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: ______________________________ SUBSTITUTIONARY ADMINISTRATION C.T.A. AFFIDAVIT OF ASSETS I, ____________________________________________, of full age, being duly sworn, depose(s) and say(s): 1. I reside at _____________________________________________________________ _____________________, and I am applying for Letters of Administration C.T.A. upon the estate of ______________________________________________, who died intestate, on _______________________ and resided at ________________________________ in the County of Essex and State of New Jersey at the time of death. The following is a brief descriptive list and valuation of all the assets constituting the real and personal property of the decedent: TOTAL ESTIMATED AMOUNT/VALUE 2. ITEMS_________________________________ Cash on hand: $ _________________________________________________________________________________ Balances in bank accounts of decedent (list accounts) $ _________________________________________________________________________________ Corporate Stocks, bonds and notes, etc: $ _________________________________________________________________________________ Life insurance taken out by decedent without $ A named beneficiary or payable to the Estate: _________________________________________________________________________________ Automobiles (include year, made, model, and VIN #): $ _________________________________________________________________________________ 1 American LegalNet, Inc. www.FormsWorkFlow.com Household effects, jewelry, other chattel, etc.: $ _________________________________________________________________________________ All other personal property belonging to the Estate: $ (Refund checks, security deposits, etc.) _________________________________________________________________________________ Real Estate, located at (list separately by type and address): $ (If market value is unknown, may use tax assessed value) _________________________________________________________________________________ REMARKS: _________________________________________________________________________________ TOTAL VALUATION OFF ALL PROPERTY: 3. $ 4. 5. 6. 7. I am familiar with the circumstance of the estate and have herein provided, to the best of my knowledge, information and belief, a true and complete list of the real and personal assets and effects of the decedent, of which the decedent died possessed or is in any way entitled to, for and in respect of which Letters of Administration C.T.A. are to be granted. The values/amounts stated herein are made without deducting anything on account of the debts due and owing from the decedent. I will post a bond in the amount of the total valuation of all property, unless a different amount is required by the Surrogate. If the valuation changes after Letters of Administration are granted, I will provide documentation of same to the Surrogate's Court and make application to adjust the administrative bond. I understand that the estate assets must be first applied to the payment of all just claims against the estate, according to legal priority, as the law does not permit the distribution of a decedent's property to the exclusion of creditors. I understand that if any of my statements are found to be willfully false, I may be liable for perjury. ___________________________ Signature Subscribed and sworn to before me on this ________day of ___________________, 20 ____ . _____________________________________ Notary Public/Attorney at Law of New Jersey 2 American LegalNet, Inc. www.FormsWorkFlow.com