State of New Jersey Docket No.: ______________ Salem County Surrogate’s Court In the matter of the Estate of: __________________________________________________, Deceased } AKA: ____________________________________________ POWER OF ATTORNEY AFFIANT 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 Affiant. 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: 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 they signed, sealed and delivered the said power of attorney as their voluntary act and deed, for the uses and purposes therein expressed. ______________________________________________ Notary Public of the State of New Jersey My Commission Expirees________________ Affix Seal PAAF.doc Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com