HUNTERDON COUNTY SURROGATE'S COURT Hunterdon County Justice Center, 65 Park Avenue, P.O. Box 2900, Flemington, NJ 08822 Tel.: (908)788-1156 - Fax: 788-1586 - email: surrogate@co.hunterdon.nj.us INFORMATION SHEET AFFIDAVIT IN LIEU OF ADMINISTRATION NEXT OF KIN AFTER COMPLETING THE INFORMATION BELOW PLEASE FAX WITH A COPY OF THE DEATH CERTIFICATE TO 788-1586. At that time if you would like to make an appointment please do so or let us know approximately when your client will appear in this Court. If you have any questions please call or fax. NAME OF DECEASED AGE Also known as Legal residence at time of death Township, Borough or City the residence was located in __________________________________________ Date of Death: Administrator: SSN: Phone Number: Full Address: Survivors and next of kin ( include age of minors only) List how exactly they are related to the decedent. (Example: Jane Doe, niece is the child of the decedent's deceased brother, Joe Doe.) Name Relationship Address Age ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Deceased children? Names of their children, and addresses ________________________________________________________________________________ ________________________________________________________________________________ Any Children of a prior marriage Yes No (Circle One) The death of the said , was the result of which occurred in _________________________________ (ex: automobile accident) ________________________________________________________________________________________________ (Location of accident including county & state) and was caused by the wrongful act, neglect or default of _ whose address is _____________________________________________________________________________________ _______________________________________________________________ or some other person or persons. Total number of certificates Attorney for Estate _____________________________________________________________________________ Address _______________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com