New York Form 20885 PDF Details

Are you a business owner in New York and looking for ways to save money on your taxes? Have you recently heard about the tax relief option that is available through Form 20885, but aren't sure what it is or how it can benefit you? If so, then this blog post is perfect for you! Here we will explain everything there is to know about New York's Form 20885: what it may mean for your taxes in terms of eligibility and deductions; how to properly complete the form; and which kinds of businesses are eligible. So keep reading if you want to learn more about this exciting potential opportunity!

Form NameNew York Form 20885
Form Length3 pages
Fillable fields0
Avg. time to fill out45 sec
Other namesget the new york life form 20885, new york mv93 form, new york life forms, lottery trust forms new york

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NYLIFE INSURANCE COMPANY OF ARIZONA (Not licensed in every state)

STATEMENT OF TRUST - (For Trusts other than Testamentary Trusts)


Use this form for Life and Annuity policies (new business and inforce changes).

Do not use this form for a Testamentary Trust (a trust created within a will).

Items 1-10 on page one must be completed in full.

Complete page three and secure required signatures.

For inforce policies, the Change of Beneficiary form (21131) and Transfer of Ownership form for life policies (21132) can be found in the Transfer of Ownership Life Kit (form 22600). The Transfer of Ownership form for annuity policies can be found in the Transfer of Ownership Annuity Kit (form 22599).

Agent Certification section on page three must be completed and signed by agent - if your agent is assisting you with this change. If completing this form without an agent and the owner is a trust, please provide a copy of the trust agreement.

In all instances New York Life reserves the right to request a copy of the trust if we deem it necessary.

Complete items 1-10 before proceeding



3. I/We affirm that the Trust Agreement created by

as Grantor/

SettLOr/Trustor is in effect and contains the following information:

4.Trust Name:

5.Trust Date:

6.State where Trust Established

7.Beneficiary(ies) of Trust:

8.Relationship of Trust Beneficiary(ies) to Proposed Insured(s)/Insured(s)/Annuitant(s):

9. Name(s) of Trustee(s):

Note: If more than one Trustee, we require all Trustees to sign applicable forms, unless we receive a copy of the Trust stating that the Trustees can act independently.

10.Relationship of Trustee(s) to

Proposed Insured(s)/Insured(s)/Annuitant(s):











For Variable Life and Variable Annuity policies:

New York Life, Variable Products Service Center




Madison Square Station, PO Box 922, New York, NY 10159


For all other policies:

If You Live In: AL, CT, DC, DE, FL, GA, IL, IN, KY, MA, ME, MD, MI, MS, NC, NH, NJ, NY, OH, PA, RI, SC, TN, VA, VT, WI, or WV, return this form to:

New York Life, Cleveland Service Center

PO Box 6916, Cleveland, OH 44101

If You Live In: AK, AR, AZ, CA, CO, HI, IA, ID, KS, LA, MN, MO, MT, NE, ND, NM, NV, OK, OR, SD, TX, UT, WA, or WY, return this form to:

New York Life, Dallas Service Center

PO Box 130539, Dallas, TX 75313-0539

Other: (i.e. foreign address, etc) return form to either location above.

20885 (1/10) Page 1 of 3

Please read this page and secure required signatures on page three.


I/We affirm that the beneficiary designation for each policy listed agrees with a Trust Agreement created by the Grantor and dated as shown on page one.

For Life Insurance Policies:

If, before the proceeds are paid, the Insurer(s) receives proof that the Trust as policy beneficiary is not in effect at the Insured’s death, the proceeds shall be paid to the contingent beneficiary(ies), if any. Otherwise, the proceeds shall be paid in a single sum to the Owner, if the Owner is living at that time. If the Owner is not living at that time, the single sum shall be paid to the Owner’s Estate.

For Annuity Contracts:

Please see your Agent/Registered Representative for payment methods available upon death of the Owner/Annuitant.

For Life Insurance Policies and Annuity Contracts:

Before the Insurer(s) pays the proceeds at death, it may ask for proof that the Trust is in effect;

The Owner possesses all rights of ownership of each policy including the right to change the beneficiary designation at any time even if there is a contrary provision in the Trust Agreement. This applies to revocable and irrevocable trusts; The Insurer(s) will not have any liability after it pays the proceeds of each policy, as set forth in this Statement;

The Interest of the Trust(s) in each of these policies shall be subject to any assignment of that policy made before or after this Statement.


I/We affirm that the Trust Agreement created by the Grantor as shown on page one (and the trust date as shown on page one) agrees with the following:

1.The Trustee(s) have full authority to pay premiums.

2.The Trust Agreement contains no limitations on the ownership rights of the Trust(s) as owner(s) of the insurance/annuity policies.

20885 (1/10) Page 2 of 3

IMPORTANT: The Internal Revenue Service (IRS) requires that the named Owner complete the following:

(The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding).

Taxpayer Identification Number and Backup Withholding Certifications

Policyowner’s Taxpayer Identification Number is

Under penalties of perjury, I certify that the number shown above is my correct Taxpayer Identification Number. I further certify that I am a U.S. person (including a U.S. resident alien).

I also certify that (please check only one box):

I have been notified by the IRS that I am subject to backup withholding.

I am not subject to backup withholding because (a) I have not been notified that I am subject to backup withholding as a result of failure to report all interest or dividends, or (b) the IRS has notified me that I am no longer subject to backup withholding.











Grantor(s) signature


Grantor(s) signature, if required



















Trustee(s) signature


Trustee(s) signature, if required












Proposed Insured(s)/Insured(s)/Annuitant(s) signature


Additional Signature, if required












Applicant(s)/Owner(s) signature, if other than above


Additional Signature, if required




If the indicated policy is corporate-owned, provide signatures and titles of two corporate officers below.

Print Name & Title of OfficerPrint Name & Title of Officer










Officer’s Signature


Officer’s Signature


(if Agent assists with completion of form)

By signing below I attest that I have reviewed the identifying trust document(s) described on page one and that the document(s) appeared to be genuine and original.

Print Name of Agent/Registered Representative




Agent/Registered Representative’s Signature




20885 (1/10) Page 3 of 3

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A way to fill in new york life statement of trust form portion 1

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Completing part 2 of new york life statement of trust form

Concerning Taxpayer Identification Number and and Grantors signature if required, be certain that you take a second look in this section. Those two are thought to be the key ones in the page.

3. Within this part, check out Print Name Title of Officer, Date, X Officers Signature, Print Name Title of Officer, Officers Signature, AGENT CERTIFICATION, if Agent assists with completion, By signing below I attest that I, Print Name of AgentRegistered, X AgentRegistered Representatives, Date, and Page of. Each of these must be filled out with greatest focus on detail.

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