IN THE IOWA DISTRICT COURT FOR _______________ COUNTY IN THE MATTER OF THE CONSERVATORSHIP OF ______________________________ Probate No. __________________ INITIAL REPORT OF CONSERVATOR AND INVENTORY NOTE: If additional space is needed, please add a separate page as an attachment. The undersigned duly appointed and qualified conservator states as follows: 1. The ward's real and personal property as of the date your conservator was appointed and the valuation of each item is itemized on the schedules attached hereto, and a summary of such schedules is as follows: Conservatorship Assets (Attach Descriptions) Total Value $ $ $ $ $ $ $ A. B. C. D. E. F. Real Estate Stocks and Bonds Mortgages, Notes, Deposits and Cash Life Insurance Jointly Owned Property Miscellaneous Property TOTAL OF ALL SCHEDULES The ward resides at: _______________________________________________________________ Street City State Zip and (check one): A. Does not have a guardian B. Has a natural guardian whose name is: _________________________________________ and whose address is: _________________________________________________________ Street City State Zip C. Has a court-appointed guardian whose name is: __________________________________ and whose address is: _________________________________________________________ Street City State Zip 3. Your conservator established a conservatorship checking account at: ________________________________________________________________________ (Name of Financial Institution) located at: ________________________________________________________________________ Street City State Zip The account number is: _____________________________________________________________________ Rule 7.11 ­ Form 3 American LegalNet, Inc. www.FormsWorkFlow.com 2. 4. 4. A conservatorship savings account been established at: __________________________________________________________________________________ (Name of Financial Institution) located at: _________________________________________________________________________ Street City State Zip The account number is: _______________________________________________________________ 5. 5. Other assets been changed into the conservatorship's name. 6. The ward's sources of income and monthly or annual amounts are: I certify under penalty of perjury and pursuant to the laws of the State of Iowa that the preceding is true and correct. Date: ____________________ Signature of Conservator: [Name] /s/ ____________________________________________________ [Law firm] _____________________________________________________ [Mailing Address] _______________________________________________ [Telephone Number] ____________________________________________ [E-mail Address] ________________________________________________ [Additional E-mail Address] _______________________________________ (NOTE: Bank statements, checks, receipts, stubs, and other items evidencing receipt of funds and payment must be available to the court on demand.) Rule 7.11 ­ Form 3 American LegalNet, Inc. www.FormsWorkFlow.com