State of New Jersey Monmouth County Surrogate's Court In the Matter of the Estate of , Deceased : : : : PROOF OF WITNESS I, ___________________________________________, being of full age and duly sworn, upon my oath depose and say: I am one of the subscribing witnesses to the purported last Will and/or Codicil(s) of the above named decedent. Said decedent willingly signed said writing in my presence, after which I subscribed my name as witness. Said decedent was at said time over eighteen (18) years of age, of sound mind and under no constraint or undue influence so far as I know and believe. Subscribed and sworn to before me this day of , 20 . _______________________________________ ______________________________ American LegalNet, Inc. www.USCourtForms.com