Surrogate Worksheet

SURROGATE COURT OF SUSSEX COUNTY GARY R. CHIUSANO, SURROGATE 3 High Street, Suite 1, Newton, New Jersey 07860 Office: (973) 579-0920 Website: www.sussex.nj.us Fax: (973) 579-0909 E-mail: scsurrogate@nac.net GENERAL INFORMATION WORKSHEET ESTATE OF:__________________________________________________________________________ Legal name of Deceased ALSO KNOWN AS:____________________________________________________________________ Another "legal" name of Deceased AGE AT DEATH:______ DATE OF DEATH:__________________ SOCIAL SECURITY #:_________________________ RESIDENT MUNICIPALITY: ___________________________________________________________ Town where Deceased was living at time of death MARITAL STATUS OF DECEASED AT DEATH: (Circle one) Never Married / Married / Married but Separated / Divorced / Widowed / Unknown DATE OF WILL:________________________ DATE OF CODICIL:__________________________ "Codicil" is a "Modification" to the Will WITNESSES TO WILL/CODICIL: SELF-PROVING: YES / NO (Office use only) _______________________________ ADDRESS:__________________________________________ _______________________________ ADDRESS:__________________________________________ APPLICANT: (Is Applicant an Attorney yes/no) Executor: Person named in Will Administrator: Deceased did not have a Will NAME: ______________________________________________________________________________ Print name of Person making application ADDRESS: ___________________________________________________________________________ _______________________________________________________________ Mailing & physical address of Person making application SOCIAL SECURITY NUMBER OF APPLICANT: _________________________________________ HOME PHONE #:________________________ WORK PHONE #:_____________________________ FAX#: __________________________________ CELL #:_____________________________________ IF CO-APPLICANTS, duplicate this boxed information on extra sheet HEIRS AT LAW & NEXT OF KIN: List living or deceased: Children & Step-children (note age if under 18 yr.), Spouse, Domestic Partner, Civil Union, Parents, Brothers & Sisters. NAME: COMPLETE ADDRESS: RELATIONSHIP: _______________________________ ________________________________________ ______________ _______________________________ ________________________________________ ______________ _______________________________ ________________________________________ ______________ _______________________________ ________________________________________ ______________ _______________________________ ________________________________________ ______________ _______________________________ ________________________________________ ______________ _______________________________ ________________________________________ ______________ Add extra page if more space needed *Does the entire estate pass to surviving spouse, civil union partner (after 2/19/07), or domestic partner (after 7/10/04), parent, grandparent, child, stepchild, legally adopted child, or the issue of any child or legally adopted child (includes a grandchild and a great-grandchild but not a stepgrandchild or a great-step-grandchild)? YES / NO *MUST BE ANSWERED ATTORNEY:________________________________________________ ADDRESS:__________________________________________________ _____________________________________________________ PHONE:_______________________FAX:_______________ Attorney information ONLY if representing the estate COMPLETE ALL INFORMATION ABOVE FAX, MAIL, OR E-MAIL TO SURROGATE COURT DEATH CERTIFICATE, THE WILL, OR ASSETS & DEBTS WORKSHEET INCLUDE COPIES OF: THEN CALL FOR APPOINTMENT THANK YOU! Rev. 4/24/13 American LegalNet, Inc. www.FormsWorkFlow.com