Form AA-1 Petition for Ancillary Letters of Administration Scpa Article 16 - New York

Form AA-1 is a Surrogate's Court of the State of New York form also known as the "Petition For Ancillary Letters Of Administration Scpa Article 16". The latest edition of the form was released in April 1, 1998 and is available for digital filing.

Download an up-to-date Form AA-1 in PDF-format down below or look it up on the Surrogate's Court of the State of New York Forms website.

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For Office Use Only
Filing Fee Paid $____________________
____________ Certs $_______________
$ ___________ Bond, Fee: $___________
Receipt No: __________ No:___________
DO NOT LEAVE ANY ITEM S BLANK
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF _________________________________
------------------------------------------------------------------------------ X
ANCILLARY ADMINISTRATION PROCEEDING,
PETITION FOR ANCILLARY
ESTATE OF __________________________________
LETTERS OF ADM INISTRATION
SCPA ARTICLE 16
a/k/a ________________________________________
Ancillary Letters of Adm inistration
a dom iciliary of the State of ______________________
Ancillary Letters of Adm inistration d.b.n.
Deceased.
File No.___________________________
------------------------------------------------------------------------------ X
TO THE SURROGATE’S COURT, COUNTY OF_______________:
It is respectfully alleged:
1.
The nam e, citizenship, dom icile (or, in the case of a bank or trust com pany, its principal office) and
interest in this proceeding of the petitioner (s) are as follows:
Nam e:____________________________________________________________________________________________
Dom icile or Principal Office:___________________________________________________________________________
(Street and Number)
_________________________________________________________________________________________________
(City, Village or Town)
(State)
(Zip Code)
Mailing Address :______________________________________________________________________
(If different from domicile)
Citizen of: _______________
Nam e:____________________________________________________________________________________________
Dom icile or Principal Office:___________________________________________________________________________
(Street and Number)
_________________________________________________________________________________________________
(City, Village or Town)
(State)
(Zip Code)
Mailing Address :______________________________________________________________________
(If different from domicile)
Citizen of: _______________
Interest (s) of Petitioner (s): [Check one]
Adm inistrator
Distributee of decedent [State relationship] ____________________
Creditor
Other [Specify] _________________________________________________________________________
2.
The nam e, dom icile, date and place of death, and national citizenship of the above-nam ed decedent are
as follows:
(a)
Nam e:________________________________________________________________________
(b)
Date of Death:__________________________________________________________________
(c)
Place of Death:_________________________________________________________________
(d)
Dom icile: Street_________________________________________________________________
City, Town, Village ______________________________________________________________
County_______________________________________ State____________________________
(e)
Citizen of:_____________________________________________________________________
AA-1 (4/98)
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For Office Use Only
Filing Fee Paid $____________________
____________ Certs $_______________
$ ___________ Bond, Fee: $___________
Receipt No: __________ No:___________
DO NOT LEAVE ANY ITEM S BLANK
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF _________________________________
------------------------------------------------------------------------------ X
ANCILLARY ADMINISTRATION PROCEEDING,
PETITION FOR ANCILLARY
ESTATE OF __________________________________
LETTERS OF ADM INISTRATION
SCPA ARTICLE 16
a/k/a ________________________________________
Ancillary Letters of Adm inistration
a dom iciliary of the State of ______________________
Ancillary Letters of Adm inistration d.b.n.
Deceased.
File No.___________________________
------------------------------------------------------------------------------ X
TO THE SURROGATE’S COURT, COUNTY OF_______________:
It is respectfully alleged:
1.
The nam e, citizenship, dom icile (or, in the case of a bank or trust com pany, its principal office) and
interest in this proceeding of the petitioner (s) are as follows:
Nam e:____________________________________________________________________________________________
Dom icile or Principal Office:___________________________________________________________________________
(Street and Number)
_________________________________________________________________________________________________
(City, Village or Town)
(State)
(Zip Code)
Mailing Address :______________________________________________________________________
(If different from domicile)
Citizen of: _______________
Nam e:____________________________________________________________________________________________
Dom icile or Principal Office:___________________________________________________________________________
(Street and Number)
_________________________________________________________________________________________________
(City, Village or Town)
(State)
(Zip Code)
Mailing Address :______________________________________________________________________
(If different from domicile)
Citizen of: _______________
Interest (s) of Petitioner (s): [Check one]
Adm inistrator
Distributee of decedent [State relationship] ____________________
Creditor
Other [Specify] _________________________________________________________________________
2.
The nam e, dom icile, date and place of death, and national citizenship of the above-nam ed decedent are
as follows:
(a)
Nam e:________________________________________________________________________
(b)
Date of Death:__________________________________________________________________
(c)
Place of Death:_________________________________________________________________
(d)
Dom icile: Street_________________________________________________________________
City, Town, Village ______________________________________________________________
County_______________________________________ State____________________________
(e)
Citizen of:_____________________________________________________________________
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3.
The decedent died INTESTATE, leaving no will.
On the _____________________________________________, letters were issued to ____________________________
by _________________________________ Court, State of _________________________________________, being a
com petent court of the state of the dom icile of decedent having jurisdiction thereof, and the am ount of the security given
on the original appointm ent was $________________________.
[If additional space is needed in Paragraph 4, 5 and 6, attach addendum.]
4. (a) The estim ated gross value of decedent’s property in the State of New York, consisting of real property and
personal property, is described and valued as follows: [list item s and described briefly, giving location. If space is
insufficient, attach addendum ].
Personal Property
$____________________
Im proved real property in New York State
$ ___________________
Unim proved real property in New York State
$ ___________________
Estim ated gross rents for a period of 18 m onths.
$ ___________________
Total
$ ___________________
4. (b) No other assets exits in New York State, nor does any cause of action exist on behalf of the estate, except
as follows:
[Enter “NONE” or specify]
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Exem plified copies of the decree and the letters issued, it any, are subm itted as part of this petition.
5.
The nam es, addresses and interests of all persons entitled [ (a) New York State Departm ent of Taxation
and Finance, (b) all dom iciliary creditors or dom iciliaries claim ing to be creditors, and (c) such other persons entitled to
letters pursuant to SCPA § 1607] are as follows:
Nature of Interest
Nam e
Address
or Am ount of Claim
New York State Departm ent of
Taxation and Finance
Albany, New York
AA-1 (4/98)
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6.
The nam e and address of each dom iciliary distributee having an interest in the property in this state is as
follows:
(a) Each distributee who is of full age and sound m ind or which is a corporation of association:
Nam e
Address
Interest
(b) Each distributee who is an infant or otherwise under a disability: [State disability and see
SCPA § 304 (3) ]
Nam e
Address
Interest
Disability:
Disability:
7.
There are no persons interested in this proceeding other than those hereinbefore m entioned. No previous
application for ancillary adm inistration with or without ancillary letters has been m ade, except _______________________
_________________________________________________________________________________________________
W HEREFORE, petitioner (s) pray (s)
(a) that process issue to all necessary parties and (b) that ancillary letters
issue thereon as follows:
Ancillary Letters of Adm inistration to:_____________________________________________________________
___________________________________________________________________________________________
Ancillary Letters of Adm inistration d.b.n. to:________________________________________________________
___________________________________________________________________________________________
(d)
[State any other relief requested]
Dated: ____________________________
1. ________________________________________
2. __________________________________________
(Signature of Petitioner)
(Signature of Petitioner)
________________________________________
__________________________________________
(Print Nam e)
(Print Nam e)
3. ________________________________________
(Nam e of Corporate Petitioner)
_________________________________________
(Signature of Officer)
_________________________________________
(Print Nam e and Title of Officer)
AA-1 (4/98)
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SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF ____________________________________
COM BINED VERIFICATION,
------------------------------------------------------------------------------ X
OATH AND DESIGNATION
ANCILLARY ADMINISTRATION PROCEEDING,
ESTATE OF ____________________________________
a/k/a __________________________________________
File No._______________________________
a dom iciliary of the State of ________________________
Deceased.
------------------------------------------------------------------------------ X
STATE OF_____________________
)
COUNTY OF___________________
) ss.:
The undersigned, the petitioner nam ed in the foregoing petition, being duly sworn, says:
1.
VERIFICATION: I have read the foregoing petition subscribed by m e and know the contents thereof, and the
sam e is true of m y own knowledge, except as to the m atters therein stated to be alleged upon inform ation and belief, and as
to those m atters I believe it to be true.
2.
OATH OF ANCILLARY
Adm inistrator
Adm inistrator d.b.n.:
I am over eighteen
(18) years of age and a citizen of the United States; I will well, faithfully and honestly discharge the duties of ancillary
adm inistrator/adm inistrator d.b.n.. I am not ineligible to receive letters.
3.
DESIGNATION OF CLERK FOR SERVICE OF PROCESS:
I do hereby designate the Clerk o f the
Surrogate’s Court of __________________________ County, and his or her successor in office as a person on whom service
of any process issuing from such Surrogate’s Court m ay be m ade, in like m anner and with like effect as if it were served
personally upon m e, whenever I cannot be found within the State of New York after due diligence used.
My dom icile is _______________________________________________________________________________
(Street Address)
(City/Town/Village)
(State)
(Zip Code)
_________________________________________
(Signature of Petitioner)
_________________________________________
(Print Nam e)
On __________________________________________________________________, before m e personally cam e
__________________________________________________________________________________________________
to m e known to be the person described in and who executed the foregoing instrum ent. Such person duly swore to such
instrum ent before m e and duly acknowledged that he/she executed the sam e.
_____________________________________
Notary Public
Com m ission Expires:
(Affix Notary Stam p or Seal)
Signature of New York Attorney:_______________________________________________________________________
Print Nam e of New York Attorney:______________________________________________________________________
Firm Nam e:__________________________________________________________ Tel No.:_______________________
Address of New York Attorney:________________________________________________________________________
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SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF ___________________________________
------------------------------------------------------------------------------ X
ANCILLARY ADMINISTRATION PROCEEDING,
ESTATE OF ___________________________________
COM BINED CORPORATE VERIFICATION,
CONSENT AND DESIGNATION
a/k/a _________________________________________
a dom iciliary of the State of _______________________
File No._______________________________
Deceased.
------------------------------------------------------------------------------ X
STATE OF
)
COUNTY OF
) ss.:
The undersigned, a ________________________________________________________________________ of
(Title)
_________________________________________________________________________________________________
(Nam e of Bank or Trust Com pany)
a corporation duly qualified to act in a fiduciary capacity without further security, being duly sworn, says:
1.
VERIFICATION: I have read the foregoing petition subscribed by m e and know the contents thereof, and the
sam e is true of m y own knowledge, except as to the m atters therein stated to be alleged upon inform ation and belief, and as
to those m atters I believe it to be true.
2.
CONSENT:
I consent to accept the appointm ent as
Ancillary Adm inistrator
Ancillary Adm inistrator d.b.n. of the decedent described in the foregoing petition and consent to act as such fiduciary.
3.
DESIGNATION OF CLERK FOR SERVICE OF PROCESS:
I d o hereby des igna te the C lerk of the
Surrogate’s Court of __________________________ County, and his or her successor in office as a person on whom service
of any process issuing from such Surrogate’s Court m ay be m ade, in like m anner and with like effect as if it were served
personally upon m e, whenever I cannot be found within the State of New York after due diligence used.
_________________________________________
(Nam e of Corporate Petitioner)
_________________________________________
(Signature of Officer)
_________________________________________
(Print Nam e and Title of Officer)
On ___________________________________, before m e personally cam e ________________________________
to m e known, who duly swore to the foregoing instrum ent and who did say that he/she resides at ______________________
of __________________________________ the corporation/national banking association described in and which executed
such instrum ent, and that he/she signed his/her nam e thereto by order of the Board of Directors of the corporation.
__________________________________
Notary Public
Com m ission Expires:
(Affix Notary Stam p or Seal)
Signature of New York Attorney:_______________________________________________________________________
Print Nam e of New York Attorney:______________________________________________________________________
Firm Nam e:__________________________________________________________ Tel No.:_______________________
Address of New York Attorney: ________________________________________________________________________
AA-1 (4/98)
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Download Form AA-1 Petition for Ancillary Letters of Administration Scpa Article 16 - New York

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