SURROGATE'S COURT OF THE STATE OF NEW YORK COUNTY In The Matter of the Estate of FIREARMS INVENTORY (SCPA §2509) _______________________________ Deceased. FILE NUMBER _______ __ __ _______ __ __ __ The undersigned, [ ] a fiduciary, or [ ] an attorney of record certifies that the following firearms, as defined by Section 265.00 of the Penal Law, make up part of the decedent's estate. Name of Fiduciary or Attorney:________________________________________________________________ (Address, if changed): ____________________________________________________________ _ Make: 1 2 3 4 5 6 7 8 9 10 11 12 TOTAL: (as indicated in section F2 of Inventory of Assets) Model: Caliber or Gauge: Serial #: $ Valuation: G (mark box if more entries are necessary - and attach extra pages) ATTORNEY Name: ______________________________ Address: ___________________________ Certified to be true on ______________, 20_____ ________________________________________ Signature ____________________________ Telephone:__________________________ A copy of this Inventory must also be filed with DCJS at: Division of Criminal Justice Services Alfred E. Smith Building 80 South Swan Street Albany, NY 12210 ________________________________________ Print Name Firearms Inventories filed with the Surrogate's Court will be kept in a secure location separate from the estate file and will be made available for inspection only to persons interested in the proceeding and their counsel, unless otherwise ordered by the Court. I-2 5/2013 American LegalNet, Inc. www.FormsWorkFlow.com