State of New Jersey
Docket No.:
Essex County Surrogate’s Court
ALTURRICK KENNEY
SURROGATE
H
all of Records, Room 206
Newark, New Jersey 07102
Phone: 973-621-4900
Fax: 973-621-2647
DEVERO D. MCDOUGAL
DEPUTY SURROGATE
ADMINISTRATION -AD.PROS. Page 1 of 2
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In the matter of the Estate of:
, Deceased
APPLICATION
ADMINISTRATION
AKA:
AD PROSEQUENDUM
Applicant (s) , at
SSN:
Says:
1.
Decedent late of , , departed this life on , intestate.
2.
The spouse and next of kin of the decedent, with their respective addresses, and the manner and degree in which they severally
stand related to the deceased are as follows:
Name Relationship Residence Age of all Minors
3.
There are no other next of kin and all the foregoing are of full age except as indicated above.
4.
Either due notice of this application has been given to, or, all competent adult a, whose right to Administration Ad Prosequendum is
prior or equal to that of the Applicant(s), have renounced their right thereto and requested that the same be granted to the Applica
nt(s).
5.
The death of the said was caused by the wrongful act, neglect or default of
or some other person or persons.
Wherefore, the Applicant(s) request(s) judgment that be appointed Administrator/rix Ad Prosequendum
of the said to prosecute any action, proceeding or claim for their death brought or made under
the statute in such cases provided.
Dated:
/ /
Signature
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signature
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STATE OF NEW JERSEY
}
Docket No.:
COUNTY OF ESSEX
SS
.
, being duly sworn, says; I am/we are the Applicant(s) in the foregoing application named.
The allegations thereof are true to the best of my/our knowledge and belief.
Sworn and subscribed before me on:
/ /20
Signature
Notary Public of the State of New Jersey
My Commission Expires:
Affix Seal
STATE OF NEW JERSEY
QUALIFICATION
COUNTY OF ESSEX
SS
.
, being duly sworn, say(s);
1.
died on or about without a Will so far as I know and verily believe.
2.
I will well and truly perform the duties of Administrator/rix Ad Prosequendum of the said deceased
.
Sworn and subscribed before me on:
ADMINISTRATION -AD.PROS. Page 2 of 2
/ /20
Signature
Notary Public of the State of New Jersey
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
Hall of Records, Room 206
ALTURRICK KENNEY
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:
_______________________________________________, Deceased
AKA: _________________________________________
}
RENUNCIATION
OF ADMINISTRATOR
AD PROSEQUENDUM
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 Ad Prosequendum, and request the
appointment of ___________________________________________.
Dated: ____/____/____ ___________
Signature
*Copy of government issued picture I.D. required*
STATE OF NEW JERSEY
COUNTY OF ESSEX
}SS.
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/Attorney at Law of New Jersey
My Commission Expires: ____________________
Affix Seal
AdPros.Ren Page 1 of 1