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Essex County Surrogates Court

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GDN-PERSON ONLY.DOC Page 1 of 2
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: 973-621-2654
In the matter of the Guardianship of:
}
GUARDIANSHIP
APPLICATION
_______________________________________________, a Minor
AKA: _________________________________________
Applicant(s) _______________________________ residing at ______________________________________
______________________________________________SSN:___________________, respectfully shows that:
1. _____________________, a minor, ___________ years of age, having a birth date ________________, and
resides at ______________________________________________________________________________
2. The names and residences the minor’s nearest next of kin, of the persons with whom they reside and those
standing in the loco parentis are as follows:
Name
Relationship
Residence
Age of all Minors
3. Said minor is the owner of personal property having an approximate value of $_______________________
as appears from the affidavit attached hereto.
4. Applicant(s) is/are the party/ies first entitled or all equally entitled to Guardianship have duly renounced in
writing. Due notice of this application has been given to all persons entitled to Guardianship.
Wherefore, applicant(s) demand(s) judgment granting Letters of Guardianship of the person only of
__________________________________, minor, to ______________________________________________.
Signature
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GDN-PERSON ONLY.DOC Page 2 of 2
Docket No.: _________________
}SS.
________________________, being duly sworn under oath according to law, depose(s) and say(s) that
_____________________________ is/are the applicant(s) named in the forgoing complaint and that the matters
and things therein contained are true to the best of their knowledge and belief. Deponent(s) further say(s) that
the value of the personal estate of said minor is $_________________________.
Signature
Sworn and subscribed before me on
______/______/______
Notary Public of the State of New Jersey
My Commission Expires: _____________________
Affix Seal
Attorney of Record:
____________________________
____________________________
____________________________
____________________________
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signature
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POWER OF ATTORNEY.DOC Page 1 of 1
Docket No.: ________________
State of New Jersey
Essex County Surrogate’s Court
In the matter of the Guardianship of
}
ACCEPTANCE AND
POWER OF ATTORNEY
____________________________________________________, a Minor
AKA: ______________________________________________
I, ________________________ about to be appointed by a judgment of the Surrogate of the County of Essex Guardian of the person
only of the above-named minor do hereby declare my acceptance of said Guardianship.
Signature
Dated: ______/______/______
Signed in the presence of:
Witness Signature (Attorney or Notary)
KNOW ALL MEN BY THESE PRESENTS, that I, _________________________ residing 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 theirs successors 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
Guardian.
And I do further agree that any process against the aforesaid estate, so served, shall be of the same force and effect as if duly served
upon me within this State.
In Witness Whereof, I have hereunto set my hand and seal this ____/____/____
__________________________________
Signature
Signed, sealed and delivered in the presence of:
Attorney or Notary Public of the State of New Jersey
STATE OF NEW JERSEY
}SS.
COUNTY OF ESSEX
BE IT REMEMBERED, that on this, ____/____/____, before me, the subscriber, a Notary Public of New Jersey, personally appeared
____________________________ who I am satisfied is the person named in the foregoing power of attorney, 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.
______________________________________________
Attorney or Notary Public of the State of New Jersey
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Guardianship of Minors Renunciation
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: 973-621-2654
In the matter of the Guardianship of:
_____________________________________________, a Minor
AKA: ________________________________________
}
GUARDIANSHIP
RENUNCIATION
To: Theodore N. Stephens II, Surrogate of the County of Essex;
Be it known that the following individuals with the indicated relationships to the above-referenced of above
named minor person of the age of _____years, do hereby consent to the appointment of
___________________________ as the guardian of said minor/incapacitated person and that I do hereby waive
any right which I may have to be so appointed.
Renouncing Name (s) Relationship Signature
Dated: ______/______/______ Signed in the presence of:
Witness Signature
STATE OF NEW JERSEY
COUNTY OF ESSEX
}SS.
BE IT REMEMBERED, that on this, ____/____/____, before me undersigned authority personally appeared;
Renouncing Name (#1) Renouncing Name (#2)
who I am satisfied is/are the person(s) named 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 act
and deed, for the uses and purposes therein expressed.
__________________________________________________
Notary Public/Attorney at Law of the State of New Jersey
My Commissi
on Expires: ____________________________
Affix Seal
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Essex County Surrogates Court

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Completed 17 March 2021

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