MERCER COUNTY SURROGATE=S COURT Diane Gerofsky, Surrogate INFORMATION SHEET GUARDIANSHIP OF MINOR NAME OF MINOR:______________________________ Minor=s Date of Birth:_______________ Address:______________________________________________State:__________________________ ___ Social Security # of Minor:____________________(If minor has no Social Security Number, application must be made for one immediately) Name of proposed Guardian:______________________________________________________ Address of proposed Guardian:________________________________________ ______________________________________________________Telephone No:__________________ Attorney of Record:_____________________________ _ Telephone No:___________________ Address:__________________________________________________________________________ LIST BELOW NEXT OF KIN, PERSONS IN LOCO PARENTIS TO MINOR AND PERSONS WITH WHOM MINOR RESIDES: NAME RESIDING ADDRESS RELATIONSHIP TO MINOR AGE IF UNDER 18 ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ As to any parent or person listed above who is not qualifying, state the reason for example: predeceased, wishes to renounce: ___________________________________________________________________________________ ___________________________________________________________________________________ Guardianship is sought of the PERSON ONLY: ______Yes ______No Guardianship is sought of the PROPERTY ONLY: ______ Yes _______No Guardianship is sought of the PERSON AND PROPERTY: _______Yes _______No Value of the estate of the minor: $______________________________ Source of the funds of the minor (please circle appropriate number) 1. Court approved settlement of minor=s claim 2. Inheritance 3. Other (explain):_____________________________________________________________ PLEASE NOTE: When making an appointment, kindly return this form with a filed copy of any Judgment approving settlement, birth certificate and social security card at least 24 hours prior to your appointment or appearance. MERCER COUNTY SURROGATE=S OFFICE P.O. BOX 8068 TRENTON, NEW JERSEY 08650-0068 Telephone No: (609) 989-6321 Fax: (609) 278-1242 E-mail: dgerofsky@mercercounty.org American LegalNet, Inc. www.USCourtForms.com