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SURROGATE’S COURT OF THE STATE OF NEW YORK $ Bond, Fee: $ 0
COUNTY OF Manhattan Receipt No: No:
X
PROBATE PROCEEDING,
PETITION FOR PROBATE AND:
WILL OF: John A, Smith □ Letters Testamentary
a/k/a John Adrew Smith □ Letters of Trusteeship
□ Letters of Administration c.t.a.
□ Temporary Administration
Deceased
X File No. To be assign by the court
To the Surrogate’s Court, County of Manhattan
It is respectfully alleged:
1. (a) The name, citizenship, domicile (or, in the case of a bank or trust company, its principal office) and
interest in this proceeding of the petitioner are as follows:
Name: Mary Louise Johnson
(First) (Middle) (Last)
th
Domicile or Principal Office: 123 east 55 Street, Apt 10b, New York, NY 10022
(Street and Number)

(City, Village or Town) (State) (Zip Code)

Mailing Address: Same as above
(If different from domicile)
Citizen of: United States
Interest (s) of Petitioner (s): [Check one] □ Executor (s) named in decedent’s Will
□ Other (Specify)
1. (b) The proposed Executor □ is □ is not an attorney.
[NOTE: A sole Executor-Attorney must comply with 22 NYCRR 207.16(e)]
1. (c) The proposed Executor □ is □
is not the attorney-draftsperson, a then-affiliated attorney
or employee thereof.
[NOTE: An attorney-draftsperson, a then-affiliated attorney or employee thereof must comply with
SCPA 2307-a]
1. □ □
(d) The proposed Executor is is not a convicted felon nor is he/she otherwise ineligible, pursuant to
SCPA 707 to receive letters. If the proposed Executor is a convicted felon, submit a copy of the Certificate of Relief from
Civil Disabilities.
2. The name, domicile, date and place of death, and national citizenship of the above-named decedent as
follows:
(a) Name: John A. Smith
(b) Date of death: January 15, 2025
(c) Place of death New York Presbyterian Hospital, Manhattan, NY
(d) Domicile: Street 450 West 57th Street, Apt 14C
City, Town, Village New York City
County New York State New York
(e) Citizen of: United Stats
3. The Last Will, herewith presented, relates to both real and personal property and consists of an
instrument or instruments dated as shown below and signed at the end thereof by the decedent and the following
attesting witnesses:
23-05-2022 Susan Clark, David Lee
(Date of Will) (Names of All Witnesses to Will)
Nil Nil
(Date of Codicil) (Names of All Witnesses to Codicil)

(Date of Codicil) (Names of All Witnesses to Codicil)

 4. No other will or codicil of the decedent is on file in this Surrogate’s Court, and upon information and
belief, after a diligent search and inquiry, including a search of any safe deposit box, there exists no will, codicil or other
testamentary instrument of the decedent later in date to any of the instruments mentioned in Paragraph 3 except as
follows: [Enter “NONE” or specify]

None

5. The decedent was survived by distributes classified as follows: [Information is required only as to
those classes of surviving relatives who would take the property of decedent pursuant to EPTL 4-1.1 and 4-1.2. State the
number of survivors in each class. Insert “NO” in all prior classes. Insert “X” in all subsequent classes].
a. □ Spouse (husband/wife). No
b. □ Child or children and/or issue of predeceased child or children. 2 children
[Must include marital, nonmarital, adopted, or adopted-out of child under DRL Section 117]
c. □ Mother/Father. No
d. □ Sisters and/or brothers, either of the whole or half blood, and issue of predeceased sisters
and/or brothers (nieces/nephews, etc.) No
e. □ Grandparents. [Include maternal and paternal] X
f. □ Aunts and/or uncles, and children of predeceased aunts and/or uncles (first cousins).
[Include maternal and paternal] X
g. □ First cousins once removed (children of predeceased first cousins). [Include maternal and
paternal] X
6. The names, relationships, domicile and addresses of all distributes (under EPTL 4-1.1 and 4-1.2), of
each person designated in the Will herewith presented as primary executor, of all persons adversely affected by the
purported exercise by such Will of any power of appointment, of all persons adversely affected by any codicil and of all
persons having an interest under any other will of the decedent on file in the Surrogate’s Court, are hereinafter set forth in
subdivisions (a) and (b).
[If the propounded will purports to revoke or modify an inter vivos trust or any other testamentary
substitute, list the names, relationships, domicile and addresses of the trustee and beneficiaries affected by the will in
subparagraphs (a) and (b) below. Submit trust agreement]
(a) All persons and parties so interested who are of full age and sound mind or which are corporations or
associations, are as follows:
Name and Relationship Domicile Address and Mailing Address Description of Legacy, Devise or Other
Interest, or Nature of Fiduciary Status
Mary L. Johnson (Daughter, Petitioner) 123 East 55th St, Apt 10B, New York, Nominated Executor, Residuary
Robert J. Smith (Son) 45 Park Avenue, Apt 6D, New York, NY Residuary Beneficiary (50%)
Susan Clark (Witness) 200 Riverside Dr, New York, NY 10025 Attesting Witness
David Lee (Witness) 18-20 Queens Blvd, Queens, NY 11375 Attesting Witness

(b) All persons so interested who are persons under disability, are as follows:
[Furnish all information specified in NOTE following 7b]
Name and Relationship Domicile Address and Mailing Address Description of Legacy, Devise or Other
Interest, or Nature of Fiduciary Status
Both children are adults, so the entry is: NONE
 7. (a) The names and domiciliary of all substitute or successor executors and of all trustees, guardians,
legatees, devisees, and other beneficiaries named in the Will and/or trustees and beneficiaries of any inter vivos trust
designated in the propounded Will other than those named in Paragraph 6 herewith are as follows:
Name and Relationship Domicile Address and Mailing Address Description of Legacy, Devise or Other
Interest, or Nature of Fiduciary Status
Robert J. Smith (Son, Substitute Executor) 45 Park Avenue, Apt 6D, New York, Named Substitute Executor in Will
NY 10066

(b) All such legatees, devisees and other beneficiaries who are persons under disability are as follows:
[Furnish all information specified in NOTE below]
Name and Relationship Domicile Address and Mailing Address Description of Legacy, Devise or Other
Interest, or Nature of Fiduciary Status
This is for minors or incapacitated beneficiaries both children are adult: None

[NOTE: In the case of each infant, state (a) name, birth date, relationship to decedent, domicile and residence address,
and the person with whom he/she resides, (b) whether or not he/she has a court-appointed guardian (if not, so state), and
whether or not his/her father and/or mother is living, and (c) the name and residence address of any court-appointed
guardian and the information regarding such appointment. In the case of each other person under a disability, state (a)
name, relationship to decedent, and residence address, (b) facts regarding his disability including whether or not a
committee, conservator, guardian, or any other fiduciary has been appointed and whether or not he/she has been
committed to any institution, and (c) the names and addresses of any committee, person or institution having care and
custody of him/her, conservator, guardian, and any relative or friend having an interest in his/her welfare. In the case of a
person confined as a prisoner, state place of incarceration and list any person having an interest in his/her welfare. In the
case of unknowns, describe such person in the same language as will be used in the process.]
8. (a) No beneficiary under the propounded will, listed in Paragraph 6 or 7 above, had a confidential
relationship to the decedent, such as attorney, accountant, doctor, or clergyperson, except: [Enter “NONE” or indicate
the nature of the confidential relationship]. None

(b) No persons, corporations or associations are interested in this proceeding other than those mentioned
above.
9. (a) To the best of the knowledge of the undersigned, the approximate total value of all property constituting
the decedent’s gross testamentary estate is greater than $ 500,000 but less than $ 1,500,000
Personal Property $ 250,000 Improved real property in New York State $ 750,000
Unimproved real property in New York State $ None
Estimated gross rents for a period of 18 months $ None
(b) No other testamentary assets exist in New York State, nor does any cause of action exist on behalf of
the estate, except as follows: [Enter “NONE” or specify]
None
 10. Upon information and belief, no other petition for the probate of any will of the
decedent or for letters of administration of the decedent’s estate has heretofore been filed in any
court.
WHEREFORE your petitioner (s) pray (s) that process be issued to all necessary parties to
show cause why the Will and the Codicil (s) set forth in Paragraph 3 and presented herewith should
not be admitted to probate; (b) that an order be granted directing the service of process, pursuant to
the provisions of Article 3 of the S.C.P.A., upon the persons named in Paragraph (6) hereof whose
names or whereabouts are unknown and cannot be ascertained, or who may be persons on whom
service by personal delivery cannot be made; and (c) that such Will and Codicil (s) be admitted to
probate as a Will of real and personal property and that letters issue thereon as follows: [Check and
complete all relief
requested.]
□ Letters Testamentary to Mary L. Johnson

□ Letters of Trusteeship to f/b/o

f/b/o

f/b/o

□ Letters of Administration c.t.a. to

and that petitioner (s) have such other relief as may be proper.

• Dated: February 15, 2025

1. Mary L. Johnson 2.
(Signature of Petitioner)
(Signature of Petitioner)

(Print Name) (Print Name)

3. (Name of Corporate Petitioner)

(Signature of Officer)

(Print Name and Title of Officer)