Docket No.: ___________________ State of New Jersey Salem County Surrogate's Court In the matter of the Estate of: _________________________________, Deceased CHILD SUPPORT VERIFICATION } KNOW ALL MEN BY THESE PRESENTS, THAT I, ____________________________________________, have been made aware of N.J.S.A. 2A:17-56.23b, advising me as to my obligation to determine if child support arrearages exist prior to making disbursements in excess of $2,000.00 and to satisfy same prior to disbursements of funds to any beneficiary which may owe such child support. _________________________________________ Signature STATE OF NEW JERSEY COUNTY OF SALEM } SS. Subscribed and sworn to before me on _________________ ________, __________ CSV.DOC Page 1 of 1 American LegalNet, Inc. www.USCourtForms.com