IN THE CIRCUIT COURT, JEFFERSON COUNTY MISSOURI IN THE ESTATE OF ______________________________________________ Estate No. ______________ Deceased Disabled Minor INVENTORY AND APPRAISEMENT (Please read carefully the inserted directions before filing out this form) The personal representative or conservator hereby makes and returns the following inventory and appraisement of all of the property of the above named decedent or protectee, including exempt property, which has come into the possession or knowledge of the personal representative or conservator, together with a statement of all encumbrances, liens and other charges on any item, and all other property possessed but not owned by the decedent or protectee. REAL PROPERTY (include plat or survey descriptions and street addresses) VALUE Total Value Real Estate $ American LegalNet, Inc. www.FormsWorkflow.com ITEM NO. PERSONAL PROPERTY VALUE $ American LegalNet, Inc. www.FormsWorkflow.com Total Value Personal Property $ RECAPITULATION OF PROPERTY VALUE Furniture, household goods, wearing apparel $ Corporate Stocks Bonds, notes, other debts owed to the decedent or disabled person Bank accounts, insurance, money All other personal property, including proportionate share in any partnership TOTAL VALUE PERSONAL PROPERTY $ TOTAL VALUE REAL ESTATE $ TOTAL VALUE ALL PROPERTY $ Property possessed but not owned by the decedent at death or by protectee, together with a statement as to the knowledge of the personal representative or conservator as to its ownership TOTAL VALUE $ American LegalNet, Inc. www.FormsWorkflow.com AFFIDAVIT OF APPRAISERS WHERE AUTHORIZED BY COURT STATE OF MISSOURI } SS COUNTY OF JEFFERSON } The appraisers, being first sworn, state that to the best of their knowledge and belief, the above and foregoing is a full inventory and description of all real and personal property of the decedent/protectee which has come into the possession or to the knowledge of the Personal Representative/Conservator, and of the property which was in the possession of the decedent/protectee but which was being held or is being claimed by another, and the appraisers further state that this is an appraisement of all property which the appraisers were employed to appraise, which property is specified by Item No. corresponding with the signature of each appraiser. ITEM NO. _______________________ ________ _______________________ ________ _______________________ ________ ______ ________________________________ ________________________________ Subscribed and sworn to before me on Personal Representative/Conservator __________________________________ ____________ ________________________________________________ Notary Public (SEAL) My Commission Expires: ____________ AFFIDAVIT OF PERSONAL REPRESENTATIVE STATE OF MISSOURI } SS COUNTY OF JEFFERSON } The undersigned Personal Representative/Conservator, being first duly sworn, states that the foregoing is a full inventory and description of all real and personal property of the decedent/protectee which has come into the possession or to the knowledge of the Personal Representative/Conservator, including a statement of all encumbrances, liens, and other charges on any property which was in the possession of the decedent/protectee but which was held, or is being claimed by another, as far as the Personal Representative/Conservator knows, and further states that the foregoing is an appraisement of all the property subject to appraisement. The Personal Representative/Conservator further states that he was not in debt or bound in any contract to the decedent at the time of his death/protectee; except as stated herein. __________________________ Personal Representative/Conservator ________________________________________ Personal Representative/Conservator (SEAL) Subscribed and sworn to before me on ______________________ My Commission Expires: ____________________ __________________________ Notary Public American LegalNet, Inc. www.FormsWorkflow.com