Docket No.: ______________ State of New Jersey Salem County Surrogate’s Court In the matter of the Estate of: ___________________________________________________, Deceased AKA: _____________________________________________ } POWER OF ATTORNEY AND QUALIFICATION ____________________ TRUSTEE KNOW ALL MEN BY THESE PRESENTS, that I, _________________ __________________ 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 ____________________ Trustee And I do further agree that any process against the aforesaid estate, so served, shall be of the same effect as if duly served upon me within this State. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ____/____/20__ Signed, sealed and delivered in the presence of: __________________________________________________ Signature ______________________________________ STATE OF NEW JERSEY COUNTY OF SALEM } SS. BE IT REMEMBERED, that on ____/____/20__, before me, the subscriber, a Notary Public of the State of New Jersey, personally appeared _______________________________, who I am satisfied is the person in the foregoing power of attorney named, and I having first made known to them the contents thereof, they did thereupon acknowledge that 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 Expires: ____________________________ Affix Seal PAQST.DOC Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com