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Receipt And Release Form. This is a New York form and can be use in Surrogates Court Statewide.
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Tags: Receipt And Release, JA-2, New York Statewide, Surrogates Court
SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF
------------------------------------------------------------------------------X
ACCOUNTING BY ________________________________
RECEIPT AND RELEASE
File No.
as the
of the ESTATE OF ________________________________
a/k/a ___________________________________________
Deceased.
------------------------------------------------------------------------------X
The undersigned, being of full age, sound m ind and under no disability, and entitled to share in the estate of the above
nam ed decedent as a [check one]
legatee under a will,
distributee of an intestate share,
trust beneficiary,
creditor of the estate,
other [specify]
(a)
Acknowledges that each fiduciary nam ed above has fully and satisfactorily accounted for all assets of the
estate;
(b)
Approves the written account verified on
, 20
as
subm itted to the undersigned;
[Delete paragraphs (a) and (b) if the undersigned is not interested in or affected by the am ount of the residuary
estate or trust, or if being m ade pursuant to a decree of the court.]
(c)
Acknowledges receipt of m oney paid or property transferred or delivered as follows:
m oney (cash or check):
the following property: _______________________
$
valued at
$
The following paym ent and/or transfer is in full paym ent or distribution of:
a legacy under Paragraph/Article
of the will or trust;
a claim against the estate;
the am ount directed to be paid by a decree of this court dated:____________________
other [specify]: ___________________________________________________________
(d)
Releases and discharges each fiduciary nam ed above from all liability to the undersigned for any and all
m atters relating to or derived from the adm inistration of the estate; waives the issuance and service of a
citation to attend any and all proceedings for the judicial settlem ent of the account; and authorizes the
Surrogate to m ake and enter a decree settling the account and fully releasing and discharging each fiduciary
nam ed above as to all m atters em braced therein.
Dated:
(Signature)
(Corporate Nam e)
(Print Nam e)
(Signature of Officer)
JA-2 (12/96)
American LegalNet, Inc.
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STATE OF NEW YORK
)
COUNTY OF_____________________ )
On
ss.:
, 20
, before m e personally appeared
[INDIVIDUAL]
to m e known and known to m e to be the person
described in and who executed the foregoing receipt and release and duly acknowledged the execution thereof.
[CORPORATION]
to m e known, who duly swore to the foregoing instrum ent and who did say
that he/she resides at
and that he/she is a
of
the
corporation/national banking association described in and which executed such instrum ent; and that he/she signed his/her
nam e thereto by order of the Board of Directors of the corporation.
Notary Public
Com m ission Expires:
____________
(Affix Notary Stam p or Seal)
Nam e of Attorney:
Tel. No.:
Address of Attorney:
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