Stipulation Reserving Domicile

Surrogate’s Court of the State of New York                                    (Attach a copy of the death certificate)
County of

In the matter of the application for

      Ancillary Letters Testamentary

      Ancillary Letters of Administration

      Letters Testamentary (original probate for a nonresident)

      Letters of Administration (original administration for a nonresident)

of the Estate of                           (deceased)

Date of death
                      (month/day/year)
Social security number

     An application having been made to the Surrogate on behalf of the estate of decedent for (Ancillary) Letters Testamentary (or of
Administration) in the above-entitled proceeding, and the Commissioner of Taxation and Finance not having had an opportunity to
investigate the alleged nonresident status of the decedent, and the representatives of the estate having requested the Commissioner,
nevertheless, to issue a Waiver of Citation in order to facilitate the granting of such application:
     It is hereby stipulated and agreed by and between the undersigned:
     (1) that the representatives of said estate will timely file a New York State Estate Tax Return, or such other required document, to
determine the New York State estate tax (if any) for which said estate may be liable, and will pay the amount thereof as finally determined;
that the issuance of (Ancillary) Letters Testamentary (or of Administration) so applied for shall not be an estoppel against the
Commissioner of Taxation and Finance on the question of the domicile of the decedent;
     (2) that the Commissioner of Taxation and Finance will issue a Waiver of Citation in the above-entitled proceeding in reliance upon
the agreement set forth in paragraph (1) hereof; and
     (3) that the attorneys for the petitioner shall serve upon the attorney for the Commissioner of Taxation and Finance a copy of the
decree herein with Notice of Entry.

                      Estate                                                  Commissioner of Taxation and Finance

Signature of petitioner’s attorney (must be admitted to practice in
New York State)

                                    ()
Date (month/day/year)               Telephone number

Print name of petitioner’s attorney
                                                                   by:

Firm’s name                                                        Signature of attorney for Commissioner of Taxation and Finance

Mailing address (number and street or rural route)                 Date (month/day/year)

                                                                   at: (city)                                                   New York
City                  State                ZIP code

ET-20 (1/04)