Surviving Spouse Affidavit Of Assets And Declaration (Estate 20K Or Less)

Docket No.: Essex County Surrogate's Court THEODORE N. STEPHENS, II SURROGATE State of New Jersey Hall of Records, Room 206 Newark, New Jersey 07102 Phone 973-621-4900 Fax 973-621-2647 Natalynn Dunson-Harrison DEPUTY SURROGATE In the matter of the Estate of: ____________________________, Deceased AKA: __________________________ SURVIVING SPOUSE AFFIDAVIT OF ASSETS AND DECLARATION In Lieu of Administration Where Real and Personal Estate Does Not Exceed $20,000.00 (R.S. 3B:10-3) I, and say(s): , of full age, being duly sworn, depose(s) 1. 2. I reside at __________________________________________________________________. I am surviving spouse of __________________________who died on , with a residence of _____________________________ in the County of Essex and State of New Jersey without leaving a Will. The decedent left no children or issue born to any person other than me. Except as show below, the parents of the decedent are not living: NAME Relationship 3. 4. ADDRESS/RESIDENCE American LegalNet, Inc. www.FormsWorkFlow.com 1 5. The assets in the sole name of the decedent or held "as tenants in common" with decedent, known to me at this time do not exceed the sum of $20,000.00, and are as follows: ITEMS_________________________________ TOTAL ESTIMATED AMOUNT/VALUE Cash on hand: $ _________________________________________________________________________________ Balances in bank accounts of decedent (list accounts) $ _________________________________________________________________________________ Corporate Stocks, bonds and notes, etc: $ _________________________________________________________________________________ Life insurance taken out by decedent without $ A named beneficiary or payable to the Estate: _________________________________________________________________________________ Automobiles (include year, made, model, and VIN #): $ _________________________________________________________________________________ Household effects, jewelry, other chattel, etc.: $ _________________________________________________________________________________ All other personal property belonging to the Estate: $ (Refund checks, security deposits, etc.) _________________________________________________________________________________ Real Estate, located at (list separately by type and address): $ (If market value is unknown, may use tax assessed value) _________________________________________________________________________________ REMARKS: _________________________________________________________________________________ TOTAL VALUATION OFF ALL PROPERTY: $ 6. Therefore, I am entitled to same without Letters of Administration, in accordance with the Laws of New Jersey, N.J.S.A. 3B:10-3. Signature Subscribed and sworn to before me on this day of , 20 . Notary Public/Attorney at Law of New Jersey 2 American LegalNet, Inc. www.FormsWorkFlow.com