surrogate’s court of the state of new york...

SURROGATE’S COURT OF THE STATE OF NEW YORK COUNTYIn The Matter of the Estate of LIST OF ASSETS/INVENTORY

(Rule §207.20(a))_______________________________ Deceased. FILE NUMBER ________________________

The undersigned, a fiduciary or an attorney for the above estate, certifies that the following recapitulationconstitutes the gross estate (for tax purposes) of the above decedent. The following documents are attached:[ ] a detailed list of assets; or a copy of one of the following: [ ] Form ET-90; [ ] Form TT-385; [ ] Form 706or Form 706NA.

IF FORM ET-90 IS ATTACHED, ALL RIGHTS TO SECRECY UNDER TAX LAW §994 ARE WAIVED

Date of Death: __________________ Date of Letters: _________________ Type of Letters: _________________________

Name of Each Fiduciary: _____________________________________________________________________________________

(Address, if changed): _______________________________________________________________________________

RECAPITULATION OF Non-Probate, Joint Individually Owned ByATTACHED SCHEDULES: or Trust Property Decedent or Payable to

EstateA. Real Estate $ _________________ $ _________________

B. Stocks and Bonds _________________ _________________

C. Mortgages, Notes, Cash, etc. _________________ _________________

D. Insurance on Decedent’s Life _________________ _________________

E. Jointly Owned Property _________________ _________________

F. Miscellaneous & Trust Property _________________ _________________

G. Transfers During Decedent’s Life _________________ _________________

H. Powers of Appointment _________________ _________________

I. Annuities _________________ _________________

TOTALS $ _________________ $ _________________

Cause of Action Pending for Filing Fee Under §2402(7) _________________Wrongful Death or Conscious Filing Fee Initially Paid _________________Pain and Suffering: Balance (Refund) Due _________________Amount Claimed $________________

Certified to be true on ______________, 20_____ATTORNEY

Name: ______________________________ ________________________________________Address: ____________________________ Signature

______________________________ ________________________________________Phone: ______________________________ Print NameI-1 5/2013

GROSS ASSETS(Attach Additional Page If Necessary)

A. REAL ESTATE (Individually owned property)

Description Date of Death Value

____________________________________________ _______________________________

____________________________________________ _______________________________

____________________________________________ _______________________________

B. STOCKS AND BONDS (Individually Owned)

Description, Including Face Amount of Bondsand Number of Shares Date of Death Value

____________________________________________ ___________________________________

____________________________________________ ___________________________________

____________________________________________ ___________________________________

C. MORTGAGES, NOTES AND CASH (Including Bank Deposits)(Jointly owned property should be reported at E and trust property at F)

Description Date of Death Value

____________________________________________ ____________________________________

____________________________________________ ____________________________________

____________________________________________ ____________________________________

D. INSURANCE ON DECEDENT’S LIFE

(1) Payable to Estate

Description Date of Death Value_________________________________________ __________________________________________________________________________ _________________________________

(2) Payable to Named Beneficiary

Description Date of Death Value_________________________________________ ___________________________________________________________________________ __________________________________

E. JOINTLY OWNED PROPERTY (Real and Personal Property)

(1) Real EstateJoint

Description Tenant Date of Death Value________________________________ _________________ _______________________________________________________ _________________ _______________________

(2) Stocks and BondsJoint

Description Tenant Date of Death Value________________________________ _________________ ________________________________________________________ _________________ ________________________

(3) Mortgages, Notes and CashJoint

Description Tenant Date of Death Value________________________________ _________________ _________________________________________________________ _________________ _________________________

F. OTHER MISCELLANEOUS PROPERTY

(1) Individually Owned

Description Date of Death Value________________________________ __________________ _________________________________________________________ __________________ _________________________

(2) Firearms (Check appropriate box)

[ ] Yes, see attached Firearms Inventory Form Date of Death Value[ ] None ___________________________________

(3) Assets Passing to the Estate from Employment

Description Date of Death Value____________________________________________ _______________________________________________________________________________ ___________________________________

(4) Trust Property

Description Date of Death Value____________________________________________ _______________________________________________________________________________ ___________________________________

G. TRANSFERS DURING DECEDENT’S LIFE

Description Date of Death Value_____________________________________________ ________________________________________________________________________________ ___________________________________

H. POWERS OF APPOINTMENT

Description Date of Death Value_____________________________________________ ________________________________________________________________________________ ___________________________________

I. ANNUITIES

Description Date of Death Value_____________________________________________ ________________________________________________________________________________ ___________________________________

CAUSE OF ACTION for decedent’s wrongful death and for conscious pain and suffering, as well as any other typeof action.

Court in which Index AmountDescription Action Pending Number Demanded

__________________ ____________________ _______________ _________________

__________________ ____________________ _______________ _________________

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 definedby Section 265.00 of the Penal Law, make up part of the decedent’s estate.

Name of Fiduciary or Attorney:________________________________________________________________(Address, if changed): _______________________________________________________________________________

Make: Model: Caliber or Gauge: Serial #: Valuation:

1 $

2

3

4

5

6

7

8

9

10

11

12

TOTAL: (as indicated in section F2 of Inventory ofAssets)

G (mark box if more entries are necessary - and attach extra pages)

ATTORNEY Certified to be true on ______________, 20_____

Name: ______________________________ ________________________________________Address: ___________________________ Signature

____________________________ ________________________________________Telephone:__________________________ Print Name

A copy of this Inventory must also be filed with DCJS at:

Division of Criminal Justice ServicesAlfred E. Smith Building80 South Swan StreetAlbany, NY 12210

Firearms Inventories filed with the Surrogate’s Court will be kept in asecure location separate from the estate file and will be made availablefor inspection only to persons interested in the proceeding and theircounsel, unless otherwise ordered by the Court.

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