Docket No.: ________________ State of New Jersey Essex County Surrogate's Court In the matter of the Guardianship of ____________________________________________________, a Minor AKA: ______________________________________________ } ACCEPTANCE AND POWER OF ATTORNEY I, ________________________ about to be appointed by a judgment of the Surrogate of the County of Essex Guardian of the person only of the above-named minor do hereby declare my acceptance of said Guardianship. Signature Dated: ______/______/______ Signed in the presence of: Witness Signature (Attorney or Notary) 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 theirs 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 Guardian. 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. In Witness Whereof, I have hereunto set my hand and seal this ____/____/____ __________________________________ Signature Signed, sealed and delivered in the presence of: Attorney or Notary Public of the State of New Jersey 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 the foregoing power of attorney, and I having first made known to them the contents thereof, they did thereupon acknowledge that they signed, sealed and delivered the said power of attorney as their voluntary act and deed, for the uses and purposes therein expressed. ______________________________________________ Attorney or Notary Public of the State of New Jersey ACCEPTANCE AND POWER OF ATTORNEY.DOC of 1 Page 1 American LegalNet, Inc. www.FormsWorkFlow.com