SURROGATE'S COURT OF THE STATE OF NEW YORK COUNTY OF _______________________________ -------------------------------------------------------------------------------VOLUNTARY ADMINISTRATION, Estate of , AMENDED AFFIDAVIT IN RELATION TO SETTLEMENT OF ESTATE UNDER ARTICLE 13, SCPA (as of 6/91) File No. _____________________________ Deceased. -------------------------------------------------------------------------------STATE OF NEW YORK ) ) ss.: COUNTY OF _______________) I, ___________________________ , being duly sworn, depose and say: 1. I am the voluntary administrator/trix of the above-named decedent and make this affidavit pursuant to Article 13 of the Surrogate's Court procedure Act. The original and any amended affidavits were filed on the following dates: [list dates] 2. I was found qualified to act as the voluntary administrator/trix of the above captioned estate by the ___________________________ County Surrogate's Court on the ________ day of , 20 . 3. The following items of personal property, owned by the above-named decedent, were not listed in paragraph 9 of the Affidavit of Voluntary Administration originally filed nor in any amended affidavits filed with the court. Items of Personal Property Separately Listed Value of Each Item Total $ 4. For the items of personal property listed in paragraph 3, I require voluntary administration. additional certificates of The value of all of the decedent's non-exempt assets still does not exceed $10,000.00. Sworn to me before on (Affiant) , 20 (Print Name) Notary Public My Commission Expires: (Affix Notary Stamp or Seal) Signature of Attorney: Print Name: Firm Name: Address of Attorney: SE1B *For use only where decedent died before August 29, 1996 American LegalNet, Inc. www.FormsWorkFlow.com