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3. The names and addresses of all persons and parties interested in this proceeding having a right
to letters of administration c.t.a. (with the will annexed) prior or equal to the petitioner under the provisions of SCPA §1418
and 1419, are as follows: [Furnish all information specified in NOTE below, if required]
Name_________________________ Domicile Address and______________________Description of Legacy, Devisee
Relationship______________________Mailing Address____________________________ or Other Interest, or Nature
of Fiduciary Status: _________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. The names and addresses of all persons and parties who are beneficiaries named in the will other than
those named in paragraph 3 above are as follows: [Furnish all information specified in NOTE below, if required]
Name_________________________ Domicile Address and______________________Description of Legacy, Devisee
Relationship______________________Mailing Address____________________________ or Other Interest, or Nature
of Fiduciary Status:__________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. There are no persons other than those hereinbefore mentioned interested in this proceeding.
6. There are no outstanding debts or funeral expenses, except: [If “NONE” so state]
7. (a) To the best of the knowledge of the undersigned, property of the estate remains unadministered as
follows:
Personal Property $ ________________ Improved real property in New York State $ ____________________
Unimproved real property in New York State $ ____________________________________________________
Estimated gross rents for a period of 18 months $ _________________________________________________
(b) No other testamentary assets exist in New York State, nor does any cause of action exist on behalf of
the estate as follows: [Enter “NONE” or specify] _______________________________________________________
[NOTE: In the case of each infant, state (a) name, birth date, relationship to decedent, domicile and residence address,
and the person with whom he/she resides, (b) whether or not he/she has a court-appointed guardian (if not, so state), and
whether or not his/her father and/or mother is living, and (c) the name and residence address of any court-appointed guardian
and the information regarding such appointment. In the case of each other person under a disability, state (a) name,
relationship to decedent, and residence address, (b) facts regarding this disability including whether or not a committee,
conservator, guardian, or any other fiduciary has been appointed and whether or not he/she has been committed to any
institution, and (c) the names and addresses of any committee, person or institution having care and custody of him/her;
conservator; guardian; and any relative or friend having an interest in his/her welfare. In the case of a person confined as a
prisoner, state place of incarceration and list any person having an interest in his/her welfare.
Wherefore, petitioner (s) pray (s) (a) that process issue to all necessary parties and
(b) that letters issue as follows:
Letters of Administration c.t.a. to: ______________________________________________________
(c) [State any other relief requested] ___________________________________________________________________
Dated: ______________________________
1. ________________________________________ 2.____________________________________
(Signature of Petitioner) (Signature of Petitioner)
__________________________________________ _____________________________________
(Print Name) (Print Name)
3.________________________________________
(Name of Corporate Petitioner)
__________________________________________
(Signature of Officer)
__________________________________________
(Print Name and Title of Officer)