NAME AND ADDRESS OF ATTORNEY OR APPLICANT: TELEPHONE NO: ATTORNEY FOR: APPRAISAL REPORT OF CALIFORNIA PROBATE REFEREE IN MATTER OF : [ ] DECEDENT [ ] DISSOLUTION [ ] OTHER (SPECIFY): DATE OF DEATH: LIST OF ASSETS AND APPRAISEMENT [ ] FINAL [ ] PARTIAL NO: APPRAISALS 1. Real Property (Schedule 1) 2. Stocks, Bonds, Notes (Schedule 2) 3. Personal Property, Trusts and Miscellaneous (Schedule 3) TOTAL APPRAISAL BY REFEREE (Schedules 1, 2, &3) STATEMENT OF APPLICANT Assets listed in Schedules 1, 2, and 3 are a correct description of the assets requested to be appraised as of date of death and/or designated date. I request appraisal of the assets listed on the: [ ] Date of Death [ ] Designated Date [ ] Both Dates DATE:___________________, 200__ Applicant's Signature: _____________________________ Printed name: ____________________ The total number of pages attached are:______ DECLARATION OF CALIFORNIA PROBATE REFEREE I have truly, honestly, and impartially appraised to the best of my ability each item set forth in the Statement of Applicant in compliance with Probate Code 400 et seq., and Business & Professions Code 11302(b). A true account of my fee and expenses actually and necessarily incurred pursuant to applicant's request is: Appraisal Fee: Expenses: TOTAL $ $ (travel, mapping, photo) ------------$ $ $ $ _________________ $ DESIGNATED DATE: I declare under penalty of perjury that the foregoing is true and correct and that this declaration was executed on (Date):__________________________ at (Place): _____________________, CA _________________________ (Type or print name of Referee) ________________________________________ Signature of Referee) American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE 1 - Real Property ITEM NUMBER DESCRIPTION VALUE DATE OF DEATH VALUE AT DESIGNATED DATE 1 TOTALS American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE 2 - Stocks, Bonds and Notes ITEM NUMBER DESCRIPTION INCLUDING FACE AMOUNT OF BONDS OR NUMBER OF SHARES UNIT VALUE VALUE DATE OF DEATH UNIT VALUE VALUE AT DESIGNAT ED DATE TOTALS American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE 3 - Personal Property and Miscellaneous Property (including Closely Held Businesses and Partnerships) ITEM NUMBER DESCRIPTION VALUE DATE OF DEATH VALUE AT DESIGNATED DATE TOTALS American LegalNet, Inc. www.FormsWorkFlow.com