Fill - Free fillable Essex County Surrogates Court (Essex County Surrogate's Court) PDF form

1_APPLIC_FOR_SUBSTITUTIONARY_ADM Page 1 of 2

Docket No.: ______________

State of New Jersey

Essex County Surrogate’s Court

Hall of Records, Room 206

DEVERO D. MCDOUGAL

ALTURRICK KENNEY

SURROGATE

Newark, New Jersey 07102

DEPUTY SURROGATE

Phone: 973-621-4900

Fax: 973-621-2654

In the matter of the Estate of:

}

APPLICATION FOR

SUBSTITUTIONARY

ADMINISTRATION

____________________________________________________, Deceased

AKA: ______________________________________________

Applicant (s) ________________________________, ______________________ at ______________________________________

________________________________________________________SSN:__________________________, respectfully shows that:

n _______________ the above-named decedent died intestate and _____________________ was duly appointed administrator/rix

of the goods, chattels, rights and credits of the said intestate on _______________________.

2. The said administrator/rix as aforesaid, after taking upon himself/herself the burden of said administration ____________________,

_______________________________, leaving certain property and assets of the estate of the said intestate un-administered, the valu

hereof does not, as nearly as your applicant can ascertain, exceed the sum of $_________________________________________.

. D

ecedent left surviving spouse, heirs at law and next of kin, the following persons:

Name

Relationship

Residence

Age of all Minors

4. There are no other heirs or next of kin known to the applicant.

1_APPLIC_FOR_SUBSTITUTIONARY_ADM Page 2 of 2

Docket No.: _________________

5. All of the said next of kin of the deceased entitled to Substitutionary Administration upon this estate have renounced in writing their

right of Administration and requested that the same be granted to your Applicant(s).

Due notice of this application has been given to all the aforesaid next of kin.

Wherefore, the Applicant(s) requests judgment that Letters of Substitutionary Administration upon the estate of the aforesaid intestate

be granted to Applicant(s).

STATE OF NEW JERSEY

}

SS.

COUNTY OF ESSEX

____________________________________, of full age, being duly sworn according to law, did upon their oath depose and say they

are the applicant named in this document and that the matters and things set forth in the within application are true to the best of their

knowledge and belief, applicant further says that the value of the entire estate, for the administration of which this application is made,

will not exceed the sum of $___________________.

Sworn and subscribed before me on:

____/____/____

Signature

Notary Public

My Commission Expires: ________________________________

Affix Seal

Attorney of Record:

____________________________

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signature

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2_POA_SUBS_ADMIN Page 1 of 1

Docket No.: ______________

State of New Jersey

Essex County Surrogate’s Court

Hall of Records, Room 206

DEVERO D. MCDOUGAL

ALTURRICK KENNEY

SURROGATE

Newark, New Jersey 07102

DEPUTY SURROGATE

Phone: 973-621-4900

Fax: 973-621-2654

In the matter of the Estate of:

}

POWER OF ATTORNEY

SUBSTITUTIONARY

ADMINISTRATOR

__________________________________________________, Deceased

AKA: ____________________________________________

KNOW ALL MEN BY THESE PRESENTS, that I, ________

_______________, _________________ at _____________________

____________________________________________________________________________________, pursuant to the provisions

of Revised Statutes 3B: 14-47 do hereby make, constitute and appoint Alturrick Kenney Surrogate of the County of Essex, in the State

of New Jersey, and his/her successor in office, my true and lawful attorney, upon whom may be served any and all process affecting

the aforesaid estate, or any interest therein, whereof I am the Substituted Administrator/rix.

And I do further agree that any process against the aforesaid estate, so served, shall be of the same effect as if duly served upon me

within this State.

_______

___________________________________________

Signature

STATE OF NEW JERSEY

}

SS.

COUNTY OF ESSEX

IT REMEMBERED, that on this ____/____/____ before me, the subscriber, a Notary Public of the State of New Jersey, personally

appeared _____________________________ who I am satisfied is the person in the foregoing power of attorney named, and I having

first made known to them the contents thereof, they did thereupon acknowledge that they signed, sealed and delivered the said power

of attorney as their voluntary act and deed for the uses and purposes therein expressed.

_______

___________________________________________

Notary Public of the State of New Jersey

My Commission Expires: ____________________________

Affix Seal

3_SUB_ADMIN_QUALIFICATION Page 1 of 1

Docket No.: ______________

State of New Jersey

Essex County Surrogate’s Court

Hall of Records, Room 206

DEVERO D. MCDOUGAL

ALTURRICK KENNEY

SURROGATE

Newark, New Jersey 07102

DEPUTY SURROGATE

Phone: 973-621-4900

Fax: 973-621-2654

In the matter of the Estate of:

}

SUBSTITUTIONARY

ADMINISTRATOR

QUALIFICATION

_____________________________________________________, Deceased

AKA: _______________________________________________

____

__________________________________, 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

y Commission Expires: ____________________________

Affix Seal

4_RENUNCIATION_OF_ADMINISTRATOR Page 1 of 1

Docket No.: _______________

State of New Jersey

Essex County Surrogate’s Court

Hall of Records, Room 206

DEVERO D. MCDOUGAL

ALTURRICK KENNEY

SURROGATE

Newark, New Jersey 07102

DEPUTY SURROGATE

Phone: 973-621-4900

Fax: 973-621-2654

In the matter of the Estate of:

}

RENUNCIATION

OF ADMINISTRATOR

_______________________________________________, Deceased

AKA: _________________________________________

To: Alturrick Kenney Surrogate of the County of Essex

I, _________________________, ____________________ of the above decedent, late of _________________

in the County of Essex do hereby renounce my right of Administration, and request the appointment of

___________________________________________.

___________

Signature

STATE OF NEW JERSEY

}

SS.

COUNTY OF ESSEX

Be it remembered, that on this, ____/____/20___, before me, undersigned authority, personally appeared

__________________________, who I am satisfied are the persons 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

5_SUBSTITUTED_ADMIN_BOND Page 1 of 3

Docket No.: ____________

OFFICE OF THE SURROGATE

ESSEX COUNTY

ALTURRICK KENNEY

SURROGATE

Devero D. McDougal

DEPUTY SURROGATE

469 D

r. Martin Luther King, Jr. Blvd.

Hall of Records, Room 206

Newark, New Jersey 07102

http:\\www.co.essex.nj.us/surrog.htm

IMPORTANT INFORMATION REGARDING BONDS

1. The Surrogate is the Judge of the Surrogate's Court. In that capacity, they have appointed you as a

fiduciary. Pursuant to New Jersey statutes, the order of appointment includes a requirement that you post

bond. NJSA 3B:15-1. The purpose of the bond is to protect the heirs and creditors of the estate.

2. A surety bond is not insurance. You are responsible for any losses which cause the surety to make payment

on your behalf. The Indemnity Agreement is your promise to repay the surety.

3. You are free to purchase this bond from any qualified source.

4. The law establishes minimum terms and conditions for indemnity and collection, which must be in each

bond. The other terms, such as premium and duration are between you and the bonding company.

5. The initial premium is due when the bond application is completed. Annual premiums are due each year

until the estate is closed. Those annual bills will come directly from the bonding agent.

6. If the value of the estate is reduced, you can have the bond reduced. Since the premium is determined by

the amount of the bond, reducing the bond will result in a savings in most cases.

7. Please remember that the bond does not terminate at the end of the first year. If you do not notify the

bonding company that the estate is closed they will continue the bond and they will bill you each year

for another premium.

5_SUBSTITUTED_ADMIN_BOND Page 2 of 3

Docket No.: _____________

State of New Jersey

Essex County Surrogate’s Court

In the matter of the Estate of:

}

SUBSTITUTED

ADMINISTRATOR BOND

____________________________________________, Deceased

AKA: ______________________________________

KNOW ALL MEN BY THESE PRESENTS, that we, ___________________________________ Substituted Administrator/rix of the

estate of ________________________________, deceased, (hereinafter referred to as Substituted Administrator/rix) as Principal, and

___________________________, a corporation of the State of__________________ as Surety, are held and firmly bound unto the

Superior Court of New Jersey in the sum of _______________________________________________________ lawful money of the

United States, to be paid to the said Superior Court, its successors or assigns, to which payment well and truly to be made, we bind

ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. Sealed with our

seals, and dated ___________________________________________.

THE CONDITION OF THIS OBLIGATION IS SUCH (N.J.S.A. 3B:15-5)

That if the above bounden Substituted Administrator/rix shall perform every one of the duties described in the numbered paragraphs

which immediately follow this paragraph, then the above obligation shall be void and of no effect, or else shall remain in full force

and virtue.

1. If required by the Court or if an exemption is to be set off as required in N.J.S.A. 3B:16-1, et seq., to make a true and perfect

inventory of the real and personal property of the decedent, which has or shall come into their hands, possession or knowledge or into

the hands of any other person or persons for them, and to cause an appraisal to be made of the real and personal property and to file

the inventory and appraisal in the Office of the Clerk of the Superior Court or of the Surrogate of Essex County, as the ease may be,

within the time so required;

2. To faithfully discharge all of the duties imposed upon them according to law;

3. To make a just and true account of their administration of the estate, and, if required by the Court, to settle his/her account therein

within the time so required;

4. To deliver and pay to the distributees entitled thereto by law the surplus property of the deceased as may remain pursuant to the

account; and

5_SUBSTITUTED_ADMIN_BOND Page 3 of 3

Docket No.: ________________

5. To deliver their Letters of Administration to the proper court when required so to do, if a Will of the deceased is found and

exhibited to it and by it admitted to probate.

6. To comply in all respects with the Statutes pertaining thereto.

The Principal and Surety hereby submit themselves to the jurisdiction of the Superior Court and do hereby irrevocably appoint the

Clerk of the Superior Court/Surrogate of Essex County as their agent upon whom papers affecting their liability on the bond may be

served. The Principal and Surety waive any right to a jury trial in an action to enforce liability on the bond. Liability on the bond may

be enforced by motion in the action, if one is pending, without the necessity of any independent action and said motion may be served

upon the Principal and Surety by mailing it, by ordinary mail, to the Clerk of the Superior Court/Surrogate of Essex County, as named

above, who shall forthwith mail copies thereof to the

Principal at:

__________________________________________________________________________________________________________

and Surety at:

___________________________________________________________________________________________________________

Signed, Sealed And Delivered

In The Presence Of

___________________________________________

Witness Signature

__________________________________PRINCIPAL

Signature

APPROVED BY:

____________________________________

SURETY

Signature

___________________________________________

SURROGATE

BY:

___________________________________________

ATTORNEY-IN-FACT

AFFIX SEAL

Attorney of Record:

____________________________

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signature

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signature

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Docket No.: ______________

State of New Jersey

Essex County Surrogate’s Court

ALTURRICK KENNEY Hall of Records, Room 206

SURROGATE Newark, New Jersey 07102

DEVERO D. MCDOUGAL

DEPUTY SURROGATE

Phone 973-621-4900

Fax 973-621-2647

_____________________________, Deceased VERIFICATIONS:

AKA: CHILD SUPPORT

NOTICE OF PROBATE

State of New Jersey

} ss

County of Essex

KNOW ALL MEN BY THESE PRESENTS, that I hereby certify that I have been given a

copy of:

_________ N.J.S.A. 2A:17-56.23b, Judgment for Child Support Lien Against Net Proceeds

of Settlement: Priority, advising me as to my obligation to determine if child support arrearages

exist against any beneficiary entitled to receive more than $2,000.00 and to satisfy same prior to

disbursement of funds payable to said beneficiary identified as owing said child support.

_________ New Jersey Court Rule 4:80-6, Notice of Probate of Will, advising me as to my

obligation to send notice of the probate of a Will to beneficiaries and all persons designated by Rule

4:80-1(a)(3), including the testator’s spouse, heirs, next of kin, and any other persons entitled to

letters.

___________________________

Signature

Print Name:

Subscribed and sworn to before me

this day of , 20 .

__________________________

Notary Public/Attorney at Law

New Jersey Permanent Statutes

Title 2A Administration of Civil and Criminal Justice

2A:17-56.23b JUDGMENT FOR CHILD SUPPORT LIEN AGAINST NET PROCEEDS OF SETTLEMENT: PRIORITY

1. a. A judgment for child support entered pursuant to P.L.1988, c.111 (C.2A:17-56.23a) and docketed with

the Clerk of the Superior Court shall be a lien against the net proceeds of any settlement negotiated prior or

subsequent to the filing of a lawsuit, civil judgment, civil arbitration award, inheritance or workers' compensation

award. The lien shall have priority over all other levies and garnishments against the net proceeds of any

settlement negotiated prior or subsequent to the filing of a lawsuit, civil judgment, civil arbitration award, inheritance

or workers' compensation award unless otherwise provided by the Superior Court, Chancery Division, Family Part.

The lien shall not have priority over levies to recover unpaid income taxes owed to the State. The lien shall stay

the distribution of the net proceeds to the prevailing party or beneficiary until the child support judgment is satisfied.

As used in this act "net proceeds" means any amount of money, in excess of $2,000, payable to the prevailing

party or beneficiary after attorney fees, witness fees, court costs, fees for health care providers, payments to the

Medicaid program under section 6 of P.L.1979, c.365 (C.30:4D-7.1), reimbursement to the Division of Employment

Security in the Department of Labor, the employer or employer's insurance carrier for temporary disability benefits

that may have been paid pending the outcome of a workers' compensation claim as provided by section 1 of

P.L.1950, c.174 (C.34:15-57.1), reimbursement to an employer or the employer's workers' compensation insuranc

carrier as provided in R.S.34:15-40, and other costs related to the lawsuit, inheritance or settlement are deducted

from the award, proceeds or estate; "prevailing party" or "beneficiary" shall not include a partnership, corporation,

limited liability partnership, financial institution, government entity or minor child; and "agent" means an authorized

representative of the prevailing party or beneficiary, a union representative, an executor or administrator of a

decedent's estate, an arbitrator or any other person or entity if such person or entity is responsible for t

distribution of net proceeds to a prevailing party or beneficiary.

b. Before distributing any net proceeds of a settlement, judgment, inheritance or award to the prevailing

party or beneficiary:

) the prevailing party or beneficiary shall provide the attorney, insurance company or agent responsible

for the final distribution of such funds with a certification that includes the prevailing party's or beneficiary's full

name, mailing address, date of birth and Social Security number; and

(2) the attorney representing the prevailing party or beneficiary shall initiate a search of child suppor

judgments, through a private judgment search company that maintains information on child support judgments, to

determine if the prevailing party or beneficiary is a child support judgment debtor.

If the prevailing party or beneficiary is not represented by an attorney, the judgment search shall be initiated by the

opposing attorney, insurance company or agent before the proceeds are distributed to the prevailing party or

beneficiary. In the case of a workers' compensation action, the Administrative Office of the Courts shall, at least

once every 60 days, transmit information on child support judgment debtors to the Division of Workers'

Compensation in the Department of Labor. The information shall include the debtor's name, Social Security

number, the amount of the child support judgment, the Probation Division case number and the Probation Division

office to which the judgment is payable. The Division of Workers' Compensation shall match the data received on

child support judgment debtors against the information it maintains for individuals who have filed workers'

compensation claims with the division. When a match is identified, the Division of Workers' Compensation shall

notify the appropriate judge of compensation of the child support judgment before the decision, award,

determination, judgment or order approving the settlement is rendered. The judge of compensation shall

incorporate in the decision, award, determination, judgment or order approving the settlement, an order requiring

the employer or the employer's insurance carrier to contact the Probation Division to satisfy the child support

judgment out of the net proceeds of the workers' compensation award, order or settlement before any such monies

are paid to the employee. The Division of Workers' Compensation shall be immune from any civil liability that may

arise from any information provided by the division or any order issued by a judge of compensation relating to a

child support judgment, in accordance with this section. In the case of judgments or settlements resulting from a

labor arbitration involving employees of a school board or school district, a judgment search shall be initiated by the

school board or district prior to the release of any net proceeds to the employees and only if there is an income

withholding for child support active against the employee in the records of the school board or district. In the case

of an inheritance, the executor or administrator of the decedent's estate shall initiate the judgment search. The

judgment search company shall provide a certification to the attorney, insurance company, agent or party initiating

the lawsuit identifying whether or not the prevailing party or beneficiary is a child support judgment debtor.

In the case of net proceeds that are to be paid through a structured settlement or other payment plan, the attorney,

insurance company or agent shall be required to conduct the child support judgment search only at the time of

settlement or prior to the distribution of the first payment under the plan. If a child support judgment is identified,

the attorney, insurance company or agent shall provide the Probation Division with a copy of the structured

settlement or payment plan within 30 days of identifying the child support judgment.

If there are no attorneys representing either party in a civil lawsuit, the party bringing the lawsuit shall initiate the

judgment search and shall be required to file the certification with the court at least 10 working days prior to the trial

or with the stipulation that the certification shall be filed at the time of the settlement or dismissal of the lawsuit.

For monies deposited with the court, no distribution of funds shall be made until the attorney, prevailing party or

beneficiary provides the Clerk of the Superior Court with a copy of the certification showing that the prevailing party

or beneficiary is not a child support judgment debtor.

The fee for a judgment search which is required by this section shall not exceed $10 for each name of a child

support judgment debtor that is searched. The fee for a judgment search is chargeable against the net proceeds as

a cost of the settlement, judgment, inheritance or award.

c. If the certification shows that the prevailing party or beneficiary is not a child support judgment debtor,

the net proceeds may be paid to the prevailing party or beneficiary immediately. If the certification shows that the

prevailing party or beneficiary is a child support judgment debtor, the attorney, insurance company or agent that

initiated the search shall contact the Probation Division of the Superior Court to arrange for the satisfaction of the

child support judgment. The attorney, insurance company or agent shall notify the prevailing party or beneficiary of

the intent to satisfy the child support judgment prior to the disbursement of any funds to the prevailing party or

beneficiary. Upon receipt of a warrant of satisfaction for the child support judgment, the attorney, insurance

company or agent shall pay the balance of the settlement, judgment, award or inheritance to the prevailing party or

beneficiary. If the net proceeds are less than the amount of the child support judgment, the entire amount of the

net proceeds shall be paid to the Probation Division as partial satisfaction of the judgment.

If there are no attorneys representing either party in a civil lawsuit and the certification filed with the court shows

that the prevailing party or beneficiary is a child support judgment debtor, the court shall order that the opposing

party pay the amount of the child support judgment to the Probation Division before any funds are paid to the

prevailing party or beneficiary. The court shall also insure that any judgment related to the lawsuit docketed with

the Clerk of the Superior Court reflect the Probation Division's superior claim to such funds.

d. An attorney, insurance company or agent shall not be liable for distributing net proceeds to the

prevailing party or beneficiary based on the results of a judgment certification showing the prevailing party or

beneficiary is not the debtor of a child support judgment, if it is later shown that the prevailing party or beneficiary

provided inaccurate personal information on the initial certification to the attorney, the insurer or agent.

e. An attorney, insurance company or agent who, in accordance with this act, satisfies a child support

judgment from the net proceeds of a settlement, judgment, inheritance or award, shall not be liable for payments

which otherwise would have been made pursuant to subsection a. of this section which were not so identified to the

attorney, insurance company or agent at the time of satisfaction.

f. An attorney, insurance company or agent who, in accordance with this act, satisfies a child support

judgment from the net proceeds of a settlement, judgment, inheritance or award, shall not be liable to the prevailing

party or beneficiary or to that party's creditors.

g. An attorney shall not be required to challenge a child support judgment unless retained by the prevailing

party or beneficiary to do so.

h. A private judgment search company is prohibited from using any information provided by an attorney,

insurance company or agent in accordance with this act for any purpose other than: (1) determining if the prevailing

party or beneficiary is the debtor of a child support judgment; and (2) preparing a certification as required pursuant

to subsection b. of this section.

i. To the extent feasible and permitted by the Rules of Court, the Administrative Office of the Courts may

share information on a child support judgment debtor with an insurance carrier for the sole purpose of complying

with the provisions of P.L.2000, c.81 (C.2A:17-56.23b et al.).

CHARLES JONES, A LexisNexis Company = P.O. Box 8488, Trenton, NJ 08650-0488

(609 538-1000 or (800) 792-8888 - Fax (609) 882-4371 - www.charlesjones.com

* INFORMATION NEEDED FOR SEARCH *

Full Name/Also Known As * Mailing Address * Date of Birth * Social Security

THIS NOTICE IS PROVIDED TO INTERESTED PARTIES AS A CONVENIENCE

AND IN NO WAY IMPLIES ENDORSEMENT OF THIS PROVIDER OR ITS SERVICES.

Notice of Probate & Proof of Mailing - REQUIREMENTS

Rule 4:80-6, N.J. Court Rules, 1969, effective September 4, 1990, requires personal

representatives to send notice of the probate of a Will to beneficiaries and all persons

designated by Rule 4:80—1(a)(3), including the testator’s spouse, heirs, next of kin,

and any other persons entitled to letters.

The notice is required to state the name and address of the personal representative*

and that a copy of the Will may be requested from the personal representative. In the

case of a charitable bequest, however, the Attorney General of the State of New Jersey

is entitled to a copy of the Will with the notice. If the names and addresses of all

personal entitled to notice are unknown and cannot be ascertained upon reasonable

inquiry, a notice of probate must be published.

Proof of Mailing of the notice must be filed with the Surrogate within 10 days thereof.

The filing fee, payable to “Essex County Surrogate,” is $5.00 per page.

* The term “personal representative” is used in lieu of executor/trix

and administrator with the Will annexed.

=======================================

For your information, the full text of Rule 4:80-6, from the Current New Jersey Court

Rules, follows:

4:80-6. Notice of Probate of Will

Within 60 days after the date of the probate of a will, the personal

representative shall cause to be mailed to all beneficiaries under the

will and to all persons designated by R. 4:80-1(a)(3), at their last

known addresses, a notice in writing that the will has been probated,

the place and date of probate, the name and address of the personal

representative and a statement that a copy of the will shall be

furnished upon request. Proof of mailing shall be filed with the

Surrogate within 10 days thereof. If the names or addresses of any of

those persons are not known, or cannot by reasonable inquiry be

determined, then a notice of probate of the will shall be published in a

newspaper of general circulation in the county naming or identifying

those persons as having a possible interest in the probate estate. If by

the terms of the will property is devoted to a present or future

charitable use or purpose, like notice and a copy of the will shall be

mailed to the Attorney General.

Note: Source-R.R. 4:99-7; former R. 4:80-8 amended and rule redesignated June 29, 1990 to be

effective September 4, 1990.

Docket No.: ______________

State of New Jersey

Essex County Surrogate’s Court

ALTURRICK KENNEY Hall of Records, Room 206

SURROGATE Newark, New Jersey 07102

DEVERO D. MCDOUGAL

DEPUTY SURROGATE

Phone 973-621-4900

Fax 973-621-2647

In the Matter of the Estate of

NOTICE OF PROBATE OF WILL

_____________________________, Deceased PURSUANT TO RULE 4:80-6

AKA:

TO:

PLEASE TAKE NOTICE that the Will of _______________________________ ,

who died on ____________________, 20____, was admitted to probate by the

Surrogate of Essex County, New Jersey, on _____________________, 20 ____.

You are entitled to have a copy of the Will upon request to the personal representative

(Executor/Executrix), ____________________________________, at the address

provided below.

Dated:

______________________ _________________________________

Signature

Address of

Personal Representative:

_________________________________

____________________________________

Docket No.: ______________

State of New Jersey

Essex County Surrogate’s Court

ALTURRICK KENNEY Hall of Records, Room 206

SURROGATE Newark, New Jersey 07102

DEVERO D MCDOUGAL

DEPUTY SURROGATE

Phone 973-621-4900

Fax 973-621-2647

In the Matter of the Estate of

PROOF OF MAILING OF

_____________________________, Deceased NOTICE OF PROBATE OF WILL

AKA: PURSUANT TO RULE 4:80-6

I, ____________________________, residing at ________________________________________,

certify as follows:

1. I am the Executor/Executrix of the above estate.

2. On_________________________, 20 ______, I forwarded Notice(s) of Probate of Will to all

next of kin and to all beneficiaries named in the Will of _________________________________.

3. I forwarded copies of the attached notice(s) by (Select the method you used):

__________ Regular Mail __________ Express Mail

__________ Certified Mail __________ Hand Delivery

To the following:

Name(s)_______________________ Address(es)___________________________________

I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing

statements made by me are willfully false, I am subject to punishment.

Dated:________________________ ___________________________

Signature

REFUNDING BOND AND RELEASE Page 1 of 2

OFFICE OF THE SURROGATE

ESSEX COUNTY

ALTURRICK KENNEY

SURROGATE

DEVERO D. MCDOUGAL

DEPUTY SURROGATE

465 Dr. Martin Luther King, Jr. Blvd.

Hall of Records, Room 206

Newark, New Jersey 07102

ww.essexsurrogate.com

IMPORTANT INFORMATION/INSTRUCTIONS FOR

REFUNDING BOND AND RELEASE

Attached is the Refunding Bond and Release. You may:

- Type or neatly print the information required.

- Fill the form out on our website, www.essexsurrogate.com, and print it out.

- Photocopy and re-use the blank form, print out additional forms at our website, or receive additional

forms by email, fax or mail by contacting the Surrogate’s Court at (973) 621-4900.

No sooner than nine months after the date of death, each beneficiary or heir of the estate, including the

Administrator/Executor, will need to fill out and sign, in front of a witness as well as a notary or a New

Jersey attorney, the Refunding Bond and Release. Please note that the Refunding Bond and Release should be

signed prior to any distribution or checks being released to a beneficiary.

If the Beneficiary/Heir is a minor, trust or is incapacitated:

- If the beneficiary or heir is a minor, the Refunding Bond and Release must be signed by the guardian

of the minor’s property that has been appointed by the Surrogate’s Court.

- If the beneficiary is a trust, the Refunding Bond and Release must be signed by the trustee.

- If the beneficiary or heir is an incapacitated person, the Refunding Bond and Release must be signed

by the guardian of the person and property of the incapacitated person that has been appointed by the

Superior Court.

Filing Instructions: (Fill in ALL blanks with the information required)

1. The value of cash and property received is the total value of all assets received from the estate and can

include cash, bank accounts, stock, personal property, and real estate. However, it does not include assets

that do not pass through the estate, such as joint accounts or assets with designated beneficiaries other than

the estate.

2. File the original signed, witnessed and notarized document along with the filing fee of $10 for a release

not more than 2 pages and $5 for any additional pages.

3. The check should be made payable to “Essex County Surrogate”.

4. If you require "Filed" stamped copies (to send to the Bond Company), you must include copies of the

Refunding Bond and Release along with your request and your own self-addressed envelope (we do not

make/provide courtesy copies). Mail/deliver your originals, copies and request to our Court.

REFUNDING BOND AND RELEASE Page 2 of 2

Docket No.: ______________

State of New Jersey

Essex County Surrogate’s Court

In the matter of the Estate of:

}

REFUNDING BOND

AND RELEASE

______________________________________________, Deceased

AKA: ________________________________________

KNOW ALL MEN BY THESE PRESENTS,

That I am and I reside at

in the city/town of , State of .

I am a beneficiary (or heir) of this estate and receiving the sum of $ (Value of cash & property received)

from Executor/Administrator (Name of Executor/Administrator).

Upon my receipt of this distribution, I am hereby obligated to refund any portion of this distribution should such

refund be required by the Executor/Administrator to discharge all proper debts and obligations of the estate as

required under N.J.S.A. 3B:23-24 through N.J.S.A. 3B:23-27. Upon my death, my obligation extends to my

heirs, Executor or Administrator.

THE CONDITION OF THIS OBLIGATION is that I receive from the Executor/Administrator the sum of

$ representing distribution to me as an intestate heir of this estate or as a beneficiary under the

Will if the decedent died testate.

AND IN CONSIDERATION THEREOF, I release and forever discharge the Executor/Administrator

from all claims and demands whatsoever in respect to the estate of the deceased and my interest therein.

Signed, Sealed and Delivered in the Presence of:

________________________________

_________________________________

(Beneficiary’s Signature)

(Witness' Signature)

STATE OF NEW JERSEY, COUNTY OF ESSEX} SS.:

Be it Remembered, that on ____________________ 20______, before me, a/an _________________ of the

State of _______________________ personally appeared ___________________________________ who, I

am satisfied, is the person named in and who executed the within Instrument in my presence, and thereupon

acknowledged that he/she signed, sealed and delivered the same as his/her act and deed for the uses and

purposes therein expressed.

____

____________________________________________

Notary Public / Attorney of the State of ________________

My commission expires on ______/______/20 ______

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Essex County Surrogates Court (Essex County Surrogate's Court)

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