REFUNDING BOND AND RELEASE Page 1 of 2 -Type or neatly print the information required.-Fill the form out on our website, www.essexsurrogate.com, and print it out.-Photocopy and re-use the blank form, print out additional forms at our website, or receive additionalforms by email, fax or mail by contacting the Surrogate222s Court at (973) 621-4900. No sooner than nine months after the date of death, each beneficiary or heir of the estate, including the Administrator/Executor, will need to fill out and the Refunding Bond and Release. Please note that the Refunding Bond and Release . -If the beneficiary or heir is a minor, the Refunding Bond and Release must be signed by the guardianof the minor222s property that has been appointed by the Surrogate222s Court. -If the beneficiary is a trust, the Refunding Bond and Release must be signed by the trustee. -If the beneficiary or heir is an incapacitated person, the Refunding Bond and Release must be signedby the guardian of the person and property of the incapacitated person that has been appointed by theSuperior Court. (Fill in ALL blanks with the information required) 1.The value of cash and property received is the total value of all assets received from the estate and caninclude cash, bank accounts, stock, personal property, and real estate. However, it does not include assetsthat do not pass through the estate, such as joint accounts or assets with designated beneficiaries other thanthe estate.2.File the original signed, witnessed and notarized document along with the 3.The 4.If you require "Filed" stamped copies (to send to the Bond Company), you must include copies of theRefunding Bond and Release along with your request and your own self-addressed envelope (we do notmake/provide courtesy copies). Mail/deliver your originals, copies and request to our Court. www.FormsWorkFlow.com SURROGATE DEVERO D. MCDOUGAL DEPUTY SURROGATE REFUNDING BOND AND RELEASE Page 2 of 2 State of New Jersey Essex County Surrogate222s Court In the matter of the Estate of: That I am and I reside at in the city/town of , State of . I am a beneficiary (or heir) of this estate and receiving the sum of $ (Value of cash & property received) from Executor/Administrator (Name of Executor/Administrator). Upon my receipt of this distribution, I am hereby obligated to refund any portion of this distribution should such refund be required by the Executor/Administrator to discharge all proper debts and obligations of the estate as required under N.J.S.A. 3B:23-24 through N.J.S.A. 3B:23-27. Upon my death, my obligation extends to my heirs, Executor or Administrator. is that I receive from the Executor/Administrator the sum of $ representing distribution to me as an intestate heir of this estate or as a beneficiary under the Will if the decedent died testate. , I release and forever discharge the Executor/Administrator from all claims and demands whatsoever in respect to the estate of the deceased and my interest therein. Signed, Sealed and Delivered in the Presence of: (Beneficiary222s Signature) (Witness' Signature) 000003000%000H000003000L000W0000030005000H000P000H000P000E000H000U000H000G, that on 20, before me, a/an of the State of personally appeared who, I am satisfied, is the person named in and who executed the within Instrument in my presence, and thereupon acknowledged that he/she signed, sealed and delivered the same as his/her act and deed for the uses and purposes therein expressed. Notary Public / Attorney of the State of My commission expires on //20 www.FormsWorkFlow.com