SURROGATE'S COURT, QUEENS COUNTY In the Matter of the Application to examine a residence of File No. ________________ Petition to Examine Residence Deceased. TO THE SURROGATE'S COURT OF THE COUNTY OF QUEENS: The petition of _______________________________________________ respectfully shows that he/she is ________________________________ of __________________________________ deceased, and resides at ___________________________________________________________. That the said _________________________________ died at ________________________ _______________________ on __________________ a resident of _________________________ __________________________ in the County of Queens and State of New York. That the said deceased has a residence at ________________________________________ in the County of _________________ and State of New York. That the names, residence addresses and relationship of the distributees of the decedent are as follows: Name Residence Relationship -1- American LegalNet, Inc. www.FormsWorkFlow.com Your petitioner believes that said deceased may have left one or more of the following papers or instruments in said residence, to wit, a will of said deceased, a policy or policies of insurance issued in the name of said decedent and payable to a named beneficiary or beneficiaries and a deed to a burial plot in which said decedent is to be interred. WHEREFORE your petitioner prays that an order be made permitting the petitioner, or agent of the petitioner, to examine the said residence accompanied by an officer of the New York City Police Department, for the purpose of ascertaining if any of said papers or instruments be deposited therein, and if a will of said deceased be found the same be delivered to the Clerk of this court; if such policy or policies of insurance be found that they be delivered to the beneficiary or beneficiaries named therein, and if a deed to such burial plot be found that the same be delivered to your petitioner, or agent of the petitioner, and that your petitioner, or agent of the petitioner, be permitted to make a copy of any paper or papers found in said residence bearing upon the desire of the said deceased as to the disposal of his/her remains, and your petitioner further prays that he/she or the agent of the petitioner, be permitted to make an inventory of the contents of said residence in order to fix the amount of the bond to be given on an application for letters of administration. Dated: Petitioner STATE OF NEW YORK, COUNTY OF }ss.: being duly sworn, says that he/she is the petitioner named in the foregoing petition, that he/she has read the foregoing petition subscribed by him/her and knows the contents thereof; and the same is true of his/her own knowledge, except as to the matters therein stated to be alleged on information and belief, and that as to those matters he/she believes it to be true. Sworn to before me this day of Petitioner Notary Public, State of New York Attorney for Petitioner (M-RESIDENCE.PET-2/11) -2- American LegalNet, Inc. www.FormsWorkFlow.com