1Docket No.: State of New Jersey Essex County Surrogate222s Court THEODORE N. STEPHENS, II Hall of Records, Room 206 SURROGATE Newark, New Jersey 07102 SURROGATE Phone 973-621-4900 Fax 973-621-2647 In the matter of the Estate of: , Deceased ADMINISTRATION C.T.A. AKA: AFFIDAVIT OF ASSETS I, , of full age, being duly sworn, depose(s) and say(s): 1.I reside at , and I am applying for Letters of Administration C.T.A. uponthe estate of , who died intestate,on and resided at inthe County of Essex and State of New Jersey at the time of death. 2.The following is a brief descriptive list and valuation of all the assets constituting thereal and personal property of the decedent: ITEMS TOTAL ESTIMATED AMOUNT/VALUE Cash on hand: $ Balances in bank accounts of decedent (list accounts) $ Corporate Stocks, bonds and notes, etc: $ Life insurance taken out by decedent without $ A named beneficiary or payable to the Estate: Automobiles (include year, made, model, and VIN #): $ American LegalNet, Inc. www.FormsWorkFlow.com 2Household effects, jewelry, other chattel, etc.: $ All other personal property belonging to the Estate: $ (Refund checks, security deposits, etc.) Real Estate, located at (list separately by type and address): $ (If market value is unknown, may use tax assessed value) REMARKS: TOTAL VALUATION OFF ALL PROPERTY: $ 3. I am familiar with the circumstance of the estate and have herein provided, to the best of my knowledge, information and belief, a true and complete list of the real and personal assets and effects of the decedent, of which the decedent died possessed or is in any way entitled to, for and in respect of which Letters of Administration C.T.A. are to be granted. 4. The values/amounts stated herein are made without deducting anything on account of the debts due and owing from the decedent. 5. I will post a bond in the amount of the total valuation of all property, unless a different amount is required by the Surrogate. If the valuation changes after Letters of Administration are granted, I will provide documentation of same to the Surrogate222s Court and make application to adjust the administrative bond. 6. I understand that the estate assets must be first applied to the payment of all just claims against the estate, according to legal priority, as the law does not permit the distribution of a decedent222s property to the exclusion of creditors. 7. I understand that if any of my statements are found to be willfully false, I may be liable for perjury. Signature Subscribed and sworn to before me on this day of , 20 . Notary Public/Attorney at Law of New Jersey American LegalNet, Inc. www.FormsWorkFlow.com