Form Ja 1 – Fill Out and Use This PDF

TO THE SURROGATE'S COURT, COUNTY OF __________________

It is respectfully alleged:

1.The name(s), and address(es) of the petitioner(s), the type and date of letters issued, and the amount and surety of petitioner's(s') bond, if any, are as follows:

Name:________________________________________________________________________

Address:____________________________________________________________________

(Street Address)(City/Town/Village)

_________________________________________________________(____)_____________

(County)(State)(Zip)(Telephone Number)

Mailing address: ______________________________________________________

(if different from above)

Type of letters issued: ____________________ Date letters issued: __________

Amount of bond: $__________________ Name of surety: ________________________

Name:_______________________________________________________________________

Address:____________________________________________________________________

(Street Address)(City/Town/Village)

_________________________________________________________(____)_____________

(County)(State)(Zip)(Telephone Number)

Mailing address: ______________________________________________________

(if different from above)

Type of letters issued: ____________________ Date letters issued: __________

2.The decedent's name, date of death and domicile are as follows: Name: __________________________________Date of death: ___________

Domicile:_________________________________________________________

(Street Address)(City/Town/Village)

_________________________________________________________

Township of:_________________ County of:_________________________

3.The petitioner(s) present(s) and render(s) herewith, a verified account of petitioner's(s') proceedings in this estate or trust, for the period from ________________ to ________________, showing the gross value of assets, including principal and income, to be the sum of $______________________.

4.[ ] (a) An order was entered in this Court on _______________, 19__ [ ] Exempting the estate from tax

[ ] Fixing and assessing the tax due

[Attach a copy of the tax order and receipt]

[ ] (b) The following return(s) (was)(were) filed:

[ ] ET-90 [For decedent's dying on or after May 25, 1990]. A copy was filed with the Surrogate's Court [ ] Yes [ ] No

[ ] TT-385 [For decedent's dying before May 25, 1990]

[ ] 706 or 706NA

The estate taxes with respect to this estate were paid in full. [Attach a copy of letter of discharge.]

[ ] (c) No tax proceeding or return was required for this estate.

5.The rendering of such account at this time is proper because [check appropriate reason]

[] seven months have elapsed since letters were issued to petitioner(s);

[ ] letters issued to the petitioner(s) have been revoked;

[ ] more than one year has elapsed since the preceding account of the petitioner(s) was settled.

[ ] other reason [specify]:

6.The names and post-office addresses of all persons and parties interested in this proceeding who are required to be cited under the provisions of Surrogate's Court Procedure Act §2210, or otherwise, or concerning whom or which the Court is required to have information, are set forth in subdivision (a) or (b):

(a)All persons and parties so interested herein who are of full age and sound mind, or which are corporations or associations, are as follows:

(b)All persons so interested herein who are infants or incompetents or persons believed to be mentally incapable to adequately protect their rights, or persons whose existence, identity, or whereabouts are unknown (including persons who are virtually represented under SCPA §315) are as follows:

[Furnish all information specified in NOTE at bottom of page]

[NOTE: In the case of each infant, state (a) name, birthdate, age, nature of interest, domicile, residence address, and the person with whom he/she resides; (b) whether or not he/she has a guardian or testamentary guardian, and whether or not his/her father, or if he/she be dead, his/her mother is living; and (c) the name and post office address of any guardian and any living parent. In the case of each incompetent or person incapable of adequately protecting his/her rights, state (a) name, nature of interest, and post office address; (b) facts regarding his/her incompetency, including whether or not a committee has been appointed and whether or not he/she has been committed to any institution; (c) the names and post office addresses of any committee, conservator, guardian, and person or institution having care and custody of him/her, and any relative or friend having an interest in his/her welfare. In the case of unknowns, describe in identical language to be used in citation for publication. In the case of a person confined as a prisoner, state place of incarceration. With respect to virtual representation see Uniform Court Rule, §207.18.]

7.There are no persons interested in this proceeding other than those herein above mentioned.

8.No prior application has been made to this or any other court for the relief requested in this petition.

WHEREFORE the petitioner(s) pray(s) that the account of proceedings be judicially settled [specify any other relief requested.]

and that process be issued to all necessary parties who have not appeared to show cause why the relief requested should not be granted; and that an order be granted directing the service of process pursuant to the provisions of SCPA Article 3 upon such persons named in Paragraph (6) whose names or whereabouts are unknown and cannot be ascertained or who may be persons on whom service by personal delivery cannot be made.

Dated: ____________________________

VERIFICATION

[For use when petitioner is an individual]

The undersigned, the petitioner(s) named in the foregoing petition, being duly sworn, say(s): (I)(We) have read the foregoing petition subscribed by me(us) and know the contents thereof, and the same is true of (my)(our) own knowledge, except as to the matters therein stated to be alleged upon information and belief, and as to those matters (I)(we) believe it to be true.

Sworn to before me on

_____________________, 19___

____________________________

Notary Public Commission Expires:

(Affix Notary Stamp or Seal)

Signature of Attorney:______________________________________________________

Print Name:_________________________________________________________________

Firm Name:_________________________________________Tel. No.:________________

Address of Attorney:________________________________________________________

VERIFICATION

[For use when a petitioner is a bank or trust company]

I, the undersigned, a _______________________________________________ of

(Title)

____________________________________________________________________________

(Name of Bank or Trust Company)

being duly sworn, say(s):

I have read the foregoing 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.

________________________________________

(Name of Bank or Trust Company)

BY______________________________________

(Signature of Officer)

________________________________________

(Print Name and Title)

Sworn to before me on

_____________________, 19___

____________________________

Notary Public Commission Expires:

(Affix Notary Stamp or Seal)

Signature of Attorney:______________________________________________________

Print Name:_________________________________________________________________

Firm Name:_________________________________________Tel. No.:________________

Address of Attorney:________________________________________________________

SURROGATE'S COURT OF THE STATE OF NEW YORK COUNTY OF

-----------------------------------------X

Deceased.

-----------------------------------------X File No. __________________

TO THE SURROGATE'S COURT OF THE COUNTY OF

The undersigned does hereby render the account of proceedings as follows:

Period of account from ____________________ to _______________________

This is a (final) (intermediate) account. [delete inapplicable term]

[The instructions concerning the schedules need not be stated at the head of each schedule. It will be sufficient to set forth only the schedule letter and heading. For convenience of reference, the schedule letter and page number of the schedule should be shown at the bottom of each sheet of the account.]

CREDITS:

The foregoing balance of $_______________ consists of $______________ in

cash and $_____________ in other property on hand as of the ______ day of

______________, 19 _____. It is subject to deduction of estimated principal

commissions amounting to $_____________ as shown in Schedule I and to the

proper charge to principal of expenses of this accounting.

The attached schedules are part of this account.

AFFIDAVIT OF ACCOUNTING PARTY

_____________________________________________________________________being duly

sworn, says: that the schedules of assets of the estate reported herein are true and complete and include all money and property of any kind, and all increment thereon, which have come into the hands of any of the accounting parties or have been received by any other persons for the use of any accounting party by order or authority of such accounting party, and include all indebtedness due by any accounting party to the estate whether discharged or not; that the moneys stated in the account as collected were all that could be collected; that all claims for credit for losses or decreases of value of assets are correctly reported; that the reported payments out of estate assets for funeral and administration expenses were actually made and made in the amounts scheduled; that the reported payments to creditors and beneficiaries were actually made at the dates and in the amounts scheduled; that no payments have been made by any accounting party on any fiduciary's claims against the estate except after prior approval and allowance by the Surrogate; that all receipts and disbursements are correctly and fully reported and scheduled; that the accounting parties do not know of any error in the account or in any schedule thereof or of any matter or thing relating to the estate omitted therefrom to the prejudice of the rights of any creditor or of any person interested in the estate; and that the schedule of commissions has been computed in conformity with the statute regulating commissions and the Rules of the Surrogate's Court applicable thereto.

Name of Attorney:__________________________________Tel. No.:________________

Address of Attorney:_________________________________________________________

Schedule D

Statement of All Creditor's Claims

This schedule must contain an itemized statement of all creditor's claims subdivided to

show:

1.Claims presented, allowed, paid and credited and appearing in the Summary Statement

together with the date of payment.

2.Claims presented and allowed but not paid.

3.Claims presented but rejected, and the date of and the reason for such rejection.

4.Contingent and possible claims.

5.Personal claims requiring approval by the court pursuant to SCPA §1805.

In the event of insolvency, preference of various claims should be stated, with the order of their priority.

Schedule E

Statement of Distributions Made

This schedule must contain an itemized statement of all moneys paid and all property delivered to the beneficiaries, legatees, trustees, surviving spouse or distributees of the deceased, the date of payment or delivery thereof, and the name of the person to whom payment or delivery was actually made.

Where estate taxes are required to be apportioned and payments have been made on account of the taxes, the amounts apportioned in Schedule K against beneficiaries of the estate shall be

charged against the respective individuals share.

Schedule F

Statement of New Investments, Exchanges and Stock Distributions

This schedule must contain an itemized statement of (a) all new investments made by the fiduciary with the date of acquisition and cost of all property purchased, (b) all exchanges made by the fiduciary, specifying dates and items received and items surrendered, and (c) all

stock dividends, stock splits, rights and warrants received by the fiduciary, showing the securities to which each relates and their allocation as between principal and income.

Schedule G

Statement of Personal Property Remaining on Hand

This schedule must contain an itemized statement showing all property constituting principal remaining on hand including a statement of all uncollected receivables and property rights due to the estate. Show the date and cost of all such property that was acquired by purchase, exchange or transfers made or received, together with the date of acquisition and the cost thereof and indicate such sums in the appropriate lines of the summary schedule. Show all unrealized increases and decreases relating to assets on hand, and report the same in the appropriate places in the summary schedule.

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Schedule H

Statement of Interested Parties

This schedule must contain the names of all persons entitled as beneficiary, legatee, devisee, trustee, surviving spouse, distributee, unpaid creditor or otherwise to a share of the estate or fund, with their post office addresses and the degree of relationship, if any, of each to the deceased, and a statement showing the nature of and the value or approximate value of the interest of each such person.

This schedule also must contain a statement that the records of this court have been searched for powers of attorney and assignments and encumbrances made and executed by any of the persons interested in or entitled to a share of the estate and a list detailing each power of attorney, assignment and encumbrance, disclosed by such search, with the date of its recording and the name and address of each attorney in fact and of each assignee and of each person beneficially interested under the encumbrance referred to in the respective instruments, and also whether the accounting party has any knowledge of the execution of any such power of attorney or assignment not so filed and recorded.

Schedule I

Statement of Computation of Commissions

This schedule must contain a computation of the amount of commissions due upon this accounting. See Uniform Court Rule, §207.40(e).

Schedule J

Statement of Other Pertinent Facts, Cash Reconciliation and Proposed Distribution

This schedule must contain a statement of all other pertinent facts affecting the administration of the estate and the rights of those interested therein. It must also contain a statement of any real property left by the decedent that it is not necessary to include as an estate asset to be accounted for, a brief description thereof, its gross value, and the amount of mortgages or liens thereon at the date of death of the deceased. A cash reconciliation must also be set forth in this schedule so that verification with bank statements and cash on hand may be readily made.

Schedule K

Statement of Estate Taxes Paid and Allocation Thereof

This schedule must contain a statement showing all estate taxes assessed and paid with respect to any property required to be included in the gross estate of the decedent under the

provisions of the Tax Law or under the laws of the United States. This schedule must also contain a computation setting forth the proposed allocation of taxes paid and to be paid and the amounts due the estate from each person in whose behalf a tax payment has been made and also the proportionate amount of the tax paid by each of the named persons interested in this estate or charged against their respective interest, as provided in §2-1.8 of the Estates, Powers and Trusts Law.

Where an allocation of taxes is required, the method of computing the allocation of said taxes must be shown in this schedule.

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The undersigned, being of full age, sound mind and under no disability, and entitled to share in the estate of the above named decedent as a [check one] [ ] legatee under a will, [ ] distributee of an intestate share, [ ] trust beneficiary, [ ] creditor of the estate, [

]other [specify] __________________

(a)Acknowledges that each fiduciary named above has fully and satisfactorily accounted for

all assets of the estate;

(b)Approves the written account verified on ______________________________, 19 ____, as

submitted to the undersigned;

[Delete paragraphs (a) and (b) if the undersigned is not interested in or affected by the amount of the residuary estate or trust, or if payment is being made pursuant to

a decree of the court.]

(c) Acknowledges receipt of money paid or property transferred or delivered as follows:

The foregoing payment and/or transfer is in full payment or distribution of:

[] a legacy under Paragraph/Article _______________ of the will or trust; [ ] a claim against the estate;

[] the amount directed to be paid by a decree of this court dated: [ ] other [specify]:

(d)Releases and discharges each fiduciary named above from all liability to the undersigned for any and all matters relating to or derived from the administration of the estate; waives the issuance and service of a citation to attend any and all proceedings for the judicial settlement of the account; and authorizes the Surrogate to make and enter a decree settling the account and fully releasing and discharging each fiduciary named above as to all matters

embraced therein.

Dated: _______________________________

JA-2 (4/98)-1-

[INDIVIDUAL]

[] _____________________________________ to me known and known to me to be the person

described in and who executed the foregoing receipt and release and duly acknowledged the

execution thereof.

[CORPORATION]

[] ______________________________________ 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 signed his/her name thereto by order of the Board of Directors of the

corporation.

______________________________

Notary Public

Commission Expires:

(Affix Notary Stamp of Seal)

Name of Attorney:_________________________________________________Tel. No.:________________

Address of Attorney:_______________________________________________________________________

JA-2 (4/98)-2-

The undersigned, being of full age, and sound mind, residing at the address written below, having an interest in this proceeding, waives the issuance and service of citation in this proceeding, and consents to the submission of a decree settling the account as filed and adjusted without further notice. I acknowledge receipt of a copy of the summary statement of

account.

On __________________________, 19_____, before me personally appeared

[INDIVIDUAL]

___________________________________________ to me known and known to me to be the person

described in and who executed the foregoing waiver and consent and duly acknowledged the

execution thereof.

[CORPORATION]

___________________________________________ 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 signed his/her name thereto by order of the Board of Directors of the

corporation.

______________________________

Notary Public

Commission Expires:

(Affix Notary Stamp of Seal)

Name of Attorney:_________________________________________________Tel. No.:________________

Address of Attorney:_______________________________________________________________________

[Note: You may request a copy of the full account from the petitioner or petitioner's

attorney.]

JA-3 (4/98)

THE PEOPLE OF THE STATE OF NEW YORK,

By the Grace of God Free and Independent

TO

A petition and an account having been duly filed by

_________________________________,

whose address is _________________________________________________________________________

__________________________________________________________________________________________

as _______________________________________________________________________________________

of the estate of ________________________________________________________________________,

should not be judicially settled.

[State any further relief requested]

Name of Attorney _______________________________________Telephone Number ________________

Address of Attorney _____________________________________________________________________

[Note: This citation is served upon you as required by law. You are not required to appear; however, 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, and you or your attorney may request a copy of the full account from the petitioner or petitioner's attorney.]

JA-6 (4/98)

SURROGATE'S COURT OF THE STATE OF NEW YORK

COUNTY OF

A petition praying for a decree judicially settling the final/intermediate account having been presented and filed in this court and the time to present claims against the estate having expired, and a

citation having been issued directed to all persons interested in this

proceeding requiring them to show cause why a decree should not be granted

judicially settling the account prayed for in the petition, and the citation having been returned with proof of due service thereof on the following:

and duly executed waivers of the service of citation or receipts and

releases having been filed for the following:

and the following parties having appeared in answer to the citation:

and, attorneys, having appeared for the petitioner, and there being no other appearances;

and the Surrogate having appointed

as

guardian ad litem for the following persons under a disability:

and each guardian ad litem having filed a report recommending that the account be judicially settled and no objection having been filed to the account;

and it appearing that all tax returns required by law have been filed and

all New York State estate taxes have been fully paid, provision made therefore, or the estate is exempt from tax; and the Surrogate having examined the account and having found that each petitioner has fully accounted for all of the monies and property of the estate that have come into the petitioner's hands for the period of the account, as adjusted, it is

ORDERED, ADJUDGED AND DECREED, that the final/intermediate account be and the same hereby is judicially settled and allowed as filed (and adjusted), and that the following is a summary thereof as settled:

JA-8 (4/98)-1-

ORDERED, ADJUDGED AND DECREED, that petitioner(s) pay the remaining cash and transfer, assign and deliver the other remaining assets as shown in the account as follows:

To the petitioner:

as and for commissions the sum of $_______________;

To the petitioner:

as and for commissions the sum of $_______________;

To the attorney:

for legal services rendered for

the benefit of the estate the sum of $_______________;

and for costs and disbursements $_______________;

(which sums are in addition to any payments made on account and allowed by the court)

To the guardian ad litem:

for services as guardian ad litem $_______________;

and it is further

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ORDERED, ADJUDGED AND DECREED, that the balance remaining on hand in the amount of $____________ be paid as follows:

To

$_______________

ORDERED, ADJUDGED AND DECREED, that upon complying with the directions of this decree and the filing of the receipts for the payments herein

directed, the petitioner(s) hereby shall be discharged as to all matters

and things contained in this accounting and decree.

Dated: _____________________

____________________________________

Judge of the Surrogate's Court

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