MERCER COUNTY SURROGATE"S COURT Diane Gerofsky, Surrogate INFORMATION SHEET FOR PROBATE/ADMINSTRATION C.T.A. NAME OF DECEASED:________________________________Date of Death_____________________ Residence of Deceased at Time of Death:________________________________________________ (Indicate borough, township, town, or city or county) ___________________________________________________________________________________ Name(s) of Executor who will qualify:_____________________________________________ ___________________________________________________________________________________ Address(es) of Executor(s):_____________________________________________________________ (Indicate borough, township, town, or city or county) _________________________________________________Telephone No:______________________ Date of Will:________________________________ Date of Codicil(s):__________________________ Is Will Self-Proving? (Yes)______(No)______ If not, give names and addresses of all witnesses to Will: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Name of Witness Appearing to Prove Will:_______________________________________ Attorney of Record:**______________________________________ Telephone No:_________________ Address:___________________________________________________________________________ NEXT OF KIN RELATIONSHIP TO TO DECEASED NAME ADDRESS AGE IF UNDER 18 ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ** Attorney of Record is the attorney whom you have retained to represent and assist you with the estate and whose name will appear on the application. Page 1 of 2 - Fact Sheet for Probate/Administration C.T.A. American LegalNet, Inc. www.FormsWorkFlow.com If named Executor is not qualifying, state the reason - e.g. predeceased, wishes to renounce: ___________________________________________________________________________________ Renunciation(s) (Yes)______(No)______ Names of Person(s) Renouncing: _____________________ ___________________________________________________________________________________ Name of Proposed Administrator C.T.A (If there is no executor living or not wishing to serve see residuary (rest and residue) clause of Will for those receiving under the Will Name: _____________________________________________________________________________ Address:____________________________________________________________________________ _____________________________________________________ Telephone No:__________________ Names and Addresses of all beneficiaries under the residuary clause under the Will ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Approximate Value of Personalty Passing By Will (if Administration C.T.A.): $__________________ Approximate Value of Real Estate Passing By Will (if Administration is C.T.A.): $___________________ Rule to Bar Creditors (Yes)______(No)______ ( Deaths on or before February 26, 2005 only) Number of Short Certificates Requested:__________________________________________ Date You Wish Executor to Qualify:___________________________________________ Is the executor appearing in the Trenton office to probate? (Yes)________ (No)_________ Is the executor appearing at a satellite office? (Yes)________ (No)__________ If yes, please indicate which satellite office (by appointment only). Lawrence Satellite___________ Ewing Satellite ___________ Hamilton Satellite___________ Hopewell Township _________ Pennington Satellite_________ E Windsor Satellite__________ Princeton Twp Satellite________ Robbinsville________________ 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 Will and Death Certificate to this office at least 48 hours hours prior to the appointment. Contact Kelly at 609 989-6336 to make an appointment for the satellite office only. MERCER COUNTY SURROGATE"S COURT P.O. BOX 8068 TRENTON, NEW JERSEY 08650-0068 Fax: (609) 278-1242 Phone: (609) 989-6331 E-mail: dgerofsky@mercercounty.org Page 2 of 2 - Fact Sheet for Probate/Administration C.T.A. American LegalNet, Inc. www.FormsWorkFlow.com