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Has appointed an authorized funeral agent as defined in N.J.S.A. 3B:10-21.1 and N.J.S.A. 45:27-22 Print Name: (If no funeral agent, proceed to surviving heirs at law.) Surviving Heirs at Law I/We herby certify that the decedent left the following surviving heirs at law: Spouse, Civil Union Partner or Domestic Partner (Separated spouses should be listed. Divorced spouses should not be listed.) Ye.

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