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 #2 WHEN THERE IS NO 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/Munici pality of Deceased Marital Status of Deceased at Death American LegalNet, Inc. www.FormsWorkFlow.com APPLICANT ADMINISTRA TOR/APPLICANT Mailing Address City State Zip Physical Address City State Zip SOCIAL SECURITY NUMBER OF APPLICANT PHONE NUMBERS HOME WORK FAX CELL IF CO-APPLICANTS, duplicate APPLICANT information on extra sheet HEIRS AT LAW & NEXT OF KIN Pursuant to R. 4:80, 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 Relationsh ip Name 2 Mailing Address City State Zip Relationship American LegalNet, Inc. www.FormsWorkFlow.com 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 ASSETS IN THE NAME OF THE DECEDENT ALONE List with complete name and/or description of all assets, including approximate value. (Example: Make of car, year, approximate value) $ $ $ $ $ TOTAL: $ Add extra page if more space needed DEBTS IN THE NAME OF THE DECEDENT ALONE List all debts including name and/or description and approximate balance due. FUNERAL cost: $ Balance due: $ Paid by Whom: Name: $ $ $ $ $ TO TAL: $ 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-step- grandchild)? 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-MAILCOMPLETED WORKSHEET #2 andA COPY OF THE DEATH CERTIFICATE (Bring original Death Certificate 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