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Information Sheet Form. This is a New Jersey form and can be use in Salem Local County.
Tags: Information Sheet, New Jersey Local County, Salem
SALEM COUNTY SURROGATE’S COURT INFORMATION SHEET
NICKI A. BURKE – SURROGATE
92 Market Street, Salem, NJ 08079
Tel. (856) 935-7510 Ext. 8323 FAX: (856) 339-9359
Website: www.salemcountynj.gov
E-Mail: surrogate@salemcountynj.gov
Will / Administration- (Asset Sheet Required R.4:80-1b) / Administration Ad Prosequendum / Affidavit in Lieu of Administration Guardianship / Other
DOCKET NO. _________________ TODAY’S DATE: ________________ INFO REC’D:
ESTATE OF:
IN PERSON [ ]
PHONE [ ]
ATTY [
]
_______________________________________________AKA________________________
LEGAL DOMICILE AT TIME OF DEATH:_______________________________________________________
DATE OF DEATH _______________ DATE OF BIRTH ______________ DATE OF WILL ____________
SS# _____________________ PAGES IN WILL ________________ (please enclose a copy of will)
Name(s) & Address(es) of Executor(s), Administrator(s) :
Name
Address
Marital Status: Married[ ]
Widowed[
Certified Domestic Partnership [ ]
Children of decedent: Son(s)[ ]
Children from previous marriage[
]
Relationship
Never Married[ ]
Civil Union [ ]
Phone
Divorced[
Daughter(s)[ ]
None[ ]
]
Children of Deceased Children[
]
]
Stepchildren[
]
Next of Kin: Begin with spouse and children (guardian of minor children). If none, include parents and/or siblings.
Indicate if they will be renouncing (use reverse side or additional sheet if necessary.)
Age if
Indicate if
Name
Relationship
Address
Minor
Renouncing
__________________________________________________________________________________ ( )
__________________________________________________________________________________ ( )
__________________________________________________________________________________ ( )
__________________________________________________________________________________ ( )
__________________________________________________________________________________ ( )
Self Proving Will: Yes [ ]
No [ ]
If NO, Name(s) and Address(es) of Witness(es) who will
prove: ________________________________________________________________________________
# of Certificates Needed _______Payment: Cash [ ] Check [ ] Atty Escrow [ ]
Mail to Atty [ ]
Give to Executor/rix [ ]
Name, Address & Phone # of Attorney_______________________________________________________
______________________________________________________________________________________
OFFICE USE: DOD____ DOW____DOI____QUARTERLY____SS____BK&PG____DOCKET____SCAN____
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