Recording Data Page (County Register)

Docket No.: ______________ Essex County Surrogate's Court THEODORE N. STEPHENS, II SURROGATE Hall of Records, Room 206 Newark, New Jersey 07102 Phone 973-621-4900 Fax 973-621-2647 DEVERO D. MCDOUGAL DEPUTY SURROGATE State of New Jersey In the matter of the Estate of: _____________________________, Deceased AKA: AFFIDAVIT OF DIVORCE I, ___________________________, being duly sworn according to law on oath, depose and say: 1. 2. 3. I reside at ______________________________________________. I personally knew the decedent for _______________ (state how long you knew decedent). The decedent: (initial correct response) _______ was related to me as my ___________________. _______ was not related to me. 4. 5. 6. At the time of death, the decedent was divorced from ______________________________. The divorce occurred on or about _____________________________. I know about the divorce from my own personal knowledge based upon the fact that: (initial correct response or fill in own response on 3rd line) _______ I was present at the divorce hearing. _______ Decedent told me that he/she was divorced. ___________________________________________________________. 7. I have made a good faith effort to find the divorce decree but cannot locate it. I make this affidavit of my own free will. The statements herein are true to the best of my knowledge, information and belief. I understand that if any of my statements are found to be willfully false, I may be liable for perjury. ___________________________ Signature Subscribed and sworn to before me this day of , 20 . _______________________ Notary Public American LegalNet, Inc. www.FormsWorkFlow.com