Docket No.: ______________ Essex County Surrogate's Court THEODORE N. STEPHENS, II SURROGATE Hall of Records, Room 206 Newark, New Jersey 07102 Phone 973-621-4900 Fax 973-621-2647 DEVERO D. MCDOUGAL DEPUTY SURROGATE State of New Jersey _____________________________, Deceased AKA: VERIFICATIONS: CHILD SUPPORT NOTICE OF PROBATE State of New Jersey } ss County of Essex KNOW ALL MEN BY THESE PRESENTS, that I hereby certify that I have been given a copy of: _________ N.J.S.A. 2A:17-56.23b, Judgment for Child Support Lien Against Net Proceeds of Settlement: Priority, advising me as to my obligation to determine if child support arrearages exist against any beneficiary entitled to receive more than $2,000.00 and to satisfy same prior to disbursement of funds payable to said beneficiary identified as owing said child support. _________ New Jersey Court Rule 4:80-6, Notice of Probate of Will, advising me as to my obligation to send notice of the probate of a Will to beneficiaries and all persons designated by Rule 4:80-1(a)(3), including the testator's spouse, heirs, next of kin, and any other persons entitled to letters. ___________________________ Signature Print Name: Subscribed and sworn to before me this day of , 20 . __________________________ Notary Public/Attorney at Law American LegalNet, Inc. www.FormsWorkFlow.com