Docket No.: ______________ State of New Jersey Salem County Surrogate’s Court In the matter of the Guardianship of: _____________________________________________, a Minor AKA: ________________________________________ } GUARDIANSHIP RENUNCIATION To: Nicki A. Burke, Surrogate of the County of Salem; Be it known that the following individuals with the indicated relationships to the above-referenced of above named minor person of the age of ________________________ years, do hereby consent to the appointment of ___________________________ as the guardian of said minor/incapacitated person and that I do hereby waive any right which I may have to be so appointed. Renouncing Name Relationship Signature Dated: ______/______/20___ Signed in the presence of: Witness Signature J2.DOC Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Docket No.: __________________ STATE OF NEW JERSEY COUNTY OF SALEM } SS. BE IT REMEMBERED, that on this, ____/____/20__, before me undersigned authority personally appeared; Renouncing Name Signature who I am satisfied is/are the person(s) named in the foregoing instrument, to whom I first made known the contents thereof, and thereupon they acknowledged that they signed, sealed and delivered the same as their act and deed, for the uses and purposes therein expressed. __________________________________________________ Notary Public of the State of New Jersey My Commission Expires: ____________________________ Affix Seal J2.DOC Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com