SURROGATES COURT OF THE STATE OF NEW YORK COUNTY OF VOLUNTARY ADMINISTRATION, Estate of RENUNCIATION OF VOLUNTARY ADMINISTRATION (as of 6/91) , Deceased. File No. TO THE SURROGATES COURT: The undersigned, whose domiciliary address is (Street Address) (City/Town/Village) (State) (Zip) Mailing Address (If different from domicile) being of full age and [check and complete] [ ] a distributee of the above-named decedent and related as a (state relationship) [ ] a fiduciary or legatee named in the decedents will dated ___________________ hereby personally appears herein and renounces all right to act as voluntary administrator/rix of the goods, chattels and credits of the decedent. (Renouncing Party) (Print Name) STATE OF NEW YORK ) ) ss.: COUNTY OF ) On the ________ day of __________________ , 20__ , before me personally came ________________________________ , known to me to be the individual described in and who executed the foregoing instrument, and to me such person duly acknowledged that he/she executed the same. ___________________________________ Notary Public My commission expires: ___________________________________ Signature of Attorney: ______________________________________________________________________ Print Name of Attorney: _____________________________________________________________________ Firm Name: ______________________________________________ Tel. No. _________________________ Address of Attorney: _______________________________________________________________________ SE-1C