SURROGATE COURT OF SUSSEX COUNTY GARY R. CHIUSANO, SURROGATE 3 High Street, Suite 1, Newton, New Jersey 07860 Office: (973) 579-0920 Fax: (973) 579-0909 Website: www.sussexcountysurrogate.com E-mail: surrogate@sussex.nj.us GENERAL INFORMATION WORKSHEET #1 WHEN THERE IS A WILL DECEDENT Legal Name of Deceased AKA: Another "Legal" Name of Deceased Date of Birth (mm/dd/yyy) Age at Death Date of Death (mm/dd/yyy) Social Security Number Residence/Municipality of Deceased Marital Status of Deceased at Death Date of Will (mm/dd/yyy) Date of Codicil (Codicil is a Modification to the Will) Names and Addresses of Witnesses to Will/Codicil Name Mailing Address ` City State Zip Name Mailing Address City State Zip Self-Proving YES NO (Office use only) American LegalNet, Inc. www.FormsWorkFlow.com APPLICANT EXECUTOR/APPLICANT Person named in Will Relationship Mailing Address City State Zip Physical Address City State Zip SOCIAL SECURITY NUMBER OF APPLICANT PHONE NUMBERS HOME FAX WORK CELL IF CO-APPLICANTS, duplicate APPLICANT information on extra sheet HEIRS AT LAW & NEXT OF KIN List living or deceased: Children & Step-children (note age if under 18 yr.), Spouse, Domestic Partner, Civil Union; or, if none of the previously indicated pertain to this estate, then list Parents, or Brothers & Sisters. Name 1 Mailing Address City State Zip Relationship Name 2 Mailing Address City State Zip American LegalNet, Inc. www.FormsWorkFlow.com Relationship Name 3 Mailing Address City State Zip Relationship Name 4 Mailing Address City State Zip Relationship Name 5 Mailing Address City State Zip Relationship Name 6 Mailing Address City State Zip Relationship Add extra page if more space needed American LegalNet, Inc. www.FormsWorkFlow.com INHERITANCE TAX QUESTION, MUST BE ANSWERED Does the entire estate pass to surviving spouse, civil union partner (after 2/19/07), or domestic partner (after 7/10/04), parent, grandparent, child, stepchild, legally adopted child, or the issue of any child or legally adopted child (includes a grandchild and a great-grandchild but not a step-grandchild or a great-stepgrandchild)? YES / NO Attorney information ONLY if representing the estate Attorney Mailing Address City State Zip Phone Fax Questions? Just call our office. 1. COMPLETE ALL INFORMATION ABOVE 2. FAX, MAIL or SCAN and E-MAIL COMPLETED WORKSHEET #1, A COPY OF THE DEATH CERTIFICATE AND A COPY OF THE WILL (Bring original Death Certificate and Will to your appointment.) THEN CALL FOR APPOINTMENT THANK YOU! SURROGATE COURT OF SUSSEX COUNTY GARY R. CHIUSANO, SURROGATE 3 High Street, Suite 1, Newton, New Jersey 07860 Office: (973) 579-0920 Fax: (973) 579-0909 Website: www.sussexcountysurrogate.com E-mail: surrogate@sussex.nj.us American LegalNet, Inc. www.FormsWorkFlow.com