SURROGATE'S COURT OF THE STATE OF NEW YORK COUNTY OF X ACCOUNTING BY as the of the ESTATE OF a/k/a Deceased. X A petition praying for a decree judicially settling the final/intermediate account having been presented and filed in this court and the time to present claims against the estate having expired, and a citation having been issued directed to all persons interested in this proceeding requiring them to show cause why a decree should not be granted judicially settling the account prayed for in the petition, and the citation having been returned with proof of due service thereof on the following: FINAL/INTERMEDIATE DECREE OF JUDICIAL SETTLEMENT EXECUTOR WITH TRUST OR TRUSTEE File No. and duly executed waivers of the service of citation or receipts and releases having been filed for the following: and the following parties having appeared in answer to the citation: and , attorneys, having appeared for the petitioner, and there being no other appearances, and the Surrogate having appointed as guardian ad litem for the following persons under a disability: and each guardian ad litem having filed a report recommending that the account be judicially settled and no objection having been filed to the account, and it appearing that all tax returns required by law have been filed and all New York State estate taxes have been fully paid, provision made therefore, or the estate is exempt from tax; and the Surrogate having examined the account having found that each petitioner has fully accounted for all of the monies and property of the estate that have come into the petitioner's hands for the period of the account, as adjusted, it is ORDERED, ADJUDGED AND DECREED, that the final/intermediate account be and the same hereby is judicially settled and allowed as filed (and adjusted), and that the following is a summary thereof as settled: JA-5 (12/96) -12001 ©American Legalnet, Inc. SUMMARY PRINCIPAL ACCOUNT CHARGES: Schedule ''All Schedule ''A-111 (Principal received) $ $ - (Realized increases in principal) Total principal charges $ CREDITS: Schedule Schedule IIBII - (Realized decreases in principal) $ IICII - (Funeral and administration expenses) $ $ [Does not apply in a trustee's account] $ Schedule I'D'' - (Creditor's claims actually paid) Schedule ''Ell - (Distributions of principal) Total principal credits $ $ Principal balance on hand shown by Schedule IIGII INCOME ACCOUNT CHARGES: Schedule ''A-211 - (Income collected) $ Total income charges $ CREDITS: Schedule IIC-211 - (Administration expenses) $ $ Schedule ''E-111 - (Distributions of income) Total income credits Balance of undistributed income remaining on hand as shown in Schedule ''G-1'' $ $ -22001 ©American Legalnet, Inc. COMBINED ACCOUNTS Principal on hand: Cash Other Property Total Income on hand: Cash Other Property Total Total on hand as of , 20 $ $ $ $ $ $ $ and it is further ORDERED, ADJUDGED AND DECREED, that petitioner(s) pay the remaining cash and transfer, assign and deliver the other remaining assets as shown in the account as follows To the petitioner: as and for commissions the sum of To the petitioner: as and for commissions the sum of To the attorney: for legal services rendered for the benefit of the estate the sum of and for costs and disbursements (which sums are in addition to any payments made on account and allowed by the court) To the guardian ad litem: for services as guardian ad litem and it is further $ $ f I $ $ I I $ I -32001 ©American Legalnet, Inc. ORDERED, ADJUDGED AND DECREED, that the balance remaining on hand in the amount of $ be paid as follows To $ ORDERED, ADJUDGED AND DECREED, that upon complying with the directions of this decree and the filing of the receipts for the payments herein directed, the petitioner(s) hereby shall be discharged as to all matters and things contained in this accounting and decree Dated: Judge of the Surrogate's Court -42001 ©American Legalnet, Inc.