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 Natalynn Dunson-Harrison DEPUTY SURROGATE In the matter of the Guardianship of ______________________________________________, a Minor AKA: ________________________________________ } APPLICATION FOR PERMISSION TO MAKE DEPOSIT OF FUNDS IN LIEU OF PROVIDING FULL SECURITY Applicant, _______________________, residing at ____________________________________________________________ says: 1. 2. 3. The applicant has instituted an action in this Court for the issuance to _________________ of Letters of Guardianship of the above-named minor, residing at _________________________________________________________________________. The said minor has an estate of $__________________ Wherefore, the applicant applies for an order directing that the said sum of $_____________________ be deposited with the ___________________________ subject to the control of this Court. ____________________________________________ Signature STATE OF NEW JERSEY COUNTY OF ESSEX }SS. ________________________________, of full age, being duly sworn according to law, upon his/her oath deposes and says: I am the applicant in the foregoing petition named and the allegations therein set forth are true to my own knowledge and belief. Subscribed and sworn to before me Date: ____/____/____ __________________________________________ Signature __________________________________________ Notary Public of the State of New Jersey My Commission Expires: ________________________________ Affix Seal AMDFLPFS.DOC Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com