Information Sheet For Administration-And-Or Ad Prosequendum

MERCER COUNTY SURROGATE'S COURT Diane Gerofsky, Surrogate INFORMATION SHEET FOR ADMINISTRATION/ADMINISTRATION AD PROSEQUENDUM Circle the type of proceedings sought: 1. General Administration Only 2. Administration Ad Prosequendum Only 3. Both General Administration and Administration Ad Prosequendum NAME OF DECEASED:_____________________________________Date of Death:_______________ Residence of Deceased at Time of Death:_________________________________________________ (Indicate borough, township, town or city or county) ___________________________________________________________________________________ NAME OF PERSON SEEKING TO QUALIFY AS ADMINISTRATOR:________________________ Address of Administrator:____________________________________________________________ ____________________________________________ Telephone No:__________________ Attorney of Record:**______________________________________ Telephone No:________________ Address:____________________________________________________________________________ SPOUSE OR DOMESTIC PARTNER OR CIVIL UNION PARTNER AND NEXT OF KIN NAME RESIDING ADDRESS RELATIONSHIP TO DECEASED AGE IF UNDER 18 ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Names of all adult persons whose right to administration is prior or equal to that of applicant and who will sign renunciations in favor of the applicant: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Approximate Value of Personal Property Passing by Intestacy (exclude assets that pass outside the Estate): $__________________________ Approximate Value of Real Property Passing by Intestacy (exclude assets that pass outside of the Estate): $_________________________ ** Attorney of Record is the attorney whom you have retained to represent and assist you with the estate and whose name will appear on the application. Page 1 of 2 - Information Sheet for Administration/Administration Ad Prosequendum American LegalNet, Inc. www.FormsWorkFlow.com If Administration Ad Prosequendum is sought: The decedent's death was caused by the wrongful act, neglect or default of: ___________________________________________________________________________________ Number of Short Certificates requested:____________________________________ Date you wish Administrator to qualify:_______________________________ Is the administrator appearing in the Trenton office to do administration? (Yes)________ (No)_________ Is the administrator appearing at a satellite office? (Yes)________ (No)__________ Lawrence Satellite________ Robbinsville Satellite _________ Ewing Satellite_________ Pennington Township _______ Hamilton Satellite_______ Hopewell Satellite________ East Windsor Twp Satellite_____ Princeton Satellite __________ (First Tuesday of each month) (First Thursday of each month) (Second Tuesday of each month) (Second Thursday of each month) (Third Tuesday of each month) (Third Friday of each month) (Fourth Tuesday of each month) (Fourth Thursday of each month) PLEASE NOTE: When making your appointment with the Surrogate's Court for a satellite office, kindly fax or return this information sheet together with a copy of the death certificate to this office at least 48 hours prior to the appointment. To schedule an appointment contact Kelly at (609) 989-6336. MERCER COUNTY SURROGATE'S COURT P.O. BOX 8068 TRENTON, NEW JERSEY 08650 Fax: (609) 278-1242 Phone: (609) 989-6331 E-mail: dgerofsky@mercercounty.org Page 2 of 2 - Information Sheet For Administration/Administration Ad Prosequendum American LegalNet, Inc. www.FormsWorkFlow.com