Docket No.: _________________ State of New Jersey Camden County Surrogates Court In the matter of the alleged Codicil of: PROOF OF WITNESS } ___________________________________, Deceased OF CODICIL STATE OF NEW JERSEY COUNTY OF CAMDEN } SS. I, ___________________________________, being of full age and duly sworn upon my oath depose and say: I am one of the subscribing witnesses to the purported last Codicil of the above named decedent. Said decedent willingly signed said writing in my presence, after which I subscribed my name as witness. Said testator/rix was at said time over eighteen (18) years of age, of sound mind and under no constraint or undue influence so far as I know and believe. I, _________________________________________________________________, th e undersigned authority, do hereby certify in the manner in which such acts are usually authenticated by me that ___________________, the person named in the within Common, personally appeared before missi e at ________________________________________________________________________ __________________ this ___________________ ________, _______ and was duly sworn by mto the truth of the above deposition e signed by same. Subscribed and sworn to before me on: ___________________ ________, _______ N4.DOC Page 1 of 1 American LegalNet, Inc. www.USCourtForms.com