COMBINED CORPORATE VERIFICATION, CONSENT AND DESIGNATION For use when petitioner to be appointed is a bank or trust company STATE OF COUNTY OF The undersigned, a Title ss.: of Name of Bank or Trust Company a corporation duly qualified to act in a fiduciary capacity without further security, being duly sworn, says: 1. VERIFICATION: I have read the foregoing petition subscribed by me and know the contents thereof, and the same is true of my own knowledge, except as to the matters therein stated to be alleged upon information and belief, and as to those matters I believe it to be true. 2. CONSENT: I consent to accept the appointment as ANCILLARY ADMINISTRATOR ANCILLARY ADMINISTRATOR d.b.n of the decedent described in the foregoing petition and consent to act as such fiduciary. 3. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I do hereby designate the Clerk of the Surrogate s Court of County, and his or her successor in office as a person on whom service of any process issuing from such Surrogate s Court may be made, in like manner and with like effect as if it were served personally upon me, whenever I cannot be found within the State of New York after due diligence used. Name of Corporate Petitioner By Signature Print Name Title On , before me personally came 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. Notary Public Commission Expires: (Affix Notary Stamp or Seal) Signature of Attorney Print Name of Attorney Firm Telephone Address NYSBA's Surrogate's Court Form AA-1 (2/06) © 2006 Matthew Bender & Co., a member of the LexisNexis Group.