For Office Use Only Filing Fee Paid $____________ __________Certs: $___________ $___________Bond, Fee:_______ Receipt No:_______ No:_______ DO NOT LEAVE ANY ITEMS BLANK SURROGATE'S COURT OF THE STATE OF NEW YORK PETITION FOR COUNTY OF LETTERS OF ADMINISTRATION d.b.n. ----------------------------------------X SCPA 1007 LETTERS OF ADMINISTRATION d.b.n. ESTATE OF [ ] Letters of Administration d.b.n. a/k/a [ ] Letters of Administration d.b.n. with Limitations [ ] Limited Letters of Administration d.b.n. Deceased. File No. ________________________ ----------------------------------------X TO THE SURROGATE'S COURT, COUNTY OF : It is respectfully alleged: 1.(a) The name, citizenship, domicile (or, in the case of a bank or trust company, its principal office) and interest in this proceeding of the petitioner(s) is/are as follows: Name: ______________________________________________________________________________________ Domicile or Principal Office: ______________________________________________________________ (Street and Number) (City, Village or Town) ____________________________________________________________________________________________ (County) (State) (Zip Code) (Telephone Number) Mailing Address:____________________________________________________________________________ (if different from domicile) Citizenship (check one): [ ] U.S.A. [ ] Other (specify) _____________________________ Name:_______________________________________________________________________________________ Domicile or Principal Office: ______________________________________________________________ (Street and Number) (City, Village or Town) ____________________________________________________________________________________________ (County) (State) (Zip Code) (Telephone Number) Mailing Address:____________________________________________________________________________ (if different from domicile) Citizenship (check one): [ ] U.S.A. [ ] Other (specify) ____________________________ Interest(s) of Petitioner(s): [Check one] [ ] Distributee of decedent (state relationship) ___________________________________ [ ] Other [Specify] ________________________________________________________________ 1.(b) 2. Is the proposed Administrator d.b.n. an attorney? Yes [ ] No [ ] [NOTE: If yes, submit statement pursuant to 22 NYCRR 207.16(e); see also 207.52] Letters of Administration of the above-named decedent were issued by this court on _____________________, to __________________________________, who on _______________________, [ ] died [ ] resigned ADM/DBN-1 (7/98) [ ] was removed. -1- 2001 © American LegalNet, Inc. [Note: For paragraphs 3a through c: Do not include any assets that are jointly held, held in trust for another, or have a named beneficiary.] 3.(a) The estimated gross value of unadministered personal property passing by intestacy is less than $_________________. (b) The estimated gross value of the decedent's unadministered real property, in this state, which is [ ] improved [ ] unimproved, passing by intestacy is less than $_________________. A brief description of each parcel is as follows: (c) The estimated gross rent for a period of eighteen (18) months is the sum of $__________________. (d) In addition to the value of the personal property stated in paragraph (3)(a), the following right of action existed on behalf of the decedent and survived his/her death, or is granted to the administrator of the decedent by special provision of law, and it is impractical to give a bond sufficient to cover the probable amount to be recovered therein: [Write "NONE" or state briefly the cause of action and the person against who it exists, including names and carrier]. (e) If decedent is survived by a spouse and a parent, or parents but no issue, and there is a claim for wrongful death, check here [ ] and furnish name(s) and address(es) of parent(s) in paragraph 5. See EPTL 5-4.4. 4. The decedent left surviving the following who would inherit his/her estate pursuant to EPTL 4-1.1 and 4-1.2: a. [ ] Spouse (husband/wife). [ ] Divorced [Attach copy of Divorce Decree] b. [ ] Child or children or descendants of predeceased child or children, include marital, non-marital, and adopted]. c. [ ] Any issue of the decedent adopted by persons related to the decedent (DRL Section 117). d. [ ] Mother/Father. e. [ ] Sisters and brothers, either of whole or half blood, and issue of predeceased sisters and brothers. f. [ ] Grandmother/Grandfather. g. [ ] h. [ ] Aunts or uncles, and children of predeceased aunts and uncles (first cousins). First cousins once removed (children of first cousins). [Must [Information is required only as to those classes of relatives who would take the property of decedent pursuant to EPTL 4-1.1. State "number" of survivors in each class. Insert "No" in all prior classes. Insert "X" in all subsequent classes]. ADM/DBN-1 (7/98) -2- 2001 © American LegalNet, Inc. 5. The decedent left surviving the following distributees, or other necessary parties, whose names, degrees of relationship, domiciles, post office addresses and citizenship are as follows: [Note: Show clearly how each person is related to decedent. If relationship is through an ancestor who is deceased, give name, date of death, and relationship of the ancestor to the decedent. Use rider sheet if space in paragraph (5) is not sufficient. See Uniform Rules 207.16(b). If any person listed in paragraph (5) is a nonmarital person, or descended from a nonmarital person, attach a copy of the order of filiation or Schedule A. If any person listed in paragraph (5) was adopted by any persons related by blood or marriage to decedent or descended from such persons, attach Schedule B.] 5a. The following are of full age and under no disability: [If nonmarital or adopted-out person, so indicate by attaching Schedule A and/or B. If any of the distributees have died subsequent to the death of the decedent, give the name and title of the legal representative appointed for such person(s), his or her address and the court that issued such letters. If any distributee who has died, subsequent to the death of the decedent, has no legal representative, then enter the name, relationship, domicile address and citizenship of that deceased person(s) distributee(s).] Name Relationship Domicile and Mailing Address Citizenship 5b. The following are infants and/or persons under disability: [Attach applicable Schedule A, B, C and/or D] Name Relationship ADM/DBN-1 (7/98) 6. Domicile and Mailing Address Citizenship -3- There are no persons interested in this proceeding other than those herein mentioned. 2001 © American LegalNet, Inc. 7. There are no outstanding debts or funeral expenses, except: [Write "NONE" or state same] WHEREFORE, your petitioner(s) respectfully pray(s) that: requested] [Check and complete all relief ( ) a. Process issue to all necessary parties to show cause why letters should not be issued as requested; ( ) b. An order be granted dispensing with service of process upon those persons named in paragraph 5 who have a right to letters prior or equal to that of the person nominated, and who are non-domiciliaries or whose names or whereabouts are unknown and cannot be ascertained; ( ) c. A decree award Letters of Administration d.b.n. to _________________________________ _________________________________________________________________________________ or to such other person or persons having a prior right as may be entitled thereto, and; ( ) d. That the authority of the representative under the foregoing Letters be limited with respect to the prosecution or enforcement of a cause of action on behalf of the estate, as follows: the administrator(s) may not enforce a judgment or receive any funds without further order of the Surrogate. ( ) e. That the authority of the representative under the foregoing Letters be limited as follows: ( ) f. [State any other relief requested]. Dated: __________________________ 1. __________________________________________ (Signature of Petitioner) 2. _____________________________________ (Signature of Petitioner) __________________________________________ (Print Name) _____________________________________ (Print Name) 3. __________________________________________ (Name of Corporate Petitioner) __________________________________________ (Signature of Officer) __________________________________________ (Print Name and Title of Officer) ADM/DBN-1 (7/98) -4- SURROGATE'S COURT OF THE STATE OF NEW YORK COUNTY OF 2001© American LegalNet, Inc. ----------------------------------------X LETTERS OF ADMINISTRATION d.b.n., ESTATE OF a/k/a SCHEDULE A NONMARITAL PERSONS (PERSONS BORN OUT OF WEDLOCK) File No. _____________________ Deceased. ----------------------------------------X [NOTE: Nonmarital children (or their issue) who would be distributees if they (or their ancestors) were born in wedlock will not be regarded as distributees unless satisfactory proof is submitted establishing paternity]. See EPTL 4-1.2, which sets forth methods of establishing paternity. Name of alleged distributee: _________________________________________________________ Date of birth: _________________________ Relationship to decedent: ____________________ Name of father: _______________________________________________________________________ Name of mother: _______________________________________________________________________ Does the birth certificate contain the father's name? Yes [ ] No [ ] If yes, attach a copy of birth certificate. Has an order of filiation establishing paternity been entered? Yes [ ] No [ ] If yes, attach copy of order. Did the nonmarital person live with his or her father? Yes [ ] No [ ] If yes, give dates and place of residence: _____________________________________ ________________________________________________________________________________ ________________________________________________________________________________ SURROGATE'S COURT OF THE STATE OF NEW YORK 2000 © American LegalNet, Inc. COUNTY OF ----------------------------------------X LETTERS OF ADMINISTRATION d.b.n., ESTATE OF a/k/a SCHEDULE B ISSUE OF THE DECEDENT WHO WERE THE SUBJECT OF AN ADOPTION File No. _____________________ Deceased. ----------------------------------------X Name of child: ________________________________________________________________________ Relationship to decedent prior to adoption: ___________________________________________ Date of adoption: _____________________________________________________________________ Was this a step-parent adoption? (i.e., was the child adopted by the spouse of the decedent's former spouse?) Yes [ ] No [ ] If yes, name of adoptive father or mother: _____________________________________ If not a step-parent adoption, indicate below the biological relationship of the adoptive parent to the child: [ ] grandparents(s) [ ] brother or sister [ ] aunt or uncle [ ] first cousin [ ] nephew or niece Name of the adoptive parent _______________________________________________________________ SURROGATE'S COURT OF THE STATE OF NEW YORK COUNTY OF 2000 © American LegalNet, Inc. ----------------------------------------X LETTERS OF ADMINISTRATION d.b.n., ESTATE OF SCHEDULE C INFANTS a/k/a File No. _____________________ Deceased. ----------------------------------------X Name: ______________________________________________________ Date of birth:____________ Relationship to the decedent: _________________________________________________________ With whom does the infant reside? _____________________________________________________ Name of mother: ____________________________________________ Is she alive? ____________ Name of father: ____________________________________________ Is he alive? _____________ Does the infant have a court-appointed guardian? Yes [ ] No [ ] If yes, name and address of guardian: __________________________________________ ________________________________________________________________________________ Name: ______________________________________________________ Date of birth:___________ Relationship to the decedent: ________________________________________________________ With whom does the infant reside? ____________________________________________________ Name of mother: ____________________________________________ Is she alive? ___________ Name of father: ____________________________________________ Is he alive? ____________ Does the infant have a court-appointed guardian? Yes [ ] No [ ] If yes, name and address of guardian: ___________________________________________ _________________________________________________________________________________ SURROGATE'S COURT OF THE STATE OF NEW YORK COUNTY OF 2000 © American LegalNet, Inc. ----------------------------------------X LETTERS OF ADMINISTRATION d.b.n., ESTATE OF SCHEDULE D PERSONS UNDER DISABILITY OTHER THAN INFANTS a/k/a File No. _____________________ Deceased. ----------------------------------------X [Use additional sheets if needed] 1. Name: __________________________________________________ Relationship: _________________ Residence: _____________________________________________________________________________ With whom does this person reside? _____________________________________________________ If this person is in prison, name of prison: ___________________________________________ Does this person have a court-appointed fiduciary? Yes [ ] No [ ] If yes, give name, title and address: ___________________________________________ _________________________________________________________________________________ If no, describe nature of disability: ___________________________________________ _________________________________________________________________________________ If no, give name and address of relative or friend interested in his or her welfare:_________________________________________________________________________ _________________________________________________________________________________ 2. Whereabouts unknown/Unknowns [persons whose addresses or names are unknown to petitioner; if known, give name and relationship to decedent]: COMBINED VERIFICATION, OATH & DESIGNATION 2000 © American LegalNet, Inc. [For use when petitioner is to be appointed administrator d.b.n.] STATE OF COUNTY OF ) ) ss: The undersigned, the petitioner named in the foregoing petition, being duly sworn, says: 1. VERIFICATION: I have read the foregoing petition subscribed by me and know the contents thereof, and the same is true of my own knowledge, except as to the matters therein stated to be alleged upon information and belief, and as to those matters I believe it to be true. 2. OATH OF ADMINISTRATOR d.b.n.: I am over eighteen (18) years of age and a citizen of the United States; I will well, faithfully and honestly discharge the duties of the administrator d.b.n.. I am not ineligible to receive letters. 3. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I do hereby designate the Clerk of the Surrogate's Court of __________________________ County, and his or her successor in office, as a person on whom service of any process issuing from such Surrogate's Court may be made, in like manner and with like effect as if it were served personally upon me, whenever I cannot be found within the State of New York after due diligence used. My domicile is _________________________________________________________________________ (Street Address) (City/Town/Village) (State) (Zip Code) __________________________________________ (Signature of Petitioner) ___________________________________________ (Print Name) On ________________________________________________, _________, before me personally came ______________________________________________________________________________________________ to me known to be the person described in and who executed the foregoing instrument. Such person duly swore to such instrument before me and duly acknowledged that he/she executed the same. ______________________________________ Notary Public Commission Expires: (Affix Notary Stamp or Seal) Signature of Attorney:________________________________________________________________________ Print Name:___________________________________________________________________________________ Firm Name: ________________________________________________________Tel. No.:__________________ Address of Attorney: _________________________________________________________________________ ADM/DBN-1 (7/98) -5- COMBINED CORPORATE VERIFICATION, CONSENT AND DESIGNATION 2000 © American LegalNet, Inc. [For use when a petitioner to be appointed is a bank or trust company] STATE OF COUNTY OF ) ) ss: The undersigned, a ___________________________________________________________________ of (Title) ______________________________________________________________________________________________ (Name of Bank or Trust Company) a corporation duly qualified to act in a fiduciary capacity without further security, being duly sworn, say: 1. VERIFICATION: I have read the foregoing petition subscribed by me and know the contents thereof, and the same is true of my own knowledge, except as to the matters therein stated to be alleged upon information and belief, and as to those matters I believe it to be true. 2. CONSENT: I consent to accept the appointment as Administrator d.b.n. of the decedent described in the foregoing petition and consent to act as such fiduciary. 3. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I do hereby designate the Clerk of the Surrogate's Court of __________________________ County, and his or her successor in office, as a person on whom service of any process issuing from such Surrogate's Court may be made, in like manner and with like effect as if it were served personally upon me, whenever I cannot be found within the State of New York after due diligence used. __________________________________________ (Name of Corporate Petitioner) __________________________________________ (Signature of Officer) __________________________________________ (Print Name and Title of Officer) On the ________________________, _____, before me personally came ______________________ to me known, who duly swore to the foregoing instrument 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 instrument, and the he/she signed his/her name thereto by order of the Board of Directors of the corporation. ________________________________________ Notary Public Commission Expires: (Affix Notary Stamp or Seal) Signature of Attorney:________________________________________________________________________ Print Name:___________________________________________________________________________________ Firm Name:_________________________________________________________Tel. No.:__________________ Address of Attorney: _________________________________________________________________________ ADM/DBN-1 (7/98) -6- LETTERS OF ADMINISTRATION d.b.n. CITATION File No. ________________ 2000 © American LegalNet, Inc. SURROGATE'S COURT CITATION COUNTY THE PEOPLE OF THE STATE OF NEW YORK, By the Grace of God Free and Independent TO A petition having been duly filed by ___________________________________________, who is domiciled at ________________________________________________________________________________ YOU ARE HEREBY CITED TO SHOW CAUSE before the Surrogate's Court, ________________ County, at _______________________________, New York, on ____________________________________, ______, at o'clock in the noon of that day, why a decree should not be made in the estate of ___________________________________________________________________________________________ lately domiciled at __________________________________________________________________________ granting administration d.b.n. and directing that [ ] Letters of Administration d.b.n. issue to: ___________________________________________ [ ] Letters of Administration d.b.n. with Limitations issue to: __________________________ [ ] Limited Letters of Administration d.b.n. issue to: ___________________________________ (State any further relief requested) HON. Dated, Attested and Sealed, Surrogate ________________________________, ______ (Seal) ___________________________________________ Chief Clerk _____________________________________________________________________________________________ Attorney for Petitioner Telephone Number _____________________________________________________________________________________________ Address of Attorney [Note: This citation is served upon you as required by law. You are not required to appear. If you fail to appear it will be assumed you do not object to the relief requested. You have a right to have an attorney appear for you.] ADM/DBN-2 (7/98) SURROGATE'S COURT OF THE STATE OF NEW YORK COUNTY OF 2000 © American LegalNet, Inc. ----------------------------------------X LETTERS OF ADMINISTRATION d.b.n. ESTATE OF WAIVER OF CITATION, RENUNCIATION AND CONSENT TO APPOINTMENT OF ADMINISTRATOR d.b.n. (INDIVIDUAL) a/k/a File No. ____________________ Deceased. ----------------------------------------X The undersigned, a distributee or creditor of the above-named decedent, and being of full age and sound mind, hereby voluntarily appears in the Surrogate's Court of ____________ County, New York, and waives the issuance and service of citation in this matter, renounces all rights to Letters of Administration d.b.n. of the above captioned estate and consents that [ ] Letters of Administration d.b.n. [ ] Letters of Administration d.b.n. with Limitations [ ] Limited Letters of Administration d.b.n. be issued to ________________________________________________________________________________ or any other person or persons entitled thereto without any notice whatsoever to the undersigned, and consents [ ] that a bond be dispensed with [ ] that a bond in the amount of $________________________________ be posted and hereby specifically releases any claim the undersigned might have under any bond that may be filed. _______ Date _______________________________ Signature _________________________ Street Address _____________________________ Print Name __________________________ Town/State/Zip STATE OF NEW YORK COUNTY OF _______________ Relationship ss.: On __________________________________________________, _______, before me personally came ______________________________________________________________________________________________ to me known and known to be the person described in and who executed the foregoing instrument. Such person duly swore to such instrument before me and duly acknowledged that he/she executed the same. ________________________________ Notary Public Commission Expires: (Affix Notary Stamp or Seal) Name of Attorney: _________________________________________________Tel. No.:____________________ Address of Attorney: ___________________________________________________________________________ ADM/DBN-3 (7/98) SURROGATE'S COURT OF THE STATE OF NEW YORK COUNTY OF 2000 © American LegalNet, Inc. ----------------------------------------X LETTERS OF ADMINISTRATION d.b.n. ESTATE OF CONSENT TO APPOINTMENT OF ADMINISTRATOR d.b.n. (CORPORATION) a/k/a File No. ________________________ Deceased. ----------------------------------------X The undersigned corporation voluntarily appears _____________________ County, New York, and consents that [ Surrogate's Court of ] Letters of Administration d.b.n. with Limitations [ the ] Letters of Administration d.b.n. [ in ] Limited Letters of Administration d.b.n. be issued to ________________________________________________________________________________ or any other person or persons entitled thereto without any notice whatsoever to the undersigned, and consents [ ] that a bond be dispensed with [ ] that a bond in the amount of $________________________________ be posted and hereby specifically releases any claim it might have under any bond that may be filed. ________ Date ____________________________________________ Name of Corporation By: ____________________________________________ (Signature of Officer) ____________________________________________ (Type Name and Title) STATE OF NEW YORK COUNTY OF ss.: On __________________________________________________, _______, before me personally came ______________________________________________________________________________________________ to me known, who being duly sworn did say that: (s)he resides at _____________________________ ___________________________________; (s)he is a ______________________________________________ ___________________________________________ of ______________________________________________, the corporation described in and which executed the foregoing consent; and that (s)he signed the same thereto by order of the board of directors of the above corporation. ________________________________ Notary Public Commission Expires: (Affix Notary Stamp or Seal) Name of Attorney: _________________________________________________Tel. No.:____________________ Address of Attorney: ___________________________________________________________________________ ADM/DBN-4 (7/98) SURROGATE'S COURT OF THE STATE OF NEW YORK COUNTY OF 2000 © American LegalNet, Inc. ----------------------------------------X LETTERS OF ADMINISTRATION d.b.n. ESTATE OF NOTICE OF APPLICATION FOR LETTERS OF ADMINISTRATION d.b.n. (SCPA 1005) a/k/a File No. ________________________ Deceased. ----------------------------------------X Notice is Hereby Given That: 1. An application for Letters of Administration d.b.n. upon the estate of the abovenamed decedent, has been made by ___________________________________________________________, petitioner, whose post office address is: ____________________________________________________ 2. Each and every name of the intestate decedent known to the undersigned is as indicated in the above caption. 3. Petitioner prays that a decree be made directing the issuance of Letters of Administration d.b.n. to ______________________________________________________________________ 4. The name and post office address of each and every distributee of the above-named decedent, as set forth in the petition and known to the undersigned, are as follows: (a) Distributees who have been duly cited or have waived citation or have appeared in this proceeding: _ Name of Distributee __________________________________________ Domicile and Post Office Address _____________________________________________ ______________________________________________ _____________________________________________ ______________________________________________ _____________________________________________ (b) Other Distributees: Name of Distributee _____________________________________________ Domicile and Post Office Address _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ [IF MORE SPACE IS NEEDED ADD RIDER] 5. The undersigned does not know of any other distributees of the said decedent. 6. Letters of Administration d.b.n. will issue on or after ________________, ____ Dated _______________________,_____ ___________________________________________________ Signature of Petitioner or Attorney ___________________________________________________ Print Name ___________________________________________________ Address Name of Attorney: _________________________________________________Tel. No.:_________________ Address of Attorney: ________________________________________________________________________ ADM/DBN-5 (7/98) SURROGATE'S COURT OF THE STATE OF NEW YORK COUNTY OF 2000 © American LegalNet, Inc. ----------------------------------------X LETTERS OF ADMINISTRATION d.b.n. ESTATE OF a/k/a AFFIDAVIT OF MAILING NOTICE OF APPLICATION FOR LETTERS OF ADMINISTRATION d.b.n. (SCPA 1005) File No. ____________________ Deceased. ----------------------------------------X STATE OF NEW YORK COUNTY OF ss.: _____________________________, residing at ____________________________________, New York, being duly sworn, deposes and says that deponent is over the age of eighteen years; that on ______________________, _____, deponent mailed a copy of the foregoing Notice of Application for Letters of Administration d.b.n., contained in a securely closed postpaid wrapper, directed to each of the persons named in paragraph 4(b), respectively, as follows: whose post office address is _________________________________________________________________ whose post office address is _________________________________________________________________ whose post office address is _________________________________________________________________ whose post office address is _________________________________________________________________ whose post office address is _________________________________________________________________ whose post office address is _________________________________________________________________ whose post office address is _________________________________________________________________ whose post office address is _________________________________________________________________ by depositing the document in a letters box or other official depository under the exclusive care and custody of the United States Post Office located at: ______________________________________________________________________________________________ _______________________________________ Signature Sworn to before me this ___________ day of ____________________,_______ ___________________________________ Notary Public Commission Expires: (Affix Stamp or Seal) ADM/DBN-6 (7/98) SURROGATE'S COURT OF THE STATE OF NEW YORK COUNTY OF 2000 © American LegalNet, Inc. ----------------------------------------X LETTERS OF ADMINISTRATION d.b.n. ESTATE OF NOTICE TO THE CONSUL GENERAL a/k/a File No. ____________________ Deceased. ----------------------------------------X TO THE CONSUL GENERAL OF AT THE CITY OF NEW YORK PLEASE TAKE NOTICE that a petition (will be) (has been) presented to the Surrogate's Court, County of _______________________, on ______________________________, _____, with respect to the Estate of the above-named decedent, and it appears from the petition that: a. the deceased was a subject of __________________________________________________ or b. the following distributees are nonresidents of the United States: Names Addresses Citizenship _______________________________________ Attorney for Petitioner _______________________________________ Address _______________________________________ Telephone Number STATE OF NEW YORK COUNTY OF ss.: ________________________________, being duly sworn, says: That he/she resides at ________________________________________________, New York; that on the ___________________________________________, _______, he/she served a copy of the above NOTICE on the Counsel General of __________________________ at _____________________________, New York City, by mailing same to the office of the aforesaid Consul. ________________________________________ Signature Sworn to before me this _________ day of ___________________, _____ _________________________________ Notary Public Commission Expires: (Affix Stamp and Seal) ADM/DBN-7 (7/98) STATE OF NEW YORK Note: File Proof of Service at least 2000 © American LegalNet, Inc. SURROGATE'S COURT : COUNTY OF ----------------------------------------X LETTERS OF ADMINISTRATION d.b.n. Estate of 3 days before return date. State clearly date, time and place of Service and name of person served (Uniform Rule 207.7(c)). a/k/a AFFIDAVIT OF SERVICE OF CITATION (Adult) Deceased. ----------------------------------------X STATE OF NEW YORK : COUNTY OF File No. __________________________ ss.: ....................................... of ................................................... .........................., being duly sworn, says that I am over the age of eighteen years; that I made personal service of the citation herein dated ..........................., 19.... on each person named below, each of whom deponent knew to be the person mentioned and described in said citation, by delivering to and leaving with each of them personally a true copy of said citation, as follows: On ................................, description, viz: sex ........, color of skin ........., color of hair ................., approximate age ......, weight ......., height ........, at .....o'clock ......m. on the ..... day of .........., 19 ..., at ............................. .............................................................................................. On ................................, description, viz: sex ........, color of color of hair ................., approximate age ......, weight ......., skin ........., height ........, at .....o'clock ......m. on the ....... day of ........., 19 ..., at ............................ .............................................................................................. On ................................, description, viz: sex ........, color of color of hair ................., approximate age ......, weight ........, skin ........., height ........, at .... o'clock ......m. on the ..... day of ..........., 19 ..., at ............................. .............................................................................................. That none of the aforesaid persons is in the Military Service as defined by the Act of Congress known as the "Soldiers' and Sailors' Civil Relief Act of 1940" and in the New York "Soldiers' and Sailors' Civil Relief Act." ........................................ Sworn to before me this day of ..................., 19.... .................................. Notary Public Commission Expires: (Affix Stamp or Seal) ADM/DBN-8 (7/98) 2000 © American LegalNet, Inc.