INSTRUCTIONS AND WORKSHEET FOR AFFIDAVIT
OF VOLUNTARY ADMINISTRATION - Complete all sections of the Article
13 Affidavit.
VOLUNTARY ADMINISTRATION or SMALL ESTATE
PROCEEDING may be used when a fiduciary is needed to
transfer estate assets (personal property only) and the value
of the assets does not exceed $20,000 (for decedents dying on
or after 8/30/96), exclusive of property set off under EPTL
5-3.1. This is a legal proceeding and you may need the assistance
of a lawyer. If you do not have a lawyer, you may wish to contact
the Lawyer Referral Service of your local County Bar Association
for assistance in obtaining one. Court employees cannot dispense
legal advice. Generally, you will file the proceeding with the
Court in the County where the decedent resided at the time of
his death.
ELIGIBILITY TO SERVE: You must be a named executor
or alternate executor in the decedent's will, or a distributee
(as that term is defined in EPTL 1-2.5 and 4-1.1) of the decedent,
or a court appointed guardian of the property of an infant distributee
to be eligible to serve as Voluntary Administrator. If you are
not eligible to serve, or, if you are applying solely to pay
a Medicaid or other public assistance claim, contact the Public
Administrator/Treasurer of your County.
DEATH CERTIFICATE: A certified copy of the
death certificate (with raised seal) must be filed with the
affidavit. Court employees cannot make a photocopy of this document.
FILING FEE: $1.00. Please make check or money
order payable to the Surrogate's Court of whatever County you
are filing in.
WILL: If the decedent had a Will, the original
Will must be filed with the affidavit. Make a copy for yourself,
without removing the staples.
ENVELOPES: Submit 4 in x 9.5 in. post paid
envelopes addressed to each person listed in items 6 & 7
of the affidavit, plus one return addressed envelope to mail
documents to the Voluntary Administrator or the attorney.
WORKSHEET
DISTRIBUTEES:
Complete the following showing the classification of the decedent's
distributees (nearest blood relatives): [Information is required
only as to those classes of surviving relatives who are deemed
to be distributees as defined in EPTL 4-1.1. Indicate the number
of survivors in each category.]
A. Spouse (husband or Wife)
If "no", was the decedent divorced at time of death?
B.1 Marital and/or adopted children.
Number of Survivors [
]
Descendants of predeceased marital and/or adopted children
Number of Survivors [
]
B.2
Non marital children
Number of Survivors [
]
[Each of the above boxes must indicate either "no"
or "yes". If "yes", the number of survivors
in each category must be shown. If the number of survivors is
unknown, insert a "?" and explain in detail in Paragraph
7. If subparagraphs a, b-1 or b-2 indicates "yes",
complete item b-3, but do not answer items c through h below.
If a, b-1 and b-2 all indicate "no", you must continue
to complete the classifications below (in the order shown) until
the answer is "yes" to ONE of the classes of distributees
or the answer is "no" to ALL of the categories shown.]
C. Father or Mother
Number of Survivors [
]
D.
Brothers or sisters (either whole or half-blood)
Number of Survivors [
]
Descendants
of predeceased brothers/sisters
Number of Survivors [
]
E. Grandparents
Number of Survivors
[ ]
F. Aunts/Uncles
Number
of Survivors [ ]
G. Descendants of predeceased aunts/uncles (1st cousins)
Number
of Survivors [ ]
H. Children of predeceased first cousins
Number
of Survivors [ ]
EXEMPT PROPERTY:
The surviving spouse of a decedent, or if there is none, the
surviving children under the age of 21 years old are entitled
to claim certain property from the decedent without including
it in the calculation of estate assets, and free from the claims
of any creditor except for funeral expenses. This property is
referred to as "exempt property", and is not included
in the calculation of the value of the estate for determining
if the estate may be administered as a "Small Estate".
In order to determine the "exempt property", complete
the following:
(A) No exemption is claimed [ ]
or
(B) An exemption is claimed for [ ] spouse [ ] children under
21 years of age for the following classifications of property
under Estates, Powers & Trusts Law Section 5-3.1(a):
(1) Furnishings, appliances, provisions, etc. (max. exemption
$10,000) $___________________
(2) Family pictures and books (max. exemption $1,000) ____________________
(3) Domestic animals, farm machinery, etc. (max. exemption $15,000)
____________________
(4) One motor vehicle (max. exemption $15,000) ____________________
(5) Money or other personal property (max. exemption $15,000)
____________________
Total exempt $___________________
A Certificate should NOT be needed for the above items. Please
check with the appropriate party.
If you will need a certificate to obtain or transfer any item
of exempt property, describe (i.e., HSBC Savings Account # 12345;
1997 Dodge Stratus auto, VIN # 12345678) item(s) and value below
and return this form to the Court along with the Affidavit:
Item:
Value:
COMPLETING THE AFFIDAVIT
CAPTION: Write the decedent's name in the caption box the same
as the signature appears on the will or, if there is no will,
as the name appears on the death certificate. Complete the blanks
with name of the State and County in which you (affiant) reside.
Do not fill in the file number, as the court will assign the
number when filed. Fill in your name and address on the top
lines above the numbered paragraphs.
(1) Complete the blanks.
(2) Complete date and place of death of decedent.
(3) Complete decedent’s address at the time of death.
Nursing homes are usually NOT considered to be a residence,
so the address where the decedent lived before entering a nursing
home.
(4) Check the appropriate box. If the decedent died with a will,
the original will must be filed with the affidavit. Photocopies
of the will are not acceptable.
(5) Read and verify.
(6) Read and verify.
(7) Complete the blanks. Write the names and addresses (with
ZIP) of the decedent's distributees identified in the distributee
worksheet on page 1 of these instructions and their relationship
to the decedent. Include age if under 18.
(8) If decedent left a will, list the names and addresses of
the beneficiaries. Please address the post paid envelopes to
each of the persons who are listed as a distributee in item
6 of the affidavit and, if there is a will, to all of the persons
listed in item 7 of the affidavit.
(9) List the assets for which you will require a certificate
from the court, together with that item's value.
(i.e., "1997 Dodge Stratus auto, VIN #12345678 - - $2,000,
etc.) Do not repeat items listed above in the "Exempt Property"
worksheet.
(10) Furnish the names of creditors of the deceased, how much
was paid by your or others to them (for which reimbursement
is sought) and how much remains unpaid. If the deceased was
receiving Medicaid or other public assistance, check with the
County Department of Social Services to determine the amount
of the claim, if any.
(11) The Voluntary Administrator will be undertaking serious
responsibilities and obligations. Please review these carefully.
(13) You will be required to file a "Report and Account"
with the court detailing the administration of the estate and
the disposition of assets. Be sure you or the Voluntary Administrator
understand these representations. Keep records and receipts
to show what you have done with the property and money that
you took control of as Voluntary Administrator.
Your application to be appointed Voluntary Administrator must
be accompanied by all necessary fees, postage paid envelopes
addressed to all distributees listed in paragraph #6 and all
the beneficiaries listed in paragraph #7, and a return addressed
envelope for the court to send certificates to the Voluntary Administrator or attorney.
If the affidavit is prepared by an attorney, sign, print name,
address and phone number of attorney or law firm.
If you have any questions, please call the Court at which you
are filing.
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