Approved, SCAO JIS CODE: INV STATE OF MICHIGAN PROBATE COURT COUNTY OF INVENTORY (CONSERVATORSHIP) AMENDED FILE NO. USE NOTE: The conservator must serve this completed inventory on all interested persons as required by Michigan Court Rules 5.105 and 5.125. Then the conservator must complete a proof of service (form PC 564) and file it and this inventory with the court. In the matter of I, Name (type or print) , am the conservator and submit the following as a complete and accurate inventory of all the assets of the estate, including the fair market valuations as of the date of qualification as conservator. I have listed on this inventory any property the protected individual owns jointly or in common with others, including the type of ownership. PERSONAL PROPERTY AND REAL PROPERTY DESCRIPTION If the property is owned by both the protected individual and others, specify the type of ownership in the description and check the box in the column "Total Value of Property." If the property has been used to secure a loan, show the nature and amount of the lien. Definitions and instructions for completing the inventory are on the other side. LIEN AMOUNT TOTAL VALUE OF PROPERTY (without reduction for lien) TOTAL ASSETS I declare under the penalties of perjury that this inventory has been examined by me and that its contents are true to the best of my information, knowledge, and belief. Date Attorney signature Attorney name (type or print) Address City, state, zip Telephone no. Bar no. Signature Name (type or print) Address City, state, zip Telephone no. USE NOTE: If this form is being filed in the circuit court family division, please enter the court name and county in the upper left-hand corner of the form. Do not write below this line - For court use only PC 674 (9/12) INVENTORY (CONSERVATORSHIP) MCL 700.5417, MCR 5.409(B) American LegalNet, Inc. www.FormsWorkFlow.com DEFINITIONS: · Real property means land, including a building or house that is built on the land. · Personal property means everything that a person owns except real property. Personal property includes bank accounts and checking accounts. INSTRUCTIONS TO COMPLETE THE INVENTORY: 1. List all real and personal property in the column "Personal Property and Real Property Description." 2. When listing real property, provide the legal description of the property and the name of any other owner. a. If real property has been used to secure a loan (including an equity line of credit), show the nature and amount of the lien. b. If the value of real property is determined by an appraisal, include the appraiser's name and address and a description of the property appraised. c. Property that the protected individual owns jointly or in common with others must be listed along with the type of ownership. The court may require additional information to support the value of property that is stated in the inventory. 3. When listing personal property, provide enough detail to adequately determine the value. Some items should be listed separately and some items should be combined under one category. Provide the name and address of each financial institution listed. The address of a financial institution shall be either that of the institution's main headquarters or the branch used most frequently by the conservator. a. Examples of items that should be listed and valued separately are: · Automobiles · Prepaid burial contracts · Jewelry · Life insurance (cash value) · Bank accounts · Annuities · Antiques · Mutual funds · Furniture · Stocks and bonds · Any other individual item of high value (such as a fur coat) b. Examples of items that can be listed in categories are: · Household items such as dishes, flatware, curtains, linens, utensils, clothing, furnishings, etc. can be grouped into several categories or combined into one category. · Multiple copies or pieces of a specific item that have the same value such as stocks and bonds. c. If personal property has been used to secure a loan, show the nature and amount of the lien. d. If the value of personal property is determined by an appraisal, include the appraiser's name and address and a description of the property appraised. e. Property that the protected individual owns jointly or in common with others must be listed along with the type of ownership. The court may require additional information to support the value of property that is stated in the inventory. American LegalNet, Inc. www.FormsWorkFlow.com