in connection therewith be dispensed with,
						and that the restrictions on the Letters of Administration be modified to allow
						the above settlement; and it is further
ORDERED, ADJUDGED AND DECREED that the
						account of, as Administrat________, is hereby judicially settled.
______________
Surrogate