State of New Jersey Docket No.: ______________ Salem County Surrogate’s Court In the matter of the Estate of: ___________________________________________, Deceased AKA: _____________________________________ } RENUNCIATION OF ADMINISTRATOR AD PROSEQUENDUM To: Nicki A. Burke, Surrogate of the County of Salem I, ___________________________, ____________________ of the above decedent, late of _______________ in the County of Salem do hereby renounce my right of Administration Ad Prosequendum, and request the appointment of ___________________________________. Dated: ____/____/20__ _______________________________________ Signature Notary Public STATE OF NEW JERSEY COUNTY OF SALEM } SS. Be it remembered, that on this, ______/______/20___, before me, undersigned authority, personally appeared ___________________________________, who I am satisfied is the person 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 voluntary act and deed, for the uses and purposes therein expressed. __________________________________________________ Notary Public My Commission Expires: ____________________ Affix Seal F5.DOC Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com