Docket No.: ____________ State of New Jersey Camden County Surrogate's Court In the matter of the Estate __________________________, Deceased AKA: _____________________________ JUDGEMENT GRANTING } ADMINISTRATION AD PROSEQUENDUM It appearing by the application of ___________________________ that the deceased, late of the County of Camden and State of New Jersey, died _______________, intestate, and it being alleged in said application that the death of the intestate was caused by the wrongful act, neglect or default of some person or persons and that all the persons entitled to administration ad prosequendum in the above entitled matter have duly renounced their said right of administration and requested the appointment of _____________________ as such administrator. It is thereupon, on ________________ ADJUDGED that Letters of Administration Ad Prosequendum be granted to the said applicant(s) upon being duly qualified as such administrator. _____________________________________ Surrogate _____________________________________ Special Deputy Surrogate STATE OF NEW JERSEY COUNTY OF CAMDEN } SS The administrator Ad Prosequendum duly swears the within named decedent died without a Will so far as he knows and verily believes; that he will duly perform his duty as such Administrator Ad Prosequendum as the law requires. Sworn and subscribed before me on _______ day of _____________, _____ F4.DOC American LegalNet, Inc. www.USCourtForms.com Page 1 of 1