Rule 7.11 -- Form 3: Initial Report of Conservator and Inventory If filing electronically, you must provide any protected information in full on form 6, according to Division VI of Chapter 16 of the Iowa Court Rules. If filing in paper, you may use form 6 to provide any protected information in full. In the Iowa District Court for In the Matter of the conservatorship of: Probate no. County Full name: first, middle, last If the Ward is a minor, use initials only Initial Report of Conservator and Inventory Ward. The undersigned duly appointed and qualified Conservator states as follows: 1. The Ward's real and personal property as of the date Conservator was appointed, and the valuation of each item, is itemized on the attached schedules. A summary of the schedules follows: Conservatorship assets Attach descriptions 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 $ Total value 2. The Ward resides at: Street address City State ZIP code and check one A. B. does not have a Guardian. has a natural Guardian. If you check B, you must fill in the following information. (1) The name and residency of the natural Guardian: Full name: first, middle, last Street address City State ZIP code has a court-appointed Guardian. If you check C, you must fill in the following information. (1) The name and residency of the court-appointed Guardian: Full name: first, middle, last C. Street address May 2014 City Rule 7.11 -- Form 3 State ZIP code Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Rule 7.11 -- Form 3: Initial Report of Conservator and Inventory, continued 3. The Conservator: has established an interest-bearing conservatorship checking account at has not non-interest-bearing Name of financial institution located at Street address City State ZIP code The (partial) account number is: 4. A conservatorship savings account : been established at Name of financial institution has has not located at Street address City State ZIP code The (partial) account number is: 5. Other assets: have have not been changed into conservatorship's name. 6. The Ward's sources of income and monthly or annual amounts are: 7. Oath and Signature I, Print Conservator's name , have read this Initial Report and Inventory, and I certify under penalty of perjury and pursuant to the laws of the State of Iowa that the information I have provided in this Initial Report and Inventory is true and correct. , 20 Month Day Year Conservator's signature* Mailing address City State ZIP code ( ). Phone number Email address Additional email address, if applicable * Whether filing electronically or in paper, you must handwrite your signature on this form. If you are filing electronically, scan the form after signing it and then file electronically. Note: Bank statements, checks, receipts, stubs, and other items evidencing receipt of funds and payment must be available to the court on demand. May 2014 Rule 7.11 -- Form 3 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com