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Wrongful Death Compromise Settlement Proceeding Checklist

WDCS-CHK release 8/9/04 PAGE 1 This Checklist is providedfor your convenience whilecompleting the petition andthe Checklist should not bereturned to the Death Compromise Settlement Proceeding Checklist (see Surrogate s Court Form WD-2, rev. 4/98)(see 22 NYCRR Uniform Rule )Fill in All Areas On All Pages - Also Mark When Not Applicable When NecessaryStrike Any Paragraphs/Sections Which Do Not ApplyCheck All Forms To Make Sure Venue Is Correct - Appropriate County Is Listed PET #DESCRIPTIONYESNODoes this Surrogate s Court have jurisdiction over the Proceeding ?

WDCS-CHK release 8/9/04 PAGE 3 15. cont. All distributee’s names, age as of decedent’s date of death, anticipated years of dependency and percent of net amount of settlement (Kaiser formula may apply) If a structured settlement, set forth cost of any annuity If parents are sole distributees and distribution is unequal, give reasons

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