Get NY CS 7630551 2013-2022
1. The name of the decedent is . 2. Decedent died on (date) at (city, state) . 3. At decedent’s death, decedent resided at (city, state) . 4. hat within three years prior to death, decedent was/was not (circle one) a resident of another State (if decedent resided in another T State within three years prior to death, set forth the prior address): STREET ADDRESS CITY STATE ZIP 5. hat any and all debts, taxes and claims against the estate have been paid or provided for; that thi.
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