OFFICE OF THE SURROGATE ESSEX COUNTY THEODORE N. STEPHENS II SURROGATE Natalynn Dunson-Harrison DEPUTY SURROGATE 465 Dr. Martin Luther King, Jr. Blvd. Hall of Records, Room 206 Newark, New Jersey 07102 www.essexsurrogate.com IMPORTANT INFORMATION/INSTRUCTIONS FOR REFUNDING BOND AND RELEASE Attached is the Refunding Bond and Release. You may: 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 additional forms by email, fax or mail by contacting the Surrogate's 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 sign, in front of a witness as well as a notary or a New Jersey attorney, the Refunding Bond and Release. Please note that the Refunding Bond and Release should be signed prior to any distribution or checks being released to a beneficiary. If the Beneficiary/Heir is a minor, trust or is incapacitated: If the beneficiary or heir is a minor, the Refunding Bond and Release must be signed by the guardian of the minor's property that has been appointed by the Surrogate's 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 signed by the guardian of the person and property of the incapacitated person that has been appointed by the Superior Court. - Filing Instructions: (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 can include cash, bank accounts, stock, personal property and real estate. However, it does not include assets that do not pass through the estate, such as joint accounts or assets with designated beneficiaries other than the estate. File the original signed, witnessed and notarized document along with the filing fee of $5.00 per page. The check should be made payable to "Essex County Surrogate." If you require "Filed" stamped copies (to send to the Bond Company), you must include copies of the Refunding Bond and Release along with your request and your own self-addressed envelope (we do not make/provide courtesy copies). Mail/deliver your originals, copies and request to our Court. 2. 3. 4. REFUNDING BOND AND RELEASE Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Docket No.: ______________ State of New Jersey Essex County Surrogate's Court In the matter of the Estate of: ______________________________________________, Deceased AKA: ________________________________________ KNOW ALL MEN BY THESE PRESENTS, That I am in the city/town of and I reside at , State of . } REFUNDING BOND AND RELEASE 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. THE CONDITION OF THIS OBLIGATION 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. AND IN CONSIDERATION THEREOF, 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: ________________________________ _________________________________ (Witness' Signature) (Beneficiary's Signature) STATE OF NEW JERSEY, COUNTY OF ESSEX } SS.: Be it Remembered, 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 ______ REFUNDING BOND AND RELEASE Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com