For Office Use Only Filing Fee Paid $ Receipt No: DO NOT LEAVE ANY ITEMS BLANK SURROGATE'S COURT OF THE STATE OF NEW YORK COUNTY OF -------------------------------------------------------------------------------X ACCOUNTING BY as the of the ESTATE OF File No. a/k/a Deceased. -------------------------------------------------------------------------------X PETITION FOR JUDICIAL SETTLEMENT OF ACCOUNT OF Executor Adm inistrator Trustee Other [specify] TO THE SURROGATE'S COURT, COUNTY OF It is respectfully alleged: 1. The nam e(s), and address(es) of the petitioner(s), the type and date of letters issued, and the am ount and surety of petitioner's (s') bond, if any, are as follows: Nam e: Address: (Street Address) (City/Town/Village) (County) Mailing address: (State) (Zip) (Telephone Num ber) (if different from above) Type of letters issued: Date letters issued: Am ount of bond: $ Nam e of surety: Nam e: Address: (Street Address) (City/Town/Village) (County) (State) (Zip) (Telephone Num ber) Mailing address: (if different from above) Type of letters issued: Date letters issued: JA-1 (4/98) -1 American LegalNet, Inc. www.FormsWorkFlow.com 2. Nam e: The decedent's nam e, date of death and dom icile are as follows: Date of death: Dom icile: (Street Address) (City/Town/Village) (State) (Zip Code) Township of: County of: 3. The petitioner(s) present (s) and render (s) herewith, a verified account of petitioner's (s') proceedings in this estate or trust, for the period from to , showing the gross value of assets, including principal and incom e, to be the sum of $ . (a) An order was entered in this Court on Exem pting the estate from tax Fixing and assessing the tax due [Attach a copy of the tax order and receipt] (b) The following return (s) (was) (were) filed: ET-90 [For decedent's dying on or after May 25, 1990]. A copy was filed with the Surrogate's Court TT-385 [For decedent's dying before May 25, 1990] 706 or 706NA The estate taxes with respect to this estate were paid in full. [Attach a copy of letter of discharge.] (c.) No tax proceeding or return was required for this estate. , 20 . 4. Yes No 5. The rendering of such account at this tim e is proper because check appropriate reason] seven m onths have elapsed since letters were issued to petitioner(s); letters issued to the petitioner(s) have been revoked, m ore than one year has elapsed since the preceding account of the petitioner(s) was settled; other reason [specify]: 6. The nam es and post-office addresses of all persons and parties interested in this proceeding who are required to be cited under the provisions of Surrogate's Court Procedure Act §2210, or otherwise, or concerning whom or which the Court is required to have inform ation, are set forth in subdivision (a) or (b): (a) All persons and parties so interested herein who are of full age and sound m ind, or which are corporations or associations, are as follows: -2 American LegalNet, Inc. www.FormsWorkFlow.com Nam e ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ Nature of Interest _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ P.O. Address _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ (b) All persons so interested herein who are infants or incom petents or persons believed to be m entally incapable to adequately protect their rights, or persons whose existence, identity, or whereabouts are unknown (including persons who are virtually represented under SCPA §315) are as follows: [Furnish all inform ation specified in NOTE at bottom of page] Nam e ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ Nature of Interest _________________________ _________________________ _________________________ _________________________ _________________________ P.O. Address __________________________ __________________________ __________________________ __________________________ __________________________ [NOTE: In the case of each infant, state (a) nam e, birth date, age, nature of interest, domicile, residence address, and the person w ith whom he/she resides; (b) w hether or not he/she has a guardian or testamentary guardian, (c) the nam e and post office and whether or not his/her father, or if he/she be dead, his/her mother is living; and address of any guardian and any living parent. In the case of each incompetent or person incapable of adequately protecting his/her rights, state (a) name, nature of interest, and post office address; (b) facts regarding his/her incompetency, including whether or not a com mittee has been appointed and whether or not he/she has been committed at any institution; (c) the names and post office addresses of any committee, conservator, guardian, and person or institution having care and custody of him/her, and any relative or friend having an interest in his/her w elfare. In the case of unknow ns, describe in identical language to be used in citation for publication. In the case of a person confined as a prisoner, state place of incarceration. W ith respect to virtual representation see Uniform Court Rule, §207.18.] 7. There are no persons interested in this proceeding other than those herein about m entioned. 8. No prior application has been m ade to this or any other court for the relief requested in this petition. W HEREFORE the petitioner(s) pray (s) that the account of proceedings be judicially settled -3 American LegalNet, Inc. www.FormsWorkFlow.com [specify any other relief requested.] _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ and that process be issued to all necessary parties who have not appeared to show cause why the relief requested should not be granted; and that an order be granted directing the service of process