AOC-841 Rev. 2-17 Page 1 of 2 Doc. Code: INV COM M O NW E A LT H O F K E lex et justitia Case No. ____________________ Court County Division ____________________ ____________________ ____________________ NT U C KY CO Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 395.250 U RT OF JUS TI INVENTORY AND APPRAISEMENT OF ESTATE IN RE: Estate of ______________________________________________________________________________ Decedent's Date of Death: ______________________ Decedent's SSN: ______________________________ Description of Assets C E Estimated Value American LegalNet, Inc. www.FormsWorkFlow.com AOC-841 Rev. 2-17 Page 2 of 2 Description of Assets Estimated Value Total Estimated Value: $_______________________ I submit the foregoing as the Inventory of the above-named Decedent's estate; which Inventory was made on ____________________________________, 2_______. ________________________________________________________ Signature of Executor/Executrix or Administrator/Administratrix Subscribed and sworn before me on ______________, 2_____. My commission expires: ______________, 2_____. ______________________________________________ Name/Title Attorney's Signature: ______________________________________________ Phone No.: ____________________ Attorney Name (Printed): __________________________________________________________________________ Address: _______________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ CLERK'S CERTIFICATE The foregoing Inventory having been returned to me in duplicate, the original is now filed in my office and the duplicate mailed to the Commissioner of Revenue, Commonwealth of Kentucky this on_____________, 2_____. _________________________________________ Clerk By: ______________________________________ D.C. Distribution: Court File (original) Revenue Cabinet American LegalNet, Inc. www.FormsWorkFlow.com