Form Se-3b - Amended Affidavit Form In Relation To Settlement Of Estate
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1SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF _________________________
---------------------------------------------------------------------------X
AM ENDED AFFIDAVIT
VOLUNTARY ADMINISTRATION, Estate of
IN RELATION TO SETTLEM ENT
OF ESTATE
UNDER ARTICLE 13, SCPA
____________________________________ ,
(as of 1/2009)
Deceased.
-------------------------------------------------------------------------- X
File No._________________________
STATE OF NEW YORK
)
) ss.:
COUNTY OF
)
I, _________________________________________, being duly sworn, depose and say:
(Nam e)
1.
I am the voluntary adm inistrator/trix of the above-nam ed decedent and m ake this affidavit pursuant to Article 13 of the
Surrogate’s Court Procedure Act. The original and any am ended affidavits were filed on the following dates: [list dates]
2.
I was found qualified to act as the voluntary adm inistrator/trix of the above captioned estate by the
________________________County Surrogate’s Court on the __________ day of __________, 20 ________.
3.
The following item s of personal property, owned by the above-nam ed decedent, were not listed in paragraph 9 of the
Affidavit of Voluntary Adm inistration originally filed nor in any am ended affidavits filed with the court.
Items of Personal
Property
Separately Listed
Value of Each Item
______________________________
____________________________________
______________________________
____________________________________
Total $ ____________________
4.
For the item of personal property listed in paragraph 3, I require _______________________ additional certificates
of voluntary adm inistration.
The value of all of the decedent’s non-exem pt assets still does not exceed $30,000.00.
___________________________________
Sworn to be fore m e on
(Affiant)
_______________, 20 ______
___________________________________
(Print Nam e)
_________________________________
Notary Public
My Com m ission Expires:
(Affix Notary Stam p or Seal)
Signature of Attorney :_______________________________________________________________________________
Print Nam e:________________________________________________________________________________________
Firm Nam e:_________________________________________ Tel No. : _______________________________________
Address of Attorney:_________________________________________________________________________________
SE-3B *For use only where decedent died on or after January 1, 2009
SE-3B
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