Docket No.: _______________ State of New Jersey Essex County Surrogate's Court THEODORE N. STEPHENS II SURROGATE Hall of Records, Room 206 Newark, New Jersey 07102 Phone: 973-621-4900 Fax: 973-621-2647 DEVERO D. MCDOUGAL DEPUTY SURROGATE In the matter of the Estate of: _______________________________________________, Deceased AKA: _________________________________________ To: Theodore N. Stephens II, Surrogate of the County of Essex } RENUNCIATION OF ADMINISTRATOR AD PROSEQUENDUM I, _________________________, ____________________ of the above decedent, late of _________________ in the County of Essex do hereby renounce my right of Administration Ad Prosequendum, and request the appointment of ___________________________________________. Dated: ____/____/____ Signature Notary Public/Attorney at Law of New Jersey STATE OF NEW JERSEY COUNTY OF ESSEX }SS. Be it remembered, that on this, ____/____/20___, before me, undersigned authority, personally appeared __________________________, who I am satisfied are the persons in the foregoing instrument, to whom I first made known the contents thereof, and thereupon they acknowledged that they signed, sealed and delivered the same as their voluntary act and deed, for the uses and purposes therein expressed. __________________________________________________ Notary Public/Attorney at Law of New Jersey My Commission Expires: ____________________ Affix Seal AdPros.Ren Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com