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 Estate of: ___________________________________________, Deceased AKA: _____________________________________ } CERTIFICATION AS TO SELF PROOF WILL Pursuant to R.S. 3B:3-4 OR R.S. 3B:3-5 and as amended The Last Will and Testament of _____________________________, deceased having been duly presented to the Essex County Surrogate's Court for Probate and upon an examination of same, it is hereby. determined that the signature thereon purporting to be that of the testator/rix was duly attested by at least two subscribing witnesses and, the said Will having been made self-proving by the acknowledgment thereof by the affidavits of the testator/rix and the affidavits of the witnesses, each made before an officer authorized pursuant to R.S. 46: 14-6, 46: 14-7 or 46: 14-8 to take acknowledgments and proof of instruments entitled to be recorded under the laws of this State, attached or annexed to the Last Will and Testament, all pursuant to R.S. 3B:3-4 and R.S. 3B:3-5 and as amended. Said Last Will and Testament having been properly executed as self-proving and no further proof being necessary as to its proper execution. ____________________________________ Special Probate Clerk Date: ______/______/20____ 4 Cert Self Proving Will Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com