New York Letters of Administration – Fill Out and Use This PDF

Do not leave any items blank.

Enter the county after COUNTY OF under SURROGATE'S COURT OF THE STATE OF NEW YORK, and after TO THE SURROGATE'S COURT, COUNTY OF.

Under ADMINISTRATION PROCEEDING, PETITION FOR LETTERS OF, check Administration, Limited Administration, Administration with Limitations or Temporary Administration.

Enter the Deceased File No.

In 1, enter the name, domicile and interest in this proceeding of the petitioner, who is of full age: the Name and the Domicile (Street Address, City/Town/Village, County, State, Zip, Telephone Number).

Enter the Mailing address if different from domicile.

Under Citizenship, check one: U.S.A. or Other (specify).

Under Interest of Petitioner, check one: Distributee of decedent (state relationship) or Other(specify).

Check Yes or No for Is proposed Administrator an attorney? If yes, submit statement pursuant to 22 NYCRR 207.16(e); see also 207.52 (Accounting of attorney-fiduciary).

Check is or is not: the proposed Administrator is or is not a convicted felon nor is he/she otherwise ineligible, pursuant to SCPA 707 to receive letters. If the proposed Administrator is a convicted felon, submit a copy of the Certificate of Relief from Civil Disabilities.

In 2, enter the name, domicile, date and place of death, and national citizenship of the decedent: Name, Domicile (Street Number, City, Village/Town, State, Zip Code), Township of, County of, Date of Death, Place of Death and Citizenship (check one): U.S.A. or Other (specify).

If the decedent's domicile is different from that shown on the death certificate, check the box and attach an affidavit explaining the reason for this inconsistency.

For Items 3a through c, do not include any assets that are jointly held, held in trust for another, or have a named beneficiary.

In 3(a), enter $ after: The estimated gross value of the decedent's personal property passing by intestacy is less than

In (b), check improved or unimproved and enter $ after: The estimated gross value of the decedent's real property, in this state, passing by intestacy is less than. Then write a brief description of each parcel.

In (c), enter $ after: The estimated gross rent for a period of eighteen (18) months is the sum of

In (d), write NONE or state briefly the cause of action and the person against whom it exists, including names and carrier.

In (e), if the decedent is survived by a spouse and a parent, or parents but no issue, and there is a claim for wrongful death, check the box and furnish the names and addresses of the parents in Paragraph 7. See EPTL 5-4.4.

In 6, check each of the following that the decedent left surviving who would inherit his/her estate pursuant to EPTL 4-1.1 and 4-1.2: a. Spouse (husband/wife). b. Child or children or descendants of predeceased child or children (must include marital, nonmarital and adopted). c. Any issue of the decedent adopted by persons related to the decedent (DRL Section 117). d. Mother/Father. e. Sisters or brothers, either of whole or half blood, and issue of predeceased sisters or brothers. f. Grandmother/Grandfather. g. Aunts or uncles, and children of predeceased aunts and uncles (first cousins). h. First cousins once removed (children of first cousins).

Information is required only as to those classes of surviving relatives who would take the property of decedent pursuant to EPTL 4-1.1. State number of survivors in each class. Insert No in all prior classes. Insert X in all subsequent classes.

In 7, enter the decedent's surviving distributees, or other necessary parties, with names, degrees of relationship, domiciles, post office address and citizenship.

Show clearly how each person is related to decedent. If relationship is through an ancestor who is deceased, give name, date of death, and relationship of the ancestor to the decedent. Use rider sheet if space in paragraph (7) is not sufficient. See Uniform Rules 207.16(b).

If any person listed in paragraph (7) is a non-marital person, or descended from a non-marital person, attach a copy of the order affiliation or Schedule A. If any person listed in paragraph (7) was adopted by any persons related by blood or marriage to decedent or descended from such persons, attach Schedule B.

In 7a, list those of full age and under no disability by Name, Relationship, Domicile and Mailing Address and Citizenship; if non-marital or adopted-out person, so indicate by attaching Schedule A and/or B.

In 7b, list the infants and/or persons under disability and attach applicable Schedule A, B, C, and/or D.

In 8, there are no outstanding debts or funeral expenses, except: write NONE or state same.

Under WHEREFORE, your petitioner respectfully prays that: check and complete all relief requested.

Check c. for a decree to award Letters of Administration, Limited Administration, Administration with Limitation or Temporary Administration, on the line after the box, to a person, or to such other person or persons having a prior right as may be entitled thereto.

Check d. so that the authority of the representative under the Letters is limited with respect to the prosecution or enforcement of a cause of action on behalf of the estate: the administrator(s) may not enforce a judgment or receive any funds without further order of the Surrogate.

Check e. and write on the lines: That the authority of the representative under the Letters be limited as follows.

Check f. and state any other relief requested.

Enter the date after Dated and print the name under Print Name.

Sign on each Signature of Petitioner line.

The Combined Verification, Oath and Designation is for use when petitioner is to be appointed administrator.

Verification: I have read the petition subscribed by me and know the contents thereof, and the same is true of my own knowledge, except as to the matters there in stated to be alleged upon information and belief, and as to those matters I believe it to be true.

Oath of Administrator: I am over eighteen (18) years of age and a citizen of the United States, and I am not ineligible, pursuant to SCPA 707, to receive letters.

Enter your domicile after My domicile is.

On the day of, 20, before me personally came, to me known to be the person described in and who executed the 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).

For the attorney, sign Signature of Attorney, and enter Print Name, Firm Name, Tel.No. and Address of Attorney.

Nonmarital children (or their issue) who would be distributees if they (or their ancestors) were born in wedlock will not be regarded as distributees unless satisfactory proof is submitted establishing paternity.

See EPTL 4-1.2 which sets forth methods of establishing paternity.

Please furnish all of the information requested, otherwise the petition may be rejected.

File proof of Service at least 3 days before return date.

State clearly date, time and place of service and name of person served (Uniform Rule 207.7(c)).