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(6) The names, relationships and addresses of all distributees, of each person desiguated_ in the Isst Will herewith
presented u primary executor, of all persons adversely affected by the purported exercise by such Will of any power of
appointment, of all person: adversely affected by any codidl and of all pet:otts having as interest trader any prior will
of the decedent on file in the Surrogate's offitye, ace hereinafter sat forth in subdivisions (a) acrd (b):
Description of legacy, Devise a
Other interest. or Nature of
Name and Address .........................Relationship................Fiduciary Status
t
(a) All persons and parties ao interested who aro of full age and sound mind, or which an eorporatioat a
associations, are u follow::
John
Bourgeois
845 Orbit Lane, Uniondale, N. Y. son ~E_xrecut~or'
V1~4 ~`~+K.-
1
J
(b) All persons so interested who are persons under disability, are u follows: none
Please famish all infomntron specified in NOTE Lefow) .
(Note: [n the case of each infagt, stain (a) name. birth date, age, relationship to decedent. residence sddress, and the person with
whom he resides; (b) whether or •~ot he has a jeneral or testamentary Euardiaa. and wheWer or not his father, or IE dead, his mother. is
living; and (c) the name and of any prardian and any h'vina parent. U the case of each incompetent aJ incapacitated
person, state (a) name, rda _ ~ody~t, acid sesidertcx address: N) facts re6ardios his iaoompeteacy, iadudiry wheWer or not a
committee has been and (c) the names and addresses of any 1
ap . • ao _ hF~ he hu been committed to any'institutioo;
rnmmittee, any person ~ip taAd onttody of hint' and any relative or friend having an interest in his welfare. In the
case of person Conlin ~s Q, -incarceration. In the case of unknowns, desuibe such persor~ in the same laaauaae as
wrll be used in the each Ease - d_
gaipdon of the party's legacy, devise or other interest ss in parigaph (ti) (a)
hereof.) j :
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