I,

domiciled at (or, in the

case of a bank or trust company, its principal office)

, nominated as an executor

and/or trustee in the (Will)(Codicil) of

dated

_________

late of

in the County of

, New York, hereby renounce the appointment and all right and claim to letters testamentary and/or letters of trusteeship of and under the (Will) (Codicil) or to act as executor and/or trustee thereof.

I hereby waive the issuance and service of a citation in the above entitled matter, and consent that the Will dated

(and Codicil dated

_______

) (and Codicil dated

_______

), a copy of which has been received by the undersigned, be forthwith admitted to probate.

I hereby consent that Letters [ ] Testamentary [ ] of Administration c.t.a.

[ ] of Trusteeship issued to

without the necessity of furnishing a bond. If a bond is furnished, I hereby waive and release all right to make any claim on the bond in any capacity whatsoever.

On

, 19__, before me personally appeared

[ ]

to me known and known to me to be the person described in and who executed the foregoing renunciation and duly acknowledged the execution thereof.

[ ]

to me known, who duly swore to the

foregoing instrument and who did say that he/she resides at

and that he/she is a

of

the corporation/national banking association described in and which executed such instrument; and that he/she signed his/her name thereto by order of the Board of Directors of the corporation.

Name of Attorney:

Tel. No.:

_____

Address of Attorney: