MERCER COUNTY SURROGATE’S COURT Diane Gerofsky, Surrogate INFORMATION SHEET FOR ADMINISTRATION Circle the type of proceedings sought: 1. General Administration Only 2. Administration Ad Prosequendum Only 3. Both General Administration and Administration Ad Prosequendum NAME OF DECEASED:_____________________________________Date of Death:_______________ Residence of Deceased at Time of Death:_________________________________________________ (Indicate borough, township, town or city or county) ___________________________________________________________________________________ NAME OF PERSON SEEKING TO QUALIFY AS ADMINISTRATOR:________________________ Address of Administrator: ____________________________________________________________ ____________________________________________ Telephone No: ______________ Attorney of Record: ________________________________________ Telephone No: _______________ Address: ____________________________________________________________________________ NAME SPOUSE, DOMESTIC PARTNER OR CIVIL UNION PARTNER AND NEXT OF KIN RESIDING RELATIONSHIP AGE IF ADDRESS TO DECEASED UNDER 18 ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Names of all adult persons whose right to administration is prior or equal to that of applicant and who will sign renunciations in favor of the applicant: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Approximate Value of Personal Property Passing by Intestacy (exclude assets that pass outside the Estate): $__________________________ Approximate Value of Real Property Passing by Intestacy (exclude assets that pass outside of the Estate): $_________________________ Page 1 of 2 - Information Sheet for Administration American LegalNet, Inc. www.FormsWorkflow.com If Administration Ad Prosequendum is sought: The decedent’s death was caused by the wrongful act, neglect or default of: ___________________________________________________________________________________ Rule to Bar Creditors? (Yes)______________ (No) _______________ Number of Short Certificates requested:____________________________________ Date you wish Administrator to qualify:_______________________________ Is the administrator appearing in the Trenton office to do administration? (Yes)________ (No)_________ Is the administrator appearing at a satellite office? (Yes)________ (No)__________ Lawrence Satellite_________ Ewing Satellite _________ Hamilton Satellite_________ Hopewell Satellite _________ Pennington Satellite________ E Windsor Satellite________ Princeton Twp Satellite________ Washington Twp Satellite_______ PLEASE NOTE: When making your appointment with the Surrogate’s Court for a satellite office, kindly fax or return this information sheet together with a copy of the death certificate to this office at least 24 hours prior to the appointment. Contact Kelly at (609) 989-6336 to make an appointment. MERCER COUNTY SURROGATE’S COURT P.O. BOX 8068 TRENTON, NEW JERSEY 08650 Fax: (609) 278-1242 Phone: (609) 989-6331 E-mail: dgerofsky@mercercounty.org Page 2 of 2 - Information Sheet For Administration American LegalNet, Inc. www.FormsWorkflow.com