FORM A -- VERIFIED COMPLAINT To be completed by litigant in all

FORMS FOR OBTAINING A DECLARATION OF DEATH AND TO PROBATE AN ESTATE FOR A
PERSON MISSING IN CONNECTION WITH THE TERRORIST ATTACKS ON SEPTEMBER 11, 2001.
(SUPERIOR COURT OF NEW JERSEY, CHANCERY DIVISION, PROBATE PART)
Full Set of Forms for Use by Surrogates, Attorneys, and others Providing Assistance to Litigants
FORM A -- VERIFIED COMPLAINT
To be completed by litigant in all cases to initiate the following actions:
1.
Obtain a Declaration of Death for an individual presumed dead because of the events of
September 11, 2001, where a death certificate has not been issued;
2.
Have the individual’s Last Will and Testament probated and an executor or executrix
appointed, or, if the individual did not have a Last Will and Testament, have a general
administrator appointed;
3.
Have the Court appoint a trustee for a missing person’s estate to permit immediate access
to certain of the decedent’s assets needed for the care and maintenance of his/her
dependents while the court considers the case.
FORM B - ORDER TO SHOW CAUSE
Applicable to all cases; to be filed with the Verified Complaint. Blanks on first page should be
completed. For cases related to the September 11, 2001 attacks, no newspaper publication of the
Order to Show Cause is required.
FORM C - TRUSTEE FOR MISSING PERSON’S PROPERTY
To be completed and filed with the Verified Complaint only if the Plaintiff is seeking to have a
Trustee named to obtain immediate access to Decedent’s estate. Blanks on the first page should
be completed.
FORM D - GUARDIAN AD LITEM
To be completed and filed with the Verified Complaint only if there are minor children whose
interests may be affected by the legal action.
FORM E - PROOF OF SERVICE
To be completed and filed after the court has issued an Order to Show Cause. Applicable to all
cases, to prove that the Plaintiff has served the Order to Show Cause on all interested parties. All
blanks should be completed and copies of return receipts should be attached.
FORM F - JUDGMENT
To be submitted to the court with the Verified Complaint in all cases; this is the document that
the judge will sign to enter the court’s determination. All blanks on the first two pages should be
completed, if the information is known. In paragraph #5 insert the name of the proposed
executor or executrix. Delete paragraphs #4 and 5 if the decedent did not have a Last Will and
Testament. In Alternate paragraph #4, insert the decedent’s name and the name of the proposed
General Administrator. The court will insert the amount of the bond if necessary.
FORM A -- VERIFIED COMPLAINT FOR A DECLARATION OF DEATH, ESTATE
ADMINISTRATION, AND TRUSTEE APPOINTMENT
__________________________________________
Plaintiff (Person filing the Complaint)
Address:
___________________________________________
___________________________________________
Telephone Number: ___________________________________
SUPERIOR COURT OF NEW JERSEY
CHANCERY DIVISION ______________
COUNTY
PROBATE PART
Docket No.
IN THE MATTER OF
(To be filled in by the court)
CIVIL ACTION
___________________________________________ ,
Print or type name of Decedent (the person who died)
DECEASED
VERIFIED COMPLAINT FOR A
DECLARATION OF DEATH, ESTATE
ADMINISTRATION AND TRUSTEE
APPOINTMENT
Plaintiff, __________________ residing at
_______________________________________, City/Township/ Borough of
_______________________, __________ County, New Jersey, by way of verified complaint
says:
COUNT I (Declaration of Death)
1.
On September 11, 2001, ____________________ (decedent) departed this life in
the New York City World Trade Center [Pentagon][Airplane] terrorist attack.
2.
The plaintiff is related to the decedent and is the decedent’s ________________.
3.
The decedent was born on ___________________ in ___________________.
4.
The decedent’s heirs-at-law are: (spouse, children, and -- possibly –
grandchildren, parents, grandparents, brothers, sisters, aunts, uncles, nieces, nephews or first
cousins. The Surrogate may be able to provide information as to whom to list.)
Name
Relationship
Age (Adult/Minor)
These are the decedent’s only heirs-at-law.
5.
On September 11, 2001, the decedent resided at ________________________,
_______________ County, New Jersey.
6.
On September 11, 2001, the decedent was employed by
__________________________________________, whose offices were located at
_____________________________ (specify address). His/her occupation was that of
______________________. Attached is documentation of the decedent’s employment
(paycheck, etc.).
7.
Describe whatever you know about the decedent’s activities on September 11,
2001, including facts showing that he or she was at or near the World Trade Center [on an
affected airplane] [at or near the Pentagon]:
8.
Recount the effort to locate the decedent after the decedent failed to communicate
or return home after the September 11, 2001 events:
9.
[Cross out one]
So far as the plaintiff has been able to ascertain, the decedent left no Last Will and Testament.
OR
The decedent left a Last Will and Testament dated ________. The names and address of the
devisees (beneficiaries) named therein, in addition to any heirs-at-law listed in paragraph 4, are:
Name
10.
Address
Beneficiary Interest (What is left to him/her.)
[If applicable] The decedent is record owner of real property commonly known
as _________________________________, New Jersey. No person other than the heirs-at-law
identified in paragraph 4 has, or would have, any interest in any real or personal estate by reason
of the death of the decedent, and no other person is entitled to any interest which expires or is
contingent upon the decedent’s death.
11.
The plaintiff believes and understands that there is life, credit life or other
insurance policy upon the life of the decedent with the following insurance companies:
Insurance Company
12.
Address
Policy Number Face Amount
Beneficiary
The plaintiff has made a diligent inquiry with the decedent’s relatives about the
decedent’s whereabouts. The decedent’s living siblings, parents and other relatives have not seen
nor heard from the decedent since September 11, 2001. The effort to locate the decedent has
been unsuccessful and no satisfactory explanation, except that the decedent died in the World
Trade Center [Pentagon] conflagration and building collapse [or airplane crash] on September
11, 2001, is known to the plaintiff.
WHEREFORE, the plaintiff demands judgment declaring that:
a.
The said _____________________ was exposed to the World Trade Center
[Pentagon][Airplane] terrorist attack of September 11, 2001 that resulted in loss of life to many
persons known and unknown and his/her absence following the catastrophic conflagration and
collapse of the World Trade Center [Pentagon] [airplane crash] is unexplained after a diligent
search and inquiry and therefore the said _______________________ be declared to be dead and
that he/she died on September 11, 2001.
b.
for such other relief as the Court may deem just and equitable.
COUNT II (Estate Administration)
The plaintiff repeats paragraphs one through twelve of Count I as if set forth at length
herein.
13.
The decedent departed this life [check one] 9testate (with a will)
9intestate (without a will)
IF TESTATE (that is, if decedent left a will):
Alternate 14a:
The decedent left a Last Will and Testament dated
_____________ that is being submitted for probate with this Complaint. Attached and made a
part hereof is the decedent's original Last Will and Testament. The decedent's Last Will and
Testament is self proving and may be admitted to probate without further affidavit, deposition or
witness proofs. Named as the executor or executrix in the decedent’s Last Will and Testament is
___________________________.
OR IF INTESTATE (that is, if decedent left no will):
Alternate 14b:
The plaintiff is first entitled to Letters of Administration.
OR
Alternate 14c:
All competent adult persons entitled to letters of administration for
the estate of the decedent, whose rights are prior or equal to the plaintiff have renounced or will
be given notice of this application.
WHEREFORE, the plaintiff demands judgment that:
a.
the court admit the decedent’s last will and testament to probate;
b.
Letters Testamentary be issued to _________________________;
c.
such other relief as the court may deem just and equitable.
OR
a.
the court grant Letters of Administration for the estate of the decedent to
_____________________________;
b.
such other relief as the court may deem just and equitable.
COUNT III
The plaintiff repeats paragraphs one through twelve of Count I and paragraphs thirteen
and fourteen of Count II as if set forth at length herein.
15.
The property of the decedent is necessary for the care, shelter and support of the
decedent’s family and dependents or is subject to waste or dissipation pending the declaration of
death and appointment of a personal representative herein demanded.
16.
The provisions of N.J.S.A. 3B:26-1 to -4 authorize the appointment of a trustee for
an absent person’s estate.
17.
It is requested that the trustee’s powers be limited to certain property and further
that the use of the property be limited to providing for the support, shelter and care for the
missing person's family and the protection of the missing person's real property pending the
declaration of death and appointment of a personal representative action herein maintained and
therefore bond be waived.
18.
The plaintiff requests that the trustee be given authority over the following of the
decedent’s property:
Bank/Institution
Account No.
Account Owner(s)
WHEREFORE, the plaintiff demands judgment that:
a.
a trustee be appointed to manage the estate of the missing decedent pending an
adjudication of death.
b.
for such other relief as the Court may deem just and equitable.
Date:___________________________
__________________________________
SIGNATURE OF PLAINTIFF
__________________________________
TYPE OR PRINT NAME
VERIFICATION
I, _________________________, hereby certify and say:
1.
I am the plaintiff in the within action.
2.
I have read the complaint and its contents are true to my personal knowledge.
3.
The value of the decedent's personal estate will not exceed $______________ and
the real estate value will not exceed $_____________.
I hereby certify that the statements made by me are true. I am aware that if any are
wilfully false I am subject to punishment.
Date:
______________________________
SIGNATURE OF PLAINTIFF
______________________________
TYPE OR PRINT NAME
FORM B --
ORDER TO SHOW CAUSE FOR DECLARATION OF DEATH, WILL
PROBATE AND APPOINTMENT OF ESTATE PERSONAL
REPRESENTATIVE (EXECUTOR OR GENERAL ADMINISTRATOR)
__________________________________________
Plaintiff (Person filing the Complaint)
Address:
___________________________________________
___________________________________________
Telephone Number: ___________________________________
SUPERIOR COURT OF NEW JERSEY
CHANCERY DIVISION ______________
COUNTY
PROBATE PART
Docket No.
IN THE MATTER OF
___________________________________________ ,
(To be filled in by the court)
CIVIL ACTION
Print or type name of Decedent (the person who died)
DECEASED
ORDER TO SHOW CAUSE
This matter having been presented to the Court for an adjudication that
_________________ died on September 11, 2001, [for probate of his/her last will and testament]
and for granting (Letters Testamentary) (Letters of General Administration)] and for such other
relief as the Court may deem just, and the Court having read and considered the verified
complaint, supporting affidavits, and other papers and pleadings for this application, and for
good cause shown:
(Do not write below this line- for court use only.)
IT IS on this
1.
day of
, 2001 , ORDERED that:
The parties-in-interest show cause before this court at the
____________________ County Court House, ______________________________, New
Jersey on the
day of
, 2001 , at
o’clock in the
noon, or as
soon thereafter as plaintiff may be heard, why a judgment should not be rendered declaring that
the above decedent died on September 11, 2001 and [his/her last will and testament be admitted
to probate] and a personal representative appointed for his/her estate.
2.
A copy of the verified complaint, supporting affidavits and this order to show
cause shall be served on the heirs-at- law, insurance companies and the other interested parties
set out in the complaint by certified mail, return receipt requested within ___ days of the date of
this order.
3.
That any person wishing to contest this application may file not later than four
days before the return date any interested party shall file and serve the court and the plaintiff,
either an answer, or answering affidavit, or a motion returnable on the return date and in default
thereof the action may proceed ex-parte and the entry of a judgment granting the relief requested.
In the event you are unable to obtain an attorney, you may communicate with the legal services
office or lawyer referral service in your county.
J. S .C.
FORM C -- ORDER APPOINTING TRUSTEE WITH LIMITED AUTHORITY FOR
MISSING PERSON
__________________________________________
Plaintiff (Person filing the Complaint)
Address:
___________________________________________
___________________________________________
Telephone Number: ___________________________________
SUPERIOR COURT OF NEW JERSEY
CHANCERY DIVISION ______________
COUNTY
PROBATE PART
Docket No.
IN THE MATTER OF
___________________________________________ ,
(To be filled in by the court)
CIVIL ACTION
Print or type name of Decedent (the person who died)
DECEASED
ORDER APPOINTING TRUSTEE WITH
LIMITED AUTHORITY FOR MISSING
PERSON’S ESTATE
This matter being presented to the Court by ________________ seeking the appointment
of a Trustee with the limited authority to protect and preserve the estate of a missing person; and
it appearing that __________________ is missing and has not been seen or heard from since
September 11, 2001; and the appointment of a Trustee to marshal and conserve the missing
person’s estate is necessary while an application for a declaration of death is pending; and it
appearing that good and sufficient cause exists for the relief requested.
It is on this _____ day of _______________________, 2001 ORDERED and
ADJUDGED that pursuant to N.J.S.A. 3B:26-2 ________________________ whose address is
__________________________________ be and hereby is appointed the Trustee of the Estate of
____________________, a missing person, without bond upon otherwise qualifying according to
law.
It is further ORDERED that pending the outcome of the declaration of death litigation and
subject to right of the Trustee to apply for additional powers deemed necessary to protect and
preserve the missing person’s estate or support the missing person’s dependents the authority of
the Trustee be and hereby is limited to:
A.
Securing the missing person's residence at ___________________________
___________________________, __________________ County, New Jersey,
B.
the procurement, if necessary, of fire and liability insurance to protect the missing
person's real and personal property including any motor vehicles;
C.
the authority to make withdrawal of funds from account #___________________
____________________ in the name of the missing person at ___________________________
Bank for the payment of any real property taxes, mortgage installments, insurance and utility
charges, accrued or accruing, connected with the missing person's residence and any funds
necessary for the support, care, welfare and maintenance of the missing person’s dependents.
And, it is further Ordered that after the Trustee qualifies as herein set out, the Surrogate
of ___________ County shall issue Letters of Trusteeship as herein provided.
__________________________________________
J.S.C.
FORM D -- ORDER APPOINTING GUARDIAN AD LITEM
__________________________________________
Plaintiff (Person filing the Complaint)
Address:
___________________________________________
___________________________________________
Telephone Number: ___________________________________
SUPERIOR COURT OF NEW JERSEY
CHANCERY DIVISION ______________
COUNTY
PROBATE PART
Docket No.
IN THE MATTER OF
___________________________________________ ,
(To be filled in by the court)
CIVIL ACTION
Print or type name of Decedent (the person who died)
DECEASED
ORDER APPOINTING
GUARDIAN AD LITEM
It appearing from the plaintiff's verified complaint in the above-entitled action that the
interest of a minor(s) without a general or testamentary guardian(s) is (are) involved; and good
cause appearing.
It is on this ___ day of _______________________ 2001, ORDERED that
_____________________________________ be, and hereby is, appointed the guardian ad litem
for ______________________________________________ for the purpose of representing the
interests of said minor(s) in the above-entitled action.
_________________________________
J.S.C.
FORM E -- PROOF OF SERVICE
__________________________________________
Plaintiff (Person filing the Complaint)
Address:
___________________________________________
___________________________________________
Telephone Number: ___________________________________
SUPERIOR COURT OF NEW JERSEY
CHANCERY DIVISION ______________
COUNTY
PROBATE PART
Docket No.
IN THE MATTER OF
___________________________________________ ,
(To be filled in by the court)
CIVIL ACTION
Print or type name of Decedent (the person who died)
PROOF OF SERVICE
DECEASED
__________________________________, of full age, hereby certifies and says:
1.
I am the plaintiff in the within matter.
2.
On ______________________, 2001, I mailed by certified mail, return receipt
requested, a true copy of the verified complaint for a declaration of death, [will probate]
appointment of [an execut(or)(rix)] [a general administrator] , supporting affidavits and
documents and the order to show cause returnable on _______________ to the following partiesin-interest:
2.
(continued)
Name
3.
Address
Attached are photocopies of the certified mail return receipt cards signed for by
the aforesaid parties in interest except: _________________________________.
I certify that the foregoing statement made by me is true. I am aware if the foregoing
statement made by me is willfully false, I am subject to punishment.
Dated:_____________________________
________________________________
Plaintiff
FORM F--
JUDGMENT DECLARATION OF DEATH [AND ADMITTING THE
DECEDENT’S LAST WILL AND TESTAMENT TO PROBATE AND
GRANTING LETTERS TESTAMENTARY ][AND APPOINTING A
GENERAL ADMINISTRATOR/ADMINISTRATRIX]
__________________________________________
Plaintiff (Person filing the Complaint)
Address:
___________________________________________
___________________________________________
Telephone Number: ___________________________________
SUPERIOR COURT OF NEW JERSEY
CHANCERY DIVISION ______________
COUNTY
PROBATE PART
Docket No.
IN THE MATTER OF
___________________________________________ ,
Print or type name of Decedent (the person who died)
DECEASED
(To be filled in by the court)
CIVIL ACTION
JUDGMENT OF DECLARATION OF
DEATH [AND ADMITTING DECEDENT’S
LAST WILL AND TESTAMENT TO
PROBATE AND GRANTING LETTERS
TESTAMENTARY] [AND APPOINTING A
GENERAL
ADMINISTRATOR/ADMINISTRATRIX]
This matter being presented to the Court by ____________________ seeking a
declaration of death for _________________________, last a resident of the _______________
County, New Jersey; [and for the probate of the Last Will and Testament and the appointment of
an Execut(or)(rix)]; and it appearing that all matters required by law for the probate of the
decedent's last will and testament have been submitted] OR [ it appearing that
____________________ died intestate and all matters required by law for the appointment of a
general administrator has been submitted]; and proof of publication and proof of service on the
parties-in-interest having been filed with the court and the court being satisfied from the proofs
submitted that oral testimony is not required; that a diligent and satisfactory inquiry has been
conducted; that ___________________________was exposed to the World Trade Center
[Pentagon][Airplane] terrorist attack on September 11, 2001,and it appearing that and good and
sufficient cause exists for the relief requested.
It is on this _____ day of __________________, 2001, ORDERED and ADJUDGED
that:
1.
The said _____________________, a resident of New Jersey, was exposed to the
World Trade Center [Pentagon][Airplane] terrorist attack on September 11, 2001 that resulted in
loss of life to many persons known and unknown.
2.
The said _____________________’s absence following the catastrophic
conflagration and collapse of the World Trade Center [Pentagon][airplane crash] is unexplained
after a diligent search and inquiry.
3.
The said _____________________ be and hereby is declared to be dead and that
he/she died on September 11, 2001.
4.
The Last Will and Testament of _______________________, deceased, dated
_____________________ be and hereby is admitted to probate.
5.
___________________________ be and hereby is appointed Execut(or)(rix) of
the Estate of __________________ upon qualifying according to law.
OR
4.
Letters of General Administration for the Estate of the said
__________________________, deceased, be granted to ______________________________
without bond [with bond in the amount of $________________ ] and upon qualifying according
to law.
______________________________________J.S.C.