Docket No.: ______________ State of New Jersey Essex County Surrogate’s Court JOSEPH P. BRENNAN, JR. SURROGATE Hall of Records, Room 206 Newark, New Jersey 07102 Phone: 973-621-4900 Fax: 973-621-2654 In the matter of the Estate of: _____________________________________________, Deceased PATRICIA A. TRABUCCO DEPUTY SURROGATE } AKA: _______________________________________ ADMINISTRATOR AD PROSEQUENDUM QUALIFICATION __________________________, the Administrator/rix Ad Prosequendum(s), in the annexed writing named, being duly sworn on oath, say(s), they will well and truly perform the responsibilities of the office, first by paying the debts of said deceased, and then the legacies therein specified, as far as the goods, chattels and credits of said deceased will thereunto extend, and the law charges; that _______________________________ will, when lawfully required, make and exhibit unto the Surrogate's Court of the County of Essex, a true and perfect inventory of all and singular the said goods, chattels and credits as far as the same have or shall come to their possession or knowledge, or to the possession of any other person or persons for their use, with their knowledge; and that ______________________________ will well and truly account when thereunto lawfully required, and that said decedent died on __________________. Signature Subscribed and Sworn to before me on: ______/______/______ __________________________________________________ Notary Public of the State of New Jersey My Commission Expires: ____________________________ Affix Seal AAPQ.DOC Page 1 of 1 American LegalNet, Inc. www.USCourtForms.com