ROSEMARIE D. PETERS MONMOUTH COUNTY SURROGATE ROOM 114 FREEHOLD, NEW JERSEY 07728 Phone: 732-431-7330 Fax: 732-303-7656 SATELLITE OFFICES: Tuesday Wednesday Thursday 9:00 AM TO 4:30 PM: Middletown Library Wall Township Library Ocean Township Library ESTATE OF: DATE OF DEATH: BIRTH DATE MARITAL STATUS OF DECEDENT AT TIME OF DEATH: (Circle One) Never Married/Married/Divorced/Widowed/Domestic Partner/Civil Union DECEDENT222S RESIDENCE AT DEATH: Address: CITY: STATE: COUNTY: ATTORNEY REPRESENTING ESTATE: NAME OF FIRM: ADDRESS: TELEPHONE NUMBER: DATE OF WILL: DATE OF CODICIL: NAME AND ADDRESS OF EXECUTOR/EXECUTRIX/PERSONAL REP. TRUSTEE: (If Applicable. List full name and address of trustee(s) NEXT OF KIN: (INCLUDE STEP-CHILDREN) NAME ADDRESS RELATIONSHIIP IS REAL ESTATE JOINTLY HELD? YES/NO IF NO, VALUE IF NO WILL, PLEASE PROVIDE A CURRENT TAX STATEMENT TOTAL VALUE OF ASSETS: $ # OF CERTIFICATES FEES PAID BY: MASTER CARD/ATTORNEY ACCOUNT/CHECK/MONEYORDER NO CASH ACCEPTED IF FILING BY MAIL, PROVIDE INFORMATION SHEET, CERTIFIED DEATH CERTIFICATE AND ORIGINAL WILL. MAIL TO ADDRESS LISTED ABOVE American LegalNet, Inc. www.FormsWorkFlow.com