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 State of New Jersey Docket No.: ________________ In the matter of the Estate of: ______________________________________________, Deceased AKA: ________________________________________ } APPLICATION ADMINISTRATION Applicant (s) ________________________________________________________________________________ , residing at ___________________________________________________________________________________, of full age, being duly sworn, says: 1. Decedent died intestate on _______________________ and, on said date of death, had a legal residence of ___________________________________________________________ in the County of Essex and State of New Jersey. 2. Decedent left surviving spouse, heirs at law and next of kin, the following persons (include parents and siblings of decedent if decedent had no spouse and/or children; if any of decedent's children are deceased, list the children of deceased children) : Name Relationship To Decedent Residence Age of Minors 3. There are no other next of kin and all the foregoing are of full age except as indicated. APPLICATION Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Docket No.: __________________ Wherefore, the Applicant(s) requests judgment granting Letters of Administration to Applicant(s). STATE OF NEW JERSEY COUNTY OF ESSEX }SS. Applicant(s), being duly sworn according to law, did upon their oath, say that the matters and things set forth in the within application are true to the best of their knowledge and belief, that to the best of their knowledge the decedent died without a valid Will, and that the value of the entire estate, for the administration of which this application is made, does not exceed the sum of $_______________. Sworn and subscribed before me on _____/_____/ 20_____ Signature Notary Public or Attorney at Law My Commission Expires: __________________ Affix Seal Attorney of Record: _________________________________________ _________________________________________ _________________________________________ _________________________________________ APPLICATION Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com