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: ________________________________________ To: Theodore N. Stephens II, Surrogate of the County of Essex; } GUARDIANSHIP RENUNCIATION Be it known that the following individuals with the indicated relationships to the above-referenced of above named minor person of the age of _____years, do hereby consent to the appointment of ___________________________ as the guardian of said minor/incapacitated person and that I do hereby waive any right which I may have to be so appointed. Renouncing Name (s) Relationship Signature Dated: ______/______/______ Signed in the presence of: Witness Signature STATE OF NEW JERSEY COUNTY OF ESSEX }SS. Renouncing Name (#2) BE IT REMEMBERED, that on this, ____/____/____, before me undersigned authority personally appeared; Renouncing Name (#1) who I am satisfied is/are the person(s) named 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 act and deed, for the uses and purposes therein expressed. __________________________________________________ Notary Public/Attorney at Law of the State of New Jersey My Commission Expires: ____________________________ Affix Seal Guardianship of Minors Renunciation American LegalNet, Inc. www.FormsWorkFlow.com