Docket No.: ______________ State of New Jersey Essex County Surrogate’s Court JOSEPH P. BRENNAN, JR. SURROGATE Hall of Records, Room 206 Newark, New Jersey 07102 Phone: 973-621-4900 Fax: 973-621-2654 In the matter of the Estate of: } _______________________________________, Deceased PATRICIA A. TRABUCCO DEPUTY SURROGATE RENUNCIATION OF RIGHT TO ADMINISTRATION C.T.A. AKA: ________________________________________ To: Joseph P. Brennan, Jr., Surrogate of the County of Essex: I, ______________________________, _____________________ of the above decedent, late of ___________ in the County of _____________ and State of ________________ being entitled to have Administration C.T.A. of the estate of ___________________, do hereby renounce right of said Administration C.T.A. and request the appointment of _________________________________ as Administrator/rix C.T.A. of said estate. Witness my hand and seal this ______/______/______ Signed in the presence of ______________________________________ ________________________________________ Signature STATE OF COUNTY OF } SS. Be it remembered, that on this, ______/______/______, before me, undersigned authority, personally appeared __________________________________ who I am satisfied are the persons in the within instrument named, and I having first made known to them the contents thereof, did acknowledged that they signed, sealed and delivered the same as their voluntary act and deed, for the uses and purposes therein expressed. ____________________________________________ Notary Public of the State of _______________________________ My Commission Expires: ______________________ Affix Seal American LegalNet, Inc. www.USCourtForms.com B3.DOC Page 1 of 1