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: 973-621-2654 DEVERO D. MCDOUGAL DEPUTY SURROGATE In the matter of the Estate of: ____________________________________________________, Deceased AKA: ______________________________________________ } APPLICATION FOR SUBSTITUTIONARY ADMINISTRATION Applicant (s) ________________________________, ______________________ at ______________________________________ ________________________________________________________SSN:__________________________, respectfully shows that: 1. On _______________ the above-named decedent died intestate and _____________________ was duly appointed administrator/rix of the goods, chattels, rights and credits of the said intestate on _______________________. 2. The said administrator/rix as aforesaid, after taking upon himself/herself the burden of said administration ____________________, _______________________________, leaving certain property and assets of the estate of the said intestate un-administered, the value whereof does not, as nearly as your applicant can ascertain, exceed the sum of $_________________________________________. 3. Decedent left surviving spouse, heirs at law and next of kin, the following persons: Name Relationship Residence Age of all Minors 4. There are no other heirs or next of kin known to the applicant. 1_APPLIC_FOR_SUBSTITUTIONARY_ADM Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Docket No.: _________________ 5. All of the said next of kin of the deceased entitled to Substitutionary Administration upon this estate have renounced in writing their right of Administration and requested that the same be granted to your Applicant(s). Due notice of this application has been given to all the aforesaid next of kin. Wherefore, the Applicant(s) requests judgment that Letters of Substitutionary Administration upon the estate of the aforesaid intestate be granted to Applicant(s). STATE OF NEW JERSEY COUNTY OF ESSEX } SS. ____________________________________, of full age, being duly sworn according to law, did upon their oath depose and say they are the applicant named in this document and that the matters and things set forth in the within application are true to the best of their knowledge and belief, applicant further says that the value of the entire estate, for the administration of which this application is made, will not exceed the sum of $___________________. Sworn and subscribed before me on: ____/____/____ Signature Notary Public My Commission Expires: ________________________________ Affix Seal Attorney of Record: ____________________________ ____________________________ ____________________________ ____________________________ 1_APPLIC_FOR_SUBSTITUTIONARY_ADM Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com