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 DEVERO D. MCDOUGAL DEPUTY SURROGATE In the matter of the Guardianship of: _______________________________________________, a Minor AKA: _________________________________________ } GUARDIANSHIP APPLICATION Applicant(s) _______________________________ residing at ______________________________________ ______________________________________________SSN:___________________, respectfully shows that: 1. _____________________, a minor, ___________ years of age, having a birth date ________________, and resides at ______________________________________________________________________________ 2. The names and residences the minor's nearest next of kin, of the persons with whom they reside and those standing in the loco parentis are as follows: Name Relationship Residence Age of all Minors 3. Said minor is the owner of personal property having an approximate value of $_______________________ as appears from the affidavit attached hereto. 4. Applicant(s) is/are the party/ies first entitled or all equally entitled to Guardianship have duly renounced in writing. Due notice of this application has been given to all persons entitled to Guardianship. Wherefore, applicant(s) demand(s) judgment granting Letters of Guardianship of the person only of __________________________________, minor, to ______________________________________________. Signature GDN-PERSON ONLY.DOC American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 Docket No.: _________________ STATE OF NEW JERSEY COUNTY OF ESSEX }SS. ________________________, being duly sworn under oath according to law, depose(s) and say(s) that _____________________________ is/are the applicant(s) named in the forgoing complaint and that the matters and things therein contained are true to the best of their knowledge and belief. Deponent(s) further say(s) that the value of the personal estate of said minor is $_________________________. Signature Sworn and subscribed before me on ______/______/______ Notary Public of the State of New Jersey My Commission Expires: _____________________ Affix Seal Attorney of Record: ____________________________ ____________________________ ____________________________ ____________________________ GDN-PERSON ONLY.DOC American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2