Affidavit in Support of Withdrawal of Funds Pursuant To SCPA $1310 (2) By a Surviving Spouse

Inheriting a spouse’s asset that is worth up to $30,000 can be done simply by executing the following affidavit and representing it along with the death certificate of the deceased spouse.

Extracted Text for Proper Search

ESTATE OF
                                                                       
Enter the Decedent’s Full Name
   AFFIDAVIT IN SUPPORT OF
WITHDRAWAL OF FUNDS
Deceased. PURSUANT TO SCPA §1310 (2)
BY A SURVIVING SPOUSE                                                                        
STATE OF                                         )
           Choose Your State
       )ss.:COUNTY OF                                     )
I,                                                                                      , being duly sworn, depose and say:
                                                         
Your Full NameA
.   I am the surviving spouse of                                                                         also known as                                                                                                                                .
                                                                                
          Any Other Names the Decedent Used B
. I reside at                                                                       ,
                                                    Your Street Address                                                                                                   ,                                                  .
                                                   
City                                                                                                           State                            Zip CodeC
.                                                                         died on                                       , a
                                                                                                                                                                                           Date of Death
resident of the State of New York as is shown on the original death certificate attached to this affidavit.
D . I hereby request that you release to me all of the decedent’s personal property in your possession and/or
pay to me any and all funds standing in the name of the decedent pursuant to New York Surrogate’s
Court Procedure Act §1310 (2), not to exceed the sum of $30,000.00.
1

E
. This payment and all other payments made under NY SCPA §1310 (2) by all debtors, known to me,
after diligent inquiry, do not in the aggregate exceed $30,000.00.
F . No Administrator, Executor or other fiduciary has qualified or been appointed to handle the decedent's
estate.
G . A copy of the Surrogate’s Court Procedure Act §1310 is attached.
H . I make this Affidavit in order to induce:                                                                                                          
                   Name of Investment Firm, Bank, Agency, Insurance Co., etc in possession of the asset to release property or funds standing in the name of                                                                        
(Account Number if applicable:                                                                                       )
 
                                                                                                                   Account or Policy Numbers, Etc.
to me.                                                                    
Sworn to before me this           day of                            ,               
                                                     
Notary Public
This form is provided free of charge as a courtesy to the visitors of  www.nycprobate.com
. By using this form you acknowledge and accept the terms
and conditions on the Web site and that you have read all instructions included with this form and on the  NEW YORK SMALL ESTATE
AFFIDAVIT
 page. Copyright © 2014 Rudolf J. Karvay - All Rights Reserved. This form may not be reproduced without the permission of the
author. 2

INSERT THE DECEDENT’S ORIGINAL
DEATH CERTIFICATE  AND 
DISCARD THIS PAGE
3

McKinney's SCPA § 1310
§ 1310. Payment of certain debts without administration
Effective: October 3, 2011
1. As used in this section
(a) “Debt” means
 
(i)  money  or  securities  payable on  account  of  a  deposit  in  a  bank,  national  bank,  trust  company,  branch  of  a
foreign banking corporation, savings bank, industrial bank, state or federal savings and loan association or state
or federal credit union or with a private banker, or funds or securities invested with, held by or deposited with
a  broker-dealer  or  with,  by  or  in  securities  of  a  management  type  investment  company  or  trust  payable  or
returnable to, or to the estate of, or to a beneficiary designated by, the depositor or
(ii) money payable by a state or federal savings and loan association or state or federal credit union to, or to the
estate of, or to a beneficiary designated by, a member on account of the withdrawal value of his shares or
(iii)  money  payable  by  an  insurance  company  or  a  savings  bank  authorized  to  conduct  the  business  of  life
insurance under an annuity or pure endowment contract or a policy of life, group life, industrial life or accident
and health insurance or a contract made by such an insurer, relating to the payment of proceeds or avails thereof,
to, or to the estate of, or to a beneficiary designated by, the owner or the person purchasing the annuity or the
person insured or the person effecting the insurance or the person effecting the supplemental contract or
(iv) money payable by a public corporation, a state or the federal government or an agency thereof, to, or to the
estate of, or to a beneficiary designated by, any natural person or
(v) a pension or retirement or death benefit, profit share, earnings, wages, salary or bonus payable by an employer
or by a pension, retirement or profit-sharing plan or system to, or to the estate of, or to a beneficiary designated
by, an employee, or
(vi) a balance of money due on an accepted claim or account payable, on account of dividends payable by the
superintendent  of  financial  services  in  liquidation  of  bank  assets,  to,  or  to  the  estate  of,  or  to  a  beneficiary
designated by, a depositor or
(vii) any personal property deposited with a county treasurer by a coroner or county medical examiner pursuant
to sections 785 and 786 of the code of criminal procedure,or
(viii)  any  personal  property  on  deposit  with  a  hospital,  nursing  home,  residential  health  care  facility  or
out-patient lodge described in section twenty-eight hundred one of the public health law at the time of the death
of a decedent that is payable or returnable to the estate of the decedent;
(b) “Debtor” means the person or persons, partnership, corporation, government or government agency by whom
a debt defined in this section is to be paid,
(c) “Creditor” means the employee, depositor, member, or other person, to whom, or to whose estate, or to a
beneficiary designated by whom, a debt defined in this section is to be paid and shall include any beneficiary
validly designated by such a creditor,
 
(d)  A  “designation  of  a  beneficiary”  means  any  writing,  signed  by  the  creditor  and  delivered  to  the  debtor
purporting to designate the person to whom a debt shall be paid on death of the creditor or any transaction which
operates pursuant to statute as such a designation.
 
2. Upon the death of a creditor, unless otherwise provided by a designation of a beneficiary which is then in effect,
it shall be lawful for the debtor forthwith to pay to the surviving spouse  of the decedent not more than thirty
4

thousand  dollars  of  the  debt,  upon  an  affidavit  made  by  the  spouse  showing  that  the  payment  and  all  other
payments received by the spouse under this subdivision do not in the aggregate exceed thirty thousand dollars.
3.  Not  less  than  thirty  days  after  the  death  of  a  creditor,  unless  otherwise  provided  by  a  designation  of  a
beneficiary which is then in effect, it shall be lawful for the debtor to pay not more than fifteen thousand dollars
of the debt to
(a) the surviving spouse,
(b) one or more of the children eighteen years of age or older,
 
(c) the father or mother,
(d) the brother or sister,
 
(e) the niece or nephew of the decedent, preference being given in the order named if request for payment shall
have been made by more than one such person,
 
(f) a creditor of the decedent or to a person who has paid or incurred the funeral expense of the decedent, upon
the request of the surviving spouse or of one of such relatives.
 
Payment under this subdivision may be made upon an affidavit by the surviving spouse or relative to whom or
at whose request the payment is made, showing
 
(i) the date of the death of the decedent,
 
(ii) the relationship of the affiant to the decedent,
 
(iii) that no fiduciary has qualified or been appointed,
 
(iv) the names and addresses of the persons entitled to and who will receive the money paid, and
(v) that such payment and all other payments made under this section by all debtors, known to the affiant, after
diligent inquiry do not in the aggregate exceed fifteen thousand dollars. This subdivision does not limit the right
of a debtor to make payment to a surviving spouse within less than thirty days after the death of the creditor as
provided in subdivision two.
4. Not less than 6 months after the death of a creditor, unless otherwise provided by a designation of a beneficiary
which is then in effect, it shall be lawful for the debtor to pay a debt which does not exceed $5,000, or any part
of such debt, to a distributee or, to the extent that the funds are not exempt from claims of creditors, to a creditor
or to a person who has paid or incurred the funeral expenses upon an affidavit made by the person paid showing
(a) the date of the death of the decedent,
(b) that no fiduciary has qualified or been appointed,
 
(c) that the decedent was not survived by a spouse or minor child,
(d) that the affiant is entitled to the payment, and
 
(e) that such payment and all other payments made under this section by all debtors, known to the affiant, after
diligent inquiry, do not in the aggregate exceed $5,000.
 
5. A payment made in good faith under this section shall be a complete discharge to the debtor to the extent of
the payment, even though the affidavit on which payment is made be false, and even though payment pursuant
to subdivision 3 was not made in the order of preference indicated in that subdivision, provided only that the
creditor be dead and that the required number of days elapse between death and payment and, in the case of a
payment under subdivision 2 or subdivision 3 that the affiant in fact bear the stated relationship to the decedent
5

and in the case of a payment under subdivision 4 that the affiant be in fact a distributee or creditor or have paid
or incurred the funeral expenses.
6. Any person receiving payment pursuant to this section is accountable therefor to the fiduciary of the decedent
if one be appointed or to the public administrator of the county having authority to take possession of the money
or property constituting the debt except that a surviving spouse entitled to have property set aside to him or to
her pursuant to EPTL 5-3.1 need not account for such payments to the extent of the exemption provided therein,
and the amount so received shall be credited to such exemption.
7. Nothing in this section shall deprive any person of any right which he would otherwise have to receive payment
of a debt, except as against a debtor who has made a payment which is a discharge under subdivision 5, nor shall
anything in this section deprive any debtor of any right to make or refuse payment which it would otherwise have.
This section does not limit article 26 of the tax law.
8. It shall be lawful for the debtor to pay a debt which does not exceed five thousand dollars or any part of such
debt, under subdivision four of this section, to the department of social services or a social services district where
the debt is money payable on account of a deposit with the debtor for the personal needs of the deceased creditor
while residing in a medical institution or other facility, or otherwise, and the deceased creditor is indebted to the
department or district on account of medical assistance furnished to or on behalf of the deceased creditor.
 
9. This section applies only to creditors who die on or after September 1, 1952.
6

INSTRUCTIONS
New York law, SCPA §1310, permits certain relatives and creditors to collect the decedent’s
assets without going to court.  The law requires that an affidavit be presented with specific informa-
tion.
You should prepare a separate affidavit for each bank, brokerage house, insurance company or
agency holding money or property. 
Once you have completed the free affidavit we provided, take the following steps:
1.  Print the completed document. 2. Sign the Affidavit before a Notary Public.
3. Attach the decedent’s 
original death certificate as page 3.
4. Make sure the statute (SCPA 1310) remains attached to the affidavit.
5. Send the original affidavit and a cover letter from you to _________________________________________________ by certified mail, return
receipt requested.  You may use another delivery method, but make sure that delivery is
verifiable.
6. If you do not hear from the financial institution within a reasonable time, call them to follow up.  Note: it is up to the financial institution to honor this request.
! DISCARD THIS PAGE BEFORE MAILING THE AFFIDAVIT AND ITS ATTACHMENTS !