Form SE-1A "Affidavit in Relation to Settlement of Estate Under Article 13, Scpa" - New York

What Is Form SE-1A?

This is a legal form that was released by the Surrogate's Court of the State of New York - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 1991;
  • The latest edition provided by the Surrogate's Court of the State of New York;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SE-1A by clicking the link below or browse more documents and templates provided by the Surrogate's Court of the State of New York.

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Download Form SE-1A "Affidavit in Relation to Settlement of Estate Under Article 13, Scpa" - New York

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SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF __________________________________
AFFIDAVIT IN RELATION
-------------------------------------------------------------------------- X
TO SETTLEMENT OF
VOLUNTARY ADMINISTRATION, Estate of
ESTATE UNDER
ARTICLE 13, SCPA
___________________________________,
Deceased.
File
-------------------------------------------------------------------------- X
No._________________________________
(as of 6/91) *
STATE OF NEW YORK
)
(INSTRUCTIONS: In completing this
)ss.:
form, answer each question. This
COUNTY OF___________________ )
may be done in some instances by
crossing out words in parenthesis
and in some instances by inserting
the required information.)
I, ________________________________________ , being duly sworn, depose and say:
(1)
My domicile is ______________________________________________________________
(Street Address)
(City/Town/Village)
________________________________________________________________________________________
(County)
(State)
(Zip)
(Telephone Number)
My mailing address is ______________________________________________________________________
(If different from domicile)
(2)
My interest is:
Distributee of decedent ___________________________
(Relationship)
other (Specify) __________________________________
(3)
The name, domicile, date, place of death, and citizenship of the decedent, to whose estate this
proceeding relates, are as follows:
Name of Decedent (a/k/a, if applicable: ________________________________________________________
Domicile of
Decedent:_______________________________________________________________________________
(Street address)
(City/Town/Village)
(County)
(State)
Date of Death:__________________ Place of death: _____________________________________________
(City/Town/Village)
(State)
Citizenship: ____________________
(4)
Decedent Died:
Intestate (without a will)
Testate (the original will is attached)
(5)
A search of the records of the Court shows that no application has been made in the estate of the decedent
for voluntary administration, letters of administration or for probate of a will, and your affiant is informed and verily
believes that no such application ever had been made to any other Surrogate’s Court in this state.
SE-1A * For use only where decedent died before August 29, 1996.
-1-
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF __________________________________
AFFIDAVIT IN RELATION
-------------------------------------------------------------------------- X
TO SETTLEMENT OF
VOLUNTARY ADMINISTRATION, Estate of
ESTATE UNDER
ARTICLE 13, SCPA
___________________________________,
Deceased.
File
-------------------------------------------------------------------------- X
No._________________________________
(as of 6/91) *
STATE OF NEW YORK
)
(INSTRUCTIONS: In completing this
)ss.:
form, answer each question. This
COUNTY OF___________________ )
may be done in some instances by
crossing out words in parenthesis
and in some instances by inserting
the required information.)
I, ________________________________________ , being duly sworn, depose and say:
(1)
My domicile is ______________________________________________________________
(Street Address)
(City/Town/Village)
________________________________________________________________________________________
(County)
(State)
(Zip)
(Telephone Number)
My mailing address is ______________________________________________________________________
(If different from domicile)
(2)
My interest is:
Distributee of decedent ___________________________
(Relationship)
other (Specify) __________________________________
(3)
The name, domicile, date, place of death, and citizenship of the decedent, to whose estate this
proceeding relates, are as follows:
Name of Decedent (a/k/a, if applicable: ________________________________________________________
Domicile of
Decedent:_______________________________________________________________________________
(Street address)
(City/Town/Village)
(County)
(State)
Date of Death:__________________ Place of death: _____________________________________________
(City/Town/Village)
(State)
Citizenship: ____________________
(4)
Decedent Died:
Intestate (without a will)
Testate (the original will is attached)
(5)
A search of the records of the Court shows that no application has been made in the estate of the decedent
for voluntary administration, letters of administration or for probate of a will, and your affiant is informed and verily
believes that no such application ever had been made to any other Surrogate’s Court in this state.
SE-1A * For use only where decedent died before August 29, 1996.
-1-
(6)
The names and addresses of the decedent’s distributees under New York law, including non-marital
children and decedents of predeceased non-marital children, and their relationship to the decedent, are as follows:
(If more space is needed, add a sheet of paper)
Post Office
Relationship
Name
Address, (Including Zip)
(Indicate if non-marital)
_______________
________________________
______________________
_______________
________________________
______________________
_______________
________________________
______________________
_______________
________________________
______________________
_______________
________________________
______________________
(7)
(If decedent had a will) The names and addresses of all beneficiaries in the will of the decedent filed
herewith are as follows:
(If more space is needed, add a sheet of paper)
Post Office
Name
Address, (Including Zip)
Request
_______________
________________________
______________________
_______________
________________________
______________________
_______________
________________________
______________________
_______________
________________________
______________________
_______________
________________________
______________________
(8)
The value of the entire personal property, wherever located, of the decedent, exclusive of joint bank
accounts, trust accounts, U.S. savings bonds POD (payable on death), and jointly owned personal property, or
property exempt under the EPTL §5-3.1, does not exceed $10,000.00.
(9)
The following, exclusive of joint bank accounts, trust accounts, U.S. savings bonds POD (payable on
death), and jointly owned personal property, or property exempt under EPTL §5-3.1, is a complete list of all
personal property owned by the decedent, either standing in his/her own name or owned by him/her beneficially
and including items of value in any safe deposit box. (If more space is needed, add a sheet of paper)
Items of Personal
Property
Separately Listed
Value of Each Item
_________________________________________
_______________________________________
_________________________________________
_______________________________________
_________________________________________
_______________________________________
_________________________________________
_______________________________________
_________________________________________
_______________________________________
TOTAL $_________________________________
-2-
(10)
All the liabilities of the decedent known to me are as follows: (If more space is needed, add a sheet of
paper)
Name of Creditor
Amount Owed
_____________________________________
___________________________________
_____________________________________
___________________________________
_____________________________________
___________________________________
_____________________________________
___________________________________
_____________________________________
___________________________________
(11)
I undertake to act as voluntary administrator/trix of the decedent’s estate, and to administer it pursuant to
Article 13 of the Surrogate’s Court Procedure Act. I agree to reduce all of the decedent’s assets to possession;
to liquidate such assets to the extent necessary; to open an estate bank account in a bank of deposit or savings
bank in this state, in which I shall deposit all money received; to sign all checks drawn on or withdrawals from such
account in the name of the estate by myself, as voluntary administrator/trix; to pay the expenses of administration,
the decedent’s reasonable funeral expenses and his/her debts in the order provided by law; and to distribute the
balance to the person or persons and in the amount or amounts provided by law. As voluntary administrator/trix,
I shall file in this court an account of all receipts and of disbursements made.
(12)
I understand that this proceeding will not determine the estate tax liability, if any, in the event that the
decedent had any interest in real property or any joint bank accounts, trust accounts, U.S. savings bonds POD
(payable on death), or jointly or trust property.
(13)
If letters testamentary or of administration are later granted, I acknowledge that my powers as voluntary
administrator/trix shall cease, and I shall deliver to the court appointed fiduciary a complete statement of my
account and all assets and funds of the estate in my possession.
_________________________________
Signature of Affiant
__________________________________
Print Name
Sworn to before m e on
________________________, 20 ______
__________________________________
Notary Public
My Com m ission Expires:
(Affix Notary Stam p or Seal)
Signature of Attorney :_______________________________________________________________________________
Print Nam e :______________________________________________________________________________
Firm Nam e:_________________________________________ Tel No. : _______________________________________
Address of Attorney:_________________________________________________________________________________
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