1 Initial Inventory SJCCOC 2018 IN THE CIRCUIT COURT, SEVENTH JUDICIAL CIRCUIT, IN AND FOR ST. JOHNS COUNTY, FLORIDA IN RE: THE GUARDIANSHIP OF Case No.: Division: INITIAL VERIFIED INVENTORY The undersigned guardian of , the ward, files this inventory a listing of all encumbrances, liens or other secured claims. SUMMARY Please refer to the attached instructions for completing the Initial Verified Inventory. Required documentation must be attached to the Worksheet. Include additional pages, if necessary. SUMMARY OF ALL ASSETS/LIABILITIES/INCOME/EXPENSES/CAUSES OF ACTION AS OF THE DATE OF THE LETTERS OF GUARDIANSHIP SCHEDULE A - ASSETS Line 1: Cash on Hand $ Line 2: Stocks/Bonds/Securities $ Line 3: Investments $ Line 4: Real Property $ Line 5: Personal Property $ Line 6: Prepaid Items $ TOTAL VALUE OF ALL ASSETS $ American LegalNet, Inc. www.FormsWorkFlow.com 2 Initial Inventory SJCCOC 2018 SCHEDULE B - LIABILITIES Line 7: Current Expenses $ Line 8: Credit Cards $ Line 9: Lines of Credit $ Line 10: Loans/Notes $ TOTAL LIABILITIES $ SCHEDULE C - INCOME Line 11: Periodic Income $ Line 12: Other Income $ TOTAL INCOME $ SCHEDULE D - EXPENSES Line 13: Periodic Expenses $ TOTAL PERIODIC EXPENSES $ (Circle one) SCHEDULE E - PENDING CAUSES OF ACTION Yes No SCHEDULE F - WITNESS TO INVENTORY Yes No SCHEDULE G - CLAIMS AGAINST THE ESTATE Yes No SCHEDULE H - SAFE DEPOSIT BOX Yes No SCHEDULE I - LAST WILL AND TESTA MENT Yes No American LegalNet, Inc. www.FormsWorkFlow.com 3 Initial Inventory SJCCOC 2018 INITIAL VERIFIED INVENTORY WORKSHEET SCHEDULE A - ASSETS (See SCHEDULE A. Instructions for detailed information) L ine 1: Cash on Hand (I nclude all cash on deposit, name/address of institution and account number(s). Attach a separate sheet if necessary . ) Institution Name/Address: Account Number: $ Institution Name/Address: Account Number: $ Institution Name/Address: Account Number: $ Institution Name/Address: Account Number: $ Institution Name/Address: Account Number: $ Institution Name/Address: Account Number: $ Institution Name/Address: Account Number: $ TOTAL OF ALL CASH ON HAND (Transfer total to Schedule A, Line 1 of Summary Page) $ American LegalNet, Inc. www.FormsWorkFlow.com 4 Initial Inventory SJCCOC 2018 Line 2: Stocks/Bonds/Securities (Include complete description of all stocks/bonds/securities, number of shares, identifying number and current market value. Attach separate sheet if necessary.) Descrip tion/Identifying Number # of S hares Current Ma rket Value $ $ $ $ $ $ $ TOTAL MARKET VALUE OF STOCKS/BONDS/SECURITIES (Transfer total to Schedule A, Line 2 of Summary Page) $ Line 3: Investments (Include complete description of all investments, including the name and address of the institution, account or identifying number, and current market value. Attach a separate sheet if necessary.) Description/Account Number # of Shares Current Market Value $ $ $ $ $ $ $ TOT AL MARKET VALUE OF INVESTMENTS (Transfer total to Schedule A, Line 3 of Summary Page) $ American LegalNet, Inc. www.FormsWorkFlow.com 5 Initial Inventory SJCCOC 2018 Line 4: Real Property (Include complete description of all real property, attach current Description Income Producing Estimated FMV Yes No $ Yes No $ Yes No $ Yes No $ Estimated FMV for Income Producing Property Estimated FMV for Non - Income Producing Property $ $ TOTAL FMV FOR ALL REAL PROPERTY (Transfer total to Schedule A, Line 4 of Summary Page) $ Line 5: Personal Property (Other than Cash. Include complete description. General household furnishings of nominal value may be shown together. Attach separate sheet if necessary.) Item Location Estimated FMV Encumbrances $ Yes No $ Yes No $ Yes No $ Yes No General Household Furnishings: $ Yes No TOTAL FMV FOR ALL PERSONAL PROPERTY (Transfer total to Schedule A, Line 5 of Summary Page) $ American LegalNet, Inc. www.FormsWorkFlow.com 6 Initial Inventory SJCCOC 2018 Line 6: Prepaid Expenses (Include a complete description and dollar value of all items prepaid on behalf of the ward. Attach separate sheet if necessary.) $ $ $ $ TOTAL DOLLAR VALUE FOR ALL PREPAID EXPENSES (Transfer total to Schedule A, Line 6 of Summary Page) $ SCHEDULE B - LIABILITIES (See Schedule B. Instructions for detailed information) Line 7: Current Expenses (Include a complete description of all outstanding obligations. Attach separate sheet if necessary.) Institution Authorized Names & Relationship Account No. Account Type Credit Line Balance Owed $ $ $ $ $ $ $ $ TOTAL OF ALL EXPENSES (Transfer total to Schedule B, Line 7 of Summary Page) $ American LegalNet, Inc. www.FormsWorkFlow.com 7 Initial Inventory SJCCOC 2018 Line 8: Credit Cards (Attach separate sheet if necessary.) Institution Authorized Names & Relationship Account No. Account Type Credit Line Balance Owed $ $ $ $ $ $ $ $ TOTAL BALANCE OWED ON ALL CREDIT CARDS (Transfer total to Schedule B , Line 8 of Summary Page) $ Line 9: Lines of Credit (Attach separate sheet if necessary.) Institution Authorized Names & Relationship Account No. Account Type Credit Line Balance Owed $ $ $ $ $ $ $ $ TOTAL BALANCE OWED ON ALL LINES OF CREDIT (Transfer total to Schedule B , Line 9 of Summary Page) $ American LegalNet, Inc. www.FormsWorkFlow.com 8 Initial Inventory SJCCOC 2018 Line 10: Loans/Notes (Include all outstanding loans/notes, name and address of payee, account number and dollar amount owing. Attach separate sheet if necessary.) Loan/Note Name & Address of Payee Account No. Dollar Amount Owed $ $ $ $ TOTAL OF ALL OUTSTANDING LOANS/NOTES (Transfer total to Schedule B, Line 10 of Summary Page) $ SCHEDULE C - INCOME (See Schedule C. Instructions for detailed information.) Line 11: Periodic Income (Include complete description of all sources, name of p ayer, frequency and amount of payments. Attach separate sheet if necessary.) Source Name of Payer Frequency of Payments Amount of Payments $ $ $ $ TOTAL OF ALL PERIODIC INCOME (Transfer total to Schedule C, Line 11 of Summary Page) $ American LegalNet, Inc. www.FormsWorkFlow.com 9 Initial Inventory SJCCOC 2018 Line 12: Other Income (Include complete description of all sources, name of payer, frequency and amount of payments. Attach separate sheet if necessary.) Source Name of Payer Frequency of Payments Amount of Payments $ $ $ $ TOTAL OF ALL OTHER INCOME (Transfer total to Schedule C, Line 12 of Summary Page) $ SCHEDULE D - EXPENSES (See Schedule D. Instructions for detailed information.) Line 13: Periodic Expenses (Include complete description of expenses, frequency and amount of payment. Attach separate sheet if necessary.) Name & Address of Payee Type of Payment Frequency of Payments Amount of Payments $ $ $ $ TOTAL OF ALL PERIODIC EXPENSES (Transfer total to Schedule D, Line 13 of Summary Page) $ American LegalNet, Inc. www.FormsWorkFlow.com 10 Initial Inventory SJCCOC 2018 SCHEDULE E - PENDING CAUSES OF ACTION (See Schedule E. Instructions for detailed information.) Type of Action/State/County/Case No. Status SCHEDULE F - WITNESSES (See Schedule F. Instructions for detailed information.) Name Address Occupation SCHEDULE G - CLAIMS AGAINST ESTATE (See Schedule G. Instructions for detailed information.) A. Secured: Creditor Description of Debt Description of Security When Occurred Amount $ $ $ TOTAL OF SECURED CLAIMS (Refer to Schedule G of Summary Page) $ American LegalNet, Inc. www.FormsWorkFlow.com 11 Initial Inventory SJCCOC 2018 B. Unsecured Creditor Description of Debt Description of Security When Occurred Amount $ $ $ TOTAL OF UNSECURED CLAIMS (Refer to Schedule G of Summary Page) $ SCHEDULE H - SAFE DEPOSIT BOX (See Schedule H. Instructions for detailed information.) Contents of Safe Deposit Box, as listed on Safe Deposit Box Inventory, are shown in applicable categories under Assets, Schedule A. Yes No (circle one) (Refer to Schedule H . of Summary Page.) SCHEDULE I - LAST WILL AND TESTAMENT (See Schedule I. Instructions for detailed information.) Yes No (circle one) If yes, the location of the Last Will and Testament is: (Refer to Schedule I. of Summary Page.) American LegalNet, Inc. www.FormsWorkFlow.com 12 Initial Inventory SJCCOC 2018 TRUST INFORMATION Does the ward have one or more T