Docket No.: _______________ 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 State of New Jersey In the matter of the Estate of: _______________________________________________, Deceased AKA: _________________________________________ To: Theodore N. Stephens II Surrogate of the County of Essex } RENUNCIATION I, _________________________, ____________________(relative status) of the above decedent, late of the County of Essex do hereby renounce my right and claim to administration of his/her goods, chattels and credits, and request the appointment of ___________________________________________ as Administratrator/trix. ___________ Signature STATE OF NEW JERSEY COUNTY OF ESSEX }SS. Be it remembered, that on this, ____/____/20___, before me, undersigned authority, personally appeared __________________________, who I am satisfied are the persons 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 voluntary act and deed, for the uses and purposes therein expressed. __________________________________________________ Notary Public or Attorney at Law of State of New Jersey My Commission Expires: ____________________ Affix Seal RENUNCIATION.DOC Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com