State of New Jersey Docket No.: ________________ Salem County Surrogate’s Court In the matter of the Guardianship of ____________________________________________________, a Minor } AKA: ______________________________________________ ACCEPTANCE AND POWER OF ATTORNEY I, ________________________ about to be appointed by a judgment of the Surrogate of the County of Salem Guardian of the person only of the above-named minor do hereby declare my acceptance of said Guardianship. Signature Dated: ______/______/20___ Signed in the presence of: Witness Signature (Attorney or Notary) KNOW ALL MEN BY THESE PRESENTS, that I, _________________________ residing at ______________________________ ___________________________________, pursuant to the provisions of Revised Statutes 3B:14-47 do hereby make, constitute and appoint Nicki A. Burke, Surrogate of the County of Salem, in the State of New Jersey, and their successors in office, my true and lawful attorney upon whom may be served any and all process affecting the aforesaid estate, or any interest therein, whereof I am the Guardian. And I do further agree that any process against the aforesaid estate, so served, shall be of the same force and effect as if duly served upon me within this State. In Witness Whereof, I have hereunto set my hand and seal this ____/____/20__ __________________________________ Signature Signed, sealed and delivered in the presence of: Attorney or Notary Public of the State of New Jersey STATE OF NEW JERSEY COUNTY OF SALEM } SS. BE IT REMEMBERED, that on this, ____/____/20__, before me, the subscriber, a Notary Public of New Jersey, personally appeared ____________________________, who I am satisfied is the person named in the foregoing power of attorney, and I having first made known to them the contents thereof, they did thereupon acknowledge that they signed, sealed and delivered the said power of attorney as their voluntary act and deed, for the uses and purposes therein expressed. ______________________________________________ Attorney or Notary Public of the State of New Jersey J4.DOC Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com