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 NATALYNN DUNSON-HARRISON State of New Jersey Docket No.: ______________ DEPUTY SURROGATE In the matter of the Estate of: __________________________________________________, Deceased AKA: ____________________________________________ } ADMINISTRATOR QUALIFICATION ____________________________________________________, the Administrator/rix(s), in the annexed writing named, being duly sworn on oath, says, the within named, deceased, died without a Will as far as they know and verily believe; that they will well and truly administer all and singular the goods, chattels and credits which were of said deceased at the time of death, that have or shall come to their possession or knowledge, or to the possession of any other person or persons for their use; and that they will make and exhibit unto the Surrogate's Office of the County of Essex, a true and perfect inventory of all and singular the goods, chattels and credits, and render a just and true account of the administration; and that said intestate died on ______________________________. Signature Subscribed and Sworn to before me on ____/____/20 ____ __________________________________________________ Notary Public / Attorney at Law of the State of New Jersey My Commission Expires: ____________________________ Affix Seal ADMINISTRATOR QUALIFICATION Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com