Form WD-6 "Waiver and Consent for Individual" - New York

What Is Form WD-6?

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 September 1, 1987;
  • 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 WD-6 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 WD-6 "Waiver and Consent for Individual" - New York

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Form WD-6 (Waiver and Consent for Individual)
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF
In the Matter of the Application of
as
WAIVER AND CONSENT
Administrat
of the Goods,
Chattels and Credits which were of
, deceased,
for leave to compromise a certain cause of action
FILE # ________________
for wrongful death of the decedent and to render and
(as of 9/87)
have judicially settled an account of the proceedings
as such Administrat
.
TO THE SURROGATE’S COURT:
The undersigned,
being over the age of 21 years,
having been born on
and residing at
being a person interested as (state relationship)
of decedent, hereby appears and
waives the issuance and service of a citation in the above proceeding and consents to the following relief:
(
The adult distributee, or other adult interested party, must specifically consent to each and every item of relief
requested by the petitioner) NOTE: If the adult distributee is entitled to share in the proceeds of the settlem ent,
but is voluntarily relinquishing that right, this must be clearly stated as well.
THAT the account of the proceedings of
, as administrat
of the
estate of
, deceased, a copy of which is attached, should be judicially
settled, and
THAT the administrat
should be empowered to compromise and settle a certain claim for the
wrongful death against
for the sum of $
and to
discontinue any claim for conscious pain and suffering, and
THAT the provisions of the limited Letters of administration issued to the petitioner on
restraining the compromise or collecting upon the aforesaid claim and cause of action should be modified to
permit said compromise, and
THAT the filing of a bond should be dispensed with, and
THAT the defendant,
, or defendant’s insurance company should
pay to
, Esqs., out of the proceeds of the settlement for the claim for
wrongful death, the sum of $
As and for attorneys’ fees together with disbursements in the sum
of $
, and
THAT the entire recovery of $
should be allocated to the cause of action for
decedent’s wrongful death, and
THAT the balance of the settlement, to wit the sum of $
, should be distributed to
those distributees having sustained a pecuniary loss as follows:
% of the balance to
widow/widower of decedent;
% of the balance to
,
1
Form WD-6 (Waiver and Consent for Individual)
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF
In the Matter of the Application of
as
WAIVER AND CONSENT
Administrat
of the Goods,
Chattels and Credits which were of
, deceased,
for leave to compromise a certain cause of action
FILE # ________________
for wrongful death of the decedent and to render and
(as of 9/87)
have judicially settled an account of the proceedings
as such Administrat
.
TO THE SURROGATE’S COURT:
The undersigned,
being over the age of 21 years,
having been born on
and residing at
being a person interested as (state relationship)
of decedent, hereby appears and
waives the issuance and service of a citation in the above proceeding and consents to the following relief:
(
The adult distributee, or other adult interested party, must specifically consent to each and every item of relief
requested by the petitioner) NOTE: If the adult distributee is entitled to share in the proceeds of the settlem ent,
but is voluntarily relinquishing that right, this must be clearly stated as well.
THAT the account of the proceedings of
, as administrat
of the
estate of
, deceased, a copy of which is attached, should be judicially
settled, and
THAT the administrat
should be empowered to compromise and settle a certain claim for the
wrongful death against
for the sum of $
and to
discontinue any claim for conscious pain and suffering, and
THAT the provisions of the limited Letters of administration issued to the petitioner on
restraining the compromise or collecting upon the aforesaid claim and cause of action should be modified to
permit said compromise, and
THAT the filing of a bond should be dispensed with, and
THAT the defendant,
, or defendant’s insurance company should
pay to
, Esqs., out of the proceeds of the settlement for the claim for
wrongful death, the sum of $
As and for attorneys’ fees together with disbursements in the sum
of $
, and
THAT the entire recovery of $
should be allocated to the cause of action for
decedent’s wrongful death, and
THAT the balance of the settlement, to wit the sum of $
, should be distributed to
those distributees having sustained a pecuniary loss as follows:
% of the balance to
widow/widower of decedent;
% of the balance to
,
1
child of decedent;
% of the balance to
, child of decedent, and
THAT the claim of
should be rejected, as a non distributee, and
THAT the claim of
in the amount of $
should be
rejected, and
THAT upon payments as hereinbefore mentioned, the said administrat
should be permitted to
execute and deliver general releases and all other necessary papers to the defendant or defendant’s insurance
company, releasing them from all claims against them arising out of the aforesaid action for wrongful death,
together with any other papers necessary to effectuate the said compromise, and
THAT the entire settlement be considered as a settlement for a cause of action for wrongful death and a
waiver of my right to receive any distributee share of the settlement.
DATED: _____________________
STATE OF NEW YORK
)
COUNTY OF
)ss:
On the __________ day of __________________________, 20____, before me personally came
known to me to be the person who is described in the
foregoing Waiver and Consent, and acknowledged to me that he/she executed same.
Notary Public
Commission Expires:
(Affix Stamp)
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