Substitutionary Administrator Qualification

Docket No.: ______________ State of New Jersey Essex County Surrogate's Court THEODORE N. STEPHENS, II SURROGATE Hall of Records, Room 206 Newark, New Jersey 07102 Phone: 973-621-4900 Fax: 973-621-2654 DEVERO D. MCDOUGAL DEPUTY SURROGATE In the matter of the Estate of: _____________________________________________________, Deceased AKA: _______________________________________________ } SUBSTITUTIONARY ADMINISTRATOR QUALIFICATION ______________________________________, the Substitutionary Administrator/rix(s), in the annexed writing named, being duly sworn on oath, says, the within named, deceased, died without a Will as far as they know and verily believe; that they will well and truly administer all and singular the goods, chattels and credits which were of said deceased at the time of death, that have or shall come to their possession or knowledge, or to the possession of any other person or persons for their use; and that _________________ will make and exhibit unto the Surrogate's Office of the County of Essex, a true and perfect inventory of all and singular the goods, chattels and credits, and render a just and true account of their Administration; and that said intestate died on __________________. Signature Subscribed and Sworn to before me on: ____/____/____ __________________________________________________ Notary Public of the State of New Jersey My Commission Expires: ____________________________ Affix Seal 3_SUB_ADMIN_QUALIFICATION Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com