NANCY D. FITZGIBBONS, SURROGATE OF SUSSEX COUNTY 3 High Street, Suite 1, Newton, New Jersey 07860 FAX (973) 579-0909 Office (973) 579-0920 ESTATE OF:_____________________________________DOD:_________________ FOR USE WITH ADMINISTRATION APPLICATIONS The real and personal estate of said decedent (circle one) Does or Does not exceed in value _____the sum of ten thousand ($10,000.00) dollars _____the sum of twenty thousand ($20,000.00) dollars consisting of assets of the following nature, value and location: THE ASSETS IN THE NAME OF THE DECEDENT ALONE ARE AS FOLLOWS: _________________________________________ $__________________ _________________________________________ $__________________ _________________________________________ $__________________ _________________________________________ $__________________ _________________________________________ $__________________ _________________________________________ $__________________ _________________________________________ $__________________ TOTAL: $__________________ American LegalNet, Inc. www.FormsWorkflow.com