Docket No.: ______________ State of New Jersey Camden County Surrogates Court In the matter of the Conservatorship of: ___________________________________________, Conservatee AUTHORIZATION TO ACCEPT } SERVICE OF PROCESS AKA: _____________________________________ To the Surrogate of the County of Camden: The undersigned petitioner(s) for Letters of Conservatorship hereby constitute the Surrogate of Camden County and their successors in office their true and lawful attorney upon whom all original process in any action at law or equity against the above estate may be served. It is agreed that any original process so served against the above estate, shall be of the same force and effect as if duly served on me (us) within this State. Dated: Signed, sealed and delivered in the Name: __________________________________ Presence of Address: ________________________________ } _______________________________________ _________________________________ Name: __________________________________ Address: ________________________________ ________________________________ J4C.DOC Page 1 of 1