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: ____________________________________________ } POWER OF ATTORNEY AFFIANT KNOW ALL MEN BY THESE PRESENTS, that I, _________________________ residing at _______________________________ ____________________________________________________, pursuant to the provisions of Revised Statutes 3B:14 - 47 do hereby make, constitute and appoint Theodore N. Stephens II, Surrogate of the County of Essex, in the State of New Jersey, and their successors in office, my true and lawful attorney upon whom may be served any and all process affecting the aforesaid estate, or any interest therein, whereof I am the Affiant. And I do further agree that any process against the aforesaid estate, so served, shall be of the same force and effect as if duly served upon me within this State. __________________________________________ Signature STATE OF NEW JERSEY COUNTY OF ESSEX }SS. BE IT REMEMBERED, that on this, ____/____/____, before me, the subscriber, a Notary Public of New Jersey, personally appeared _________________________________ who I am satisfied is the person named in they signed, sealed and delivered the said power of attorney as their voluntary act and deed, for the uses and purposes therein expressed. ______________________________________________ Notary Public/Attorney at Law of the State of New Jersey My Commission Expirees________________ Affix Seal PAAF.doc Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com