Docket No.: _____________ State of New Jersey Camden County Surrogate's Court In the matter of the Estate of: ________________________________________, Deceased AKA: __________________________________ } SUPPLEMENTAL AFFIDAVIT OF HEIR I, ______________________________ of full age, being sworn upon my oath according to law, depose and say: 1. I reside at _____________________________________________________________ 2. Decedent departed this life _____________ without leaving a Will. 3. Decedent resided at their death at _____________________________________ in the County of Camden and State of New Jersey. 4. The names, residences and relationship of all the heirs at law of said decedent are as follows: Name Relationship Residence Age of all Minors The real and personal estate of said decedent does not exceed in value the sum of ten thousand ($10,000.00) dollars consisting of assets of the following nature, value and location: Asset Description Value Location I have presented for filing the consent of all of said heirs who have capacity to consent and am therefore entitled to said personal assets without Letters of Administration in accordance with N.J.S.A. 3B: 10-4. Subscribed and sworn to this Day _________ of __________ before me G1S.DOC Page 1 of 1 American LegalNet, Inc. www.USCourtForms.com