Small Estates Affidavit Form (S.c.p.a. Section 1310), Table Of Heirs - New York State Comptroller Page 3
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5THOMAS P. DINAPOLI
110 STATE STREET
STATE COMPTROLLER
ALBANY, NEW YORK 12236
STATE OF NEW YORK
OFFICE OF THE STATE COMPTROLLER
OFFICE OF UNCLAIMED FUNDS
Table of Heirs
DECEASED _____________________________________________
DATE OF DEATH________________________
IF NO SPOUSE OR BLOOD RELATIVES EVER EXISTED IN A CATEGORY, WRITE “NONE”. IF MORE SPACE IS NEEDED IN A PARTICULAR
CATEGORY, PLEASE ATTACH A SEPARATE SHEET. ANY CATEGORY MISSING DETAIL MAY RESULT IN DELAYED PROCESSING.
Living
Date of
Name
Address
Y or N
Death
Spouse(s)
1.
of
I.
Deceased
2.
Living
Date of
Spouse
Name
Address
S.S.N.*
Y or N
Death
Name
1.
ALL
Children
II.
2.
of
Deceased
3.
4.
Living
Date of
Parent
Name
Address
S.S.N.*
Y or N
Death
Name
1.
ONLY
Children
2.
III.
of
Deceased
Children
3.
4.
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