Form I-1 - Inventory Of Assets - New York State Surrogate Court
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1TO BE COMPLETED BY FIDUCIARY or
ATTORNEY FOR FIDUCIARY
SURROGATE’S COURT OF THE STATE OF NEW YORK
Total Estate Assets (see below)*
__________
COUNTY OF _______________________________
Filing fee SCPA 2402(7)
$__________
Filing fee initially paid
$__________
-----------------------------------------------------------------x
$0.00
Balance (Refund) Due
$__________
In the Matter of
INVENTORY OF ASSETS (Rule §207.20)
Deceased.
-----------------------------------------------------------------x
File No:_____________________________
The undersigned, a fiduciary or attorney for the fiduciary of the above Decedent’s estate, certifies that the following
constitutes the gross estate for tax purposes and identifies whether non-estate assets exist. Complete below according
to the following value categories:
Category A - under $10,000; Category B - $10,000 to under $20,000; Category C - $20,000 to under $50,000;
Category D - $50,000 to under $100,000; Category E - $100,000 to under $250,000;
Category F - $250,000 to under $500,000; Category G - $500,000 or over.
Date of Death:____________
Date of Letters:____________
Type of Letters:______________________________
Name of Fiduciary(ies) and, if changed, fiduciary(ies) address: _____________________________________________
ASSETS INDIVIDUALLY OWNED BY DECEDENT
CATEGORY
OR PAYABLE TO ESTATE
1.
Real Estate
___________
2.
Stocks and Bonds
___________
3.
Insurance Payable to Estate
___________
4.
IRAs, 401 Ks Payable to Estate
___________
5.
Mortgages or Notes Held by Decedent
___________
6.
Cash
___________
7.
Miscellaneous
___________
Yes – see attached firearms inventory
8.
Firearms (Check appropriate box)
None
___________
*TOTAL ESTATE ASSETS
NON-ESTATE ASSETS - CHECK YES OR NO TO EACH OF THE FOLLOWING:
9.
Living Trust
Yes
No
If yes, set forth the Name of the Trustee(s)
____________________________________________
10.
Gifts in Excess of Federal Annual Exclusion Made
Yes
No
Within 3 Years of Decedent’s Death
11.
Jointly Held Property (Real or Personal)
Yes
No
12.
Insurance Payable to Beneficiary
Yes
No
IRAs, 401K’s Payable to Beneficiary
13.
Yes
No
14.
Annuities
Yes
No
15.
Powers of Appointment
Yes
No
16.
Cause(s) of Action Pending
Yes
No
If yes, identify Court and Index Number
____________________________________________
Certified to be true on the ______ day of _____________________, 20____.
____________________________________________________
________________________________________
Signature
Attorney’s Name
________________________________________
____________________________________________________
Print Name
Attorney’s Address
____________________________________________________
Attorney’s Telephone No.
I-1 3/2016
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