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The New York WD-3 form is a legal document used in Surrogate’s Court for settling the accounts of an administrator handling the estate of a deceased person. This form is particularly relevant when seeking permission to compromise a wrongful death claim and accounts for the distribution of funds related to that claim. Understanding this form is essential for ensuring proper administration of the estate and compliance with legal requirements.

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The New York WD-3 form plays a crucial role in the administration of estates, particularly in cases involving wrongful death claims. This form is utilized by an administrator of a decedent's estate to seek court approval for settling claims and to provide a detailed account of the estate’s financial activities. It outlines the claim against an insurance company, stemming from a wrongful death due to an automobile accident. The form requires the administrator to present essential documentation, including a petition, an affidavit from the attorney, and waivers from necessary parties. It also addresses the payment of funeral expenses and ensures that no outstanding medical bills remain. The WD-3 form highlights the distribution of any proceeds from the settlement, detailing the beneficiaries involved, such as the decedent's spouse and children. Moreover, it provides space for listing any claims against the estate, ensuring transparency in the administration process. By completing this form, the administrator seeks to confirm that all financial transactions are accounted for and that the estate is settled in accordance with New York law.

Form WD-3 (4/98)

SURROGATE’S COURT OF THE STATE OF NEW YORK

COUNTY OF

In the Matter of the Application of

as Administrat

of the Goods, Chattels and

Credits which were of

ACCOUNT

Deceased.

File #

For leave to compromise a certain cause of action for

wrongful death of the decedent and to render and have

judicially settled an account of the proceedings as such

Administrat

TO THE SURROGATE’S COURT:

1. I

do render the following account of my

proceedings as administrat

of the goods, chattels and credits which were of

deceased, consisting of a claim against

, who is insured by

Insurance Company, for wrongful death arising on or about

as the result of an automobile accident involving the decedent and

2.Letters of Administration of the goods, chattels and credits of the decedent were issued to me on

_______________________, said letters being limited to the prosecution only, and not for the collection of any proceeds of, any action or claim for wrongful death. Simultaneously herewith, leave is being asked to

compromise the claim for wrongful death of the decedent for the sum of $

3.There is submitted with this account my petition as administrat________; and affidavit by

,Esq., attorney for the petitioner herein; a copy of the paid funeral bill; and waivers of the necessary parties.

4.In view of the facts and circumstances, it is my opinion that a satisfactory result has been achieved through the efforts of my attorneys, and they are requesting disbursements in the sum of


$		and that they receive thereafter a fee of		% of the net proceeds.
5.	The funeral bill in the sum of $		has been paid through no-fault insurance.

6.There are no outstanding hospital bills or doctors’ bills.

7.The only property coming into my hands is by reason of the compromise of the claim against the

Insurance Company in the sum of $		.
8. The decedent left surviving no other next of kin except				,

his/her widow/widower, and

his/her children. All of the above persons are entitled to share in the proceeds of the compromise.

(NOTE: WHERE THERE ARE NO DISTRIBUTEES UNDER A DISABILITY, THE RENDERING OF AN ACCOUNT IS USUALLY NOT REQUIRED.)

(NOTE: REIMBURSEMENT OF FUNDS PAID FOR FUNERAL AND OTHER ADMINISTRATIVE EXPENSES, UNDER MOST CIRCUMSTANCES, ARE ALLOWABLE, AS ARE STATUTORY COMMISSIONS TO THE ADMINISTRAT(OR)(RIX). IF REIMBURSEMENT OR COMMISSIONS ARE NOT SOUGHT, THE PETITION SHOULD CONTAIN A WAIVER THEREOF).

9.There are no other claims or creditors of the estate that have been presented to or have come into my hands or knowledge except for the following:

a)The Commissioner of Social Services has submitted a claim of $

for public assistance rendered to decedent and his/her family for the years

. This claim was rejected.

b)		has submitted a claim for $
	based on
This claim was rejected.

c) Decedent’s father/mother,

has sought a share of the recovery based on an alleged pecuniary loss. This claim was rejected.

10. The following are the only persons interested in this proceeding:

	[L IST NAMES OF DISTRIBUTEES, ETC .]
NAME	RELATIONSHIP	DATE OF BIRTH

County Department
of Social Services			Possible Creditor
New York State Tax Commission			Possible Creditor
			Attorneys
			Defendant
Insurance Company			Defendant’s Insurance Company

11.I charge myself as follows with the amount to be received on compromise of the claim for wrongful death against

Insurance Company:

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12. I credit myself as follows:

a) With the amount to be paid to

Esqs., attorneys, including disbursements:

b) With the amount to be paid to

widow/widower and distributee: (

c) With the amount to be paid to the guardian of the person

and property of

infant, jointly with the Trust Officer of

Bank (

%):

d) with the amount to be paid to

son/daughter (

%):

Total:

Leaving no balance.

Dated:

STATE OF NEW YORK
COUNTY OF	SS.:

being duly sworn, deposes and says:

That I am the administrat_______ /accountant in the above estate, having been duly appointed by a

decree of this Court.

The foregoing account of proceedings contains to the best of my knowledge and belief a true and complete statement of my receipts and disbursements in the estate of

of all monies and other property belonging to the estate or fund which have come into my hands or which have been received by any person or persons by my order or authority for use since my appointment, and a full and true statement of account of the manner in which I have disposed of same and all property remaining in my hands at the present time, and a full and true account of the nature of each and every transaction may by me since my appointment.

Notary Public

(Form WD-3)

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Fact Name	Description
Purpose	The New York WD-3 form is used to seek court approval for compromising a wrongful death claim and to settle the estate's account.
Governing Law	This form is governed by the New York Surrogate's Court Procedure Act.
Filing Requirements	To file the WD-3 form, the administrator must include a petition, affidavit from the attorney, and waivers from necessary parties.
Funeral Expenses	The form allows for reimbursement of funeral expenses paid through no-fault insurance.
Claims Against Estate	All claims or creditors must be disclosed. The form requires a statement of any claims presented to the estate.
Distribution of Proceeds	The form details how the proceeds from the compromise will be distributed among the decedent's survivors.
Notarization	The form must be sworn before a notary public to validate the account of proceedings.

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I do not know of any error or omission in said account to the prejudice of any person interested in

said estate or fund.

___________________________________

Sworn to before me this

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