Docket No.: _______________ State of New Jersey Camden County Surrogates Court In the matter of the Estate of: RENUNCIATION } ______________________________________, Deceased OF ADMINISTRATOR AKA: ________________________________ AD PROSEQUENDUM To: __________________________, Surrogate of the County of Camden I ___________________, ________________ of the above decedent, late of _____________ in the County of Camden do hereby renounce my right of Administration Ad Prosequendum, and request the appointment of _________________________________. Dated: ____/____/____ STATE OF NEW JERSEY } SS. COUNTY OF CAMDEN Be it remembered, that on this, _____________, before me, undersigned authority, personally appeared ____________________, who I am satisfied is the person named in the foregoing instrument, to whom I first made known the contents thereof, and thereupon they acknowledged that they signed, sealed and delivered the same as their act and deed, for the uses and purposes therein expressed. F5.DOC Page 1 of 1