surrogate’s court of the state of new york...
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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.
I-2 5/2013
