Docket No.: State of New Jersey Essex County Surrogate222s Court Hall of Records, Room 206 SURROGATE Newark, New Jersey 07102 DEPUTY SURROGATE Phone: 973-621-4900 Fax: 973-621-2654 In the matter of the Estate of: , Deceased AKA: }RENUNCIATION OF RIGHT OF ADMINISTRATION To: Surrogate of the County of Essex I, , (relative status) of the above decedent, late of the County of Essex do hereby renounce my right and claim to administration of his/her goods, chattels and credits, and request the appointment of as Administratrator/trix. Dated: // Signature *Copy of government issued picture I.D. required* Witness 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 or Attorney at Law of State of New Jersey My Commission Expires: Affix Seal RENUNCIATION.DOC Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com