AFFIDAVIT I, the undersigned, certify that I am the surviving spouse or domestic partner of _____________________________________________________, as recognized by the State of New Jersey or a competent jurisdiction. The decedent's name and my name, _____________________________________________________, appear on certificate of title number _____________________________________________ as follows: _____________________________________________________. I further certify that from the time my name and the decedent's name appeared on the certificate of title until the death of the decedent on ___________________________________________, our relationship was that of a marriage or domestic partnership. X ______________________________ Signature Sworn and subscribed before me this _____ day of _________, 20_______ ______________________________ Notary Public of New Jersey BA-62 (R4/14) American LegalNet, Inc. www.FormsWorkFlow.com