Form JA-1 - Petition for judicial settlement of account
For Office Use Only
Filing Fee Paid $ ____________
Receipt No: ____________
DO NOT LEAVE ANY ITEMS BLANK
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
________X
ACCOUNTING BY PETITION FOR JUDICIAL
SETTLEMENT OF ACCOUNT OF
as the [ ] Executor
of the ESTATE OF [ ] Administrator
a/k/a [ ] Trustee
[ ] Other [specify] ________
Deceased.
________X File No. ________
TO THE SURROGATE'S COURT, COUNTY OF ________
It is respectfully alleged:
1. The name(s), and address(es) of the petitioner(s), the type and date of letters issued, and the amount and surety of petitioner's(s') bond, if any, are as follows:
Name: ____________
Address: ____________
(Street Address) (City/Town/Village)
____________( )________
(County) (State) (Zip) (Telephone Number)
Mailing address is:____________
(if different from above)
Type of letters issued:________ Date letters issued: ____________
Amount of bond: $____________ Name of surety: ____________
Name: ____________
Address: ____________
(Street Address) (City/Town/Village)
________( )____________
(County) (State) (Zip) (Telephone Number)
Mailing address is:____________
(if different from above)
Type of letters issued: ________ Date letters issued: ____________
JA-1 (4/98)
2. The decedent's name, date of death and domicile are as follows:
Name: ____________ Date of death: ____________
Domicile: ____________
(Street Address) (City/Town/Village)
____________
(State) (Zip Code)
Township of: ____________ County of: ____________
3. The petitioner(s) present(s) and render(s) herewith, a verified account of petitioner's(s') proceedings in this estate or trust, for the period from ________ to ________, showing the gross value of assets, including principal and income, to be the sum of $________.
4. [ ] (a) An order was entered in this Court on ____________, 19________
[ ] Exempting the estate from tax
[ ] Fixing and assessing the tax due
[Attach a copy of the tax order and receipt]
[ ] (b) The following return(s) (was) (were) filed:
[ ] ET-90 [For decedent's dying on or after May 25, 1990]. A copy was filed with the Surrogate's Court [ ] Yes [ ] No
[ ] TT-385 [For decedent's dying before May 25, 1990]
[ ] 706 or 706NA
The estate taxes with respect to this estate were paid in full.
[Attach a copy of letter of discharge.]
[ ] (c) No tax proceeding or return was required for this estate.
5. The rendering of such account at this time is proper because [check appropriate reason]
[ ] seven months have elapsed since letters were issued to petitioner(s);
[ ] letters issued to the petitioner(s) have been revoked;
[ ] more than one year has elapsed since the preceding account of the petitioner(s) was settled.
[ ] other reason [specify]:
JA-1 (4/98)
6. The names and post-office addresses of all persons and parties interested in this proceeding who are required to be cited under the provisions of Surrogate's Court Procedure Act, § 2210, or otherwise, or concerning whom or which the Court is required to have information, are set forth in subdivision (a) or (b):
(a) All persons and parties so interested herein who are of full age and sound mind, or which are corporations or associations, are as follows:
Name Nature of Interest P.O. Address
(b) All persons so interested herein who are infants or incompetents or persons believed to be mentally incapable to adequately protect their rights, or persons whose existence, identity, or whereabouts are unknown (including persons who are virtually represented under SCPA § 315) are as follows:
[Furnish all information specified in NOTE at bottom of page]
Name Nature of Interest P.O. Address
[NOTE: In the case of each infant, state (a) name, birthdate, age, nature of interest, domicile, residence address, and the person with whom he/she resides; (b) whether or not he/she has a guardian or testamentary guardian, and whether or not his/her father, or if he/she be dead, his/her mother is living; and (c) the name and post office address of any guardian and any living parent. In the case of each incompetent or person incapable of adequately protecting his/her rights, state (a) name, nature of interest, and post office address; (b) facts regarding his/her incompetency, including whether or not a committee has been appointed and whether or not he/she has been committed to any institution; (c) the names and post office addresses of any committee, conservator, guardian, and person or institution having care and custody of him/her, and any relative or friend having an interest in his/her welfare. In the case of unknowns, describe in identical language to be used in citation for publication. In the case of a person confined as a prisoner, state place of incarceration. With respect to virtual representation, see Uniform Court Rule, § 207.18.]
JA-1 (4/98)
7. There are no persons interested in this proceeding other than those herein above mentioned.
8. No prior application has been made to this or any other court for the relief requested in this petition.
WHEREFORE the petitioner(s) pray(s) that the account of proceedings be judicially settled [specify any other relief requested.]
and that process be issued to all necessary parties who have not appeared to show cause why the relief requested should not be granted; and that an order be granted directing the service of process pursuant to the provisions of SCPA Article 3 upon such persons named in Paragraph (6) whose names or whereabouts are unknown and cannot be ascertained or who may be persons on whom service by personal delivery cannot be made.
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)
JA-1 (4/98)
VERIFICATION
[For use when petitioner is an individual]
STATE OF NEW YORK )
COUNTY OF ) ss.:
The undersigned, the petitioner(s) named in the foregoing petition, being duly sworn, say(s): (I) (We) have read the foregoing petition subscribed by me (us) and know the contents thereof, and the same is true of (my) (our) own knowledge, except as to the matters therein stated to be alleged upon information and belief, and as to those matters (I) (we) believe it to be true.
(Signature of Petitioner)
(Signature of Petitioner)
_____________
(Print Name)
_____________
(Print Name)
Sworn to before me this
________ day of ________, 19________.
_________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Signature of Attorney: ____________
Print Name: ____________
Firm Name: ____________ Tel. No.: ________
Address of Attorney: ____________
JA-1 (4/98)
VERIFICATION
[For use when a petitioner is a bank or trust company]
STATE OF NEW YORK )
COUNTY OF ) ss.:
I, the undersigned, a
(Title) of
(Name of Bank or Trust Company)
being duly sworn, say(s):
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.
______________
(Name of Bank or Trust Company)
BY
_____________
(Signature of Officer)
______________
(Print Name and Title)
Sworn to before me this
________ day of ________, 19________.
_________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Signature of Attorney: ____________
Print Name: ____________
Firm Name: ____________ Tel. No.: ________
Address of Attorney: ____________
JA-1 (4/98)