MERCER COUNTY SURROGATE’S COURT Diane Gerofsky, Surrogate INFORMATION SHEET FOR AFFIDAVIT OF SURVIVING SPOUSE, DOMESTIC PARTNER OR NEXT OF KIN Circle the type of proceedings sought: 1. Affidavit of Surviving Spouse, Domestic Partner or Civil Union Partner 2. Affidavit of Next of Kin 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 AFFIANT:__________________________________ Address of Affiant:__________________________________________________________________ ____________________________________________ Telephone No:____________________ 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 who have equal right to affidavit (next of kin) is prior to or equal to that of the applicant and who will sign consents in favor of the applicant: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Exact Value and description of Personal or Real Property Passing by Intestacy (exclude assets that pass outside of the Estate): _________________________________________________________________ _________________________________________________________________$__________________ ________ Date you wish Affiant to qualify:_______________________________ Is the Affiant appearing in the Trenton office to do Affidavit? (Yes)________ (No)_________ Page 1 of 2 - Information Sheet for Affidavit American LegalNet, Inc. www.FormsWorkflow.com Is the affiant 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 return this sheet together with a copy of the Death Certificate to this office at least 24 hours prior to the appointment: MERCER COUNTY SURROGATE’S COURT P.O. BOX 8068 TRENTON, NEW JERSEY 08650 Fax: (609) 278-1242 Phone: (609) 989-6331 Email: dgerofsky@mercercounty.org American LegalNet, Inc. www.FormsWorkflow.com