IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI - PROBATE DIVISION AT IN THE ESTATE OF ESTATE NUMBER . Deceased. Protectee. INVENTORY OF PROPERTY The undersigned fiduciary of the above captioned estate avers that a description of all real and personal property owned by the decedent/protectee, valued as required by law, is attached hereto as Appendix A, and that a recapitulation of said personal property is set forth below. RECAPITULATION OF PERSONAL PROPERTY (FROM APPENDIX A) 1. Furniture, household goods, wearing apparel. $ 2. Corporation stocks. 3. Mortgages, bonds, notes. 4. Cash $ , Bank accounts $ . Insurance $ . 5. All other personal property. TOTAL PERSONAL PROPERTY $ AFFIDAVIT OF FIDUCIARY STATE OF MISSOURI ) ) ss COUNTY OF JACKSON) The undersigned fiduciary, being first duly sworn, says that Appendix A attached hereto is a full inventory and description of all the real and personal property of said estate which has come to his possession or knowledge, including a statement of all encumbrances, liens, and other charges on any property and that the said fiduciary was not in debt or bound in any contract to the decedent/protectee, except as stated herein. Subscribed and sworn to before me on . Commission expires: Notary Public Division Clerk ATTORNEY FOR ESTATE: MO BAR No ADDRESS AND ZIP CODE: TELEPHONE: ( ) FAX NUMBER: ( ) E-MAIL ADDRESS: Form 10260 Page 1 of 2 10/7/87>>>> 2 APPENDIX A REAL PROPERTY Tract No. Legal Description Value PERSONAL PROPERTY Item No. Description ValueForm 10260 Page 2 of 2 10/7/87