Docket No.: _________________ State of New Jersey Salem County Surrogates Court In the matter of the Estate of: AFFIDAVIT OF SURVIVING SPOUSE ________________________________________________, Deceased } In Lieu Of Administration Where Real and Personal Estate Does Not Exceed $20,000.00 (R.S. 3B:10-3) AKA: __________________________________________ I ________________________________________________________, being duly sworn according to law on oath, depose and say: 1. I reside at ________________________________________________________________________________________________ 2. I am the spouse of decedent who departed this life on or about _________________, with a residence _______________________ ___________________________________________in the County of Salem and State of New Jersey without leaving a Will; that the entire estate, both real and personal, of said decedent does not exceed the sum of twety thousannd ($20,000.00) dollars consisting of assets of the following nature, value and location: Asset Description Value Location The deponent is therefore entitled to same without Letters of Administration, in accordance with N.J.S.A. 3B: 10-3 Laws of New Jersey. Sworn and subscribed before me on: ______/______/20___ _______________________________________________ Signature __________________________________ H1.DOC Page 1 of 1 American LegalNet, Inc. www.USCourtForms.com