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:____________________________________________ D.O.D.:__________________ AKA:___________________________________AGE:____________SS#:_____________________ RESIDENT MUNICIPALITY:_____________________________________ Marital Status of Deceased at Death: (Circle one) Never Married / Married / Married but Separated / Divorced / Widowed / Unknown D.O.WILL:___________________ D.O.CODICIL:____________________ WITNESSES TO WILL/CODICIL: SELF-PROVING: YES / NO _______________________________ ADDRESS:_______________________________________ _______________________________ ADDRESS:_______________________________________ FIDUCIARY: {ESQ-yes/no} Executor / Trustee / Administrator / Ad Pros / SP-Affi / NOK-Affi NAME: _______________________________________________SS#: ______________________ ADDRESS: _______________________________________________________________________ HOME PHONE #:_________________________ WORK PHONE #:________________________ FAX #: __________________________________ CELL #:_________________________________ HEIRS AT LAW & NEXT OF KIN: List all children (note age if under 18 yr.) and deceased or living Spouse / Domestic Partner / Civil Union / Issue / Parents / Siblings / Stepchildren NAME: FULL ADDRESS: RELATION: _______________________________ _________________________________ ______________ _______________________________ _________________________________ ______________ _______________________________ _________________________________ ______________ _______________________________ _________________________________ ______________ _______________________________ _________________________________ ______________ _______________________________ _________________________________ ______________ _______________________________ _________________________________ ______________ *Entire estate passes to surviving spouse, civil union partner after 2/19/07, or domestic partner after 7/10/04, parent, grandparent, child, stepchild, legally adopted child, or the issue of any child or legally adopted child (includes a grandchild and a great-grandchild but not a stepgrandchild or a great-step-grandchild). YES / NO *(MUST BE ANSWERED) ATTORNEY:________________________________________________ ADDRESS:__________________________________________________ _____________________________________________________ PHONE:_______________________FAX:_________________________ FILL IN ALL OF ABOVE; THEN FAX/MAIL WITH COPIES OF DEATH CERTIFICATE, WILL OR ASSETS & DEBTS; CALL FOR APPOINTMENT. THANK YOU! American LegalNet, Inc. www.FormsWorkflow.com