N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. VII, subch. A, Surrogate's Forms, form A-4 - Affidavit of service of mailing notice of application

SURROGATE'S COURT OF THE STATE OF NEW YORK

COUNTY OF ________

________X

ADMINISTRATION PROCEEDING AFFIDAVIT OF MAILING

Estate of ________ NOTICE OF APPLICATION FOR

LETTERS OF ADMINISTRATION

a/k/a (SCPA 1005)

________ Deceased. File No. ________

________X

STATE OF NEW YORK)

) ss.:

COUNTY OF ________)

________, residing at ________, New York, being duly sworn, deposes and says that deponent is over the age of eighteen years; that on ________, 19 ________, deponent mailed a copy of the foregoing Notice of Application for Letters of Administration, contained in a securely closed postpaid wrapper, directed to each of the persons named in paragraph 4(b), respectively, as follows:

whose post office address is ____________

whose post office address is ____________

whose post office address is ____________

whose post office address is ____________

whose post office address is ____________

whose post office address is ____________

whose post office address is ____________

whose post office address is ____________

by depositing the document in a letter box or other official depository under the exclusive care and custody of the United States Post Office, located at:

____________

______________

Signature

Sworn to before me this

________ day of ________, 19________.

_________

Notary Public

Commission Expires: ________

(Affix Stamp or Seal)

Notes

N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. VII, subch. A, Surrogate's Forms, form A-4