SURROGATE222S COURT OF THE STATE OF NEW YORK þ COUNTY OF þ þ þ XPROBATE PROCEEDING, þ þ AFFIDAVIT OF NO DEBTWILL OF þ þ (For use with Letters of þ þ Administration c.t.a.)a/k/a þ þ þ þ þ þ þ Deceased. þ þ X þ File No. þ STATE OF NEW YORK þ þ ) COUNTY OF þ þ þ ) þ ss.: þ þ , being duly sworn, deposes and says:that he/she resides at þ , County of þ , þ State of þ ; that he/she is the person seeking appointment as administrator c.t.a. in the above entitled proceeding; that the value of all personal property receivable by þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ months will not exceed the sum of $ þ ; that deponent has made a diligent search to ascertain whether or not there are any debts or claims against the estate of said decedent and that there are no claims, including unpaid funeral and medical bills, except as follows:[If 223none224, write 223NONE224] þ NAME þ þ AMOUNT $ þ ADDRESS þ NATURE OF CLAIM þ NAME þ þ AMOUNT $ þ ADDRESS þ NATURE OF CLAIM þ NAME þ þ AMOUNT $ þ ADDRESS þ NATURE OF CLAIM þ Sworn to before me this þ day of , 20 þ þ þ Signature þ þ þ Print NameNotary Public: þ þ Commission Expires: þ þ þ þ þ Name of Attorney: þ þ Tel No.: þ Address of Attorney: þ þ P-12 (10/96) American LegalNet, Inc. www.FormsWorkFlow.com