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: __________________________________________ } EXECUTOR QUALIFICATION ________________________________________, the Executor/rix, in the annexed writing named, being duly sworn on oath, says, the annexed writing contains the true last Will and Testament, of ___________________________, the testator/rix therein named, deceased, as far as they know and verily believe; that __________________________________-, the executor/rix thereof , well and truly perform the same, first by paying the debts of said deceased, and then the legacies therein specified, as far as the goods, chattels and credits of said deceased will thereunto extend, and the law charges; that _____________________________ will, when lawfully required, make and exhibit unto the Surrogate's Court of the County of Essex, a true and perfect inventory of all and singular the said goods, chattels and credits as far as the same have or shall come to said possession or knowledge, or to the possession of any other person or persons for said use, with said knowledge; and that ________________________________ will well and truly account when thereunto lawfully required, and that said testator/rix died on ______________________. Signature Subscribed and Sworn to before me on _____________________ , 20 ___ __________________________________________________ Notary Public of the State of New Jersey My Commission Expires: ____________________________ Affix Seal 3_EXECUTOR_QUALIFICATION Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com