1 2 3 4 5 6 CC25 _____________________________________________ __________________________________ __________________________________ __________________________________ __________________________________ DISTRICT COURT CLARK COUNTY, NEVADA 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 In the Matter of the Estate of _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ Deceased. CASE NO.__________ DEPT. NO.__________ INVENTORY, APPRAISAL AND RECORD OF VALUE (1) Gross Asset Value (2) Amount of Encumbrance Estate's Interest* (1 Less 2) Net VALUE of Estate's Interest A. REAL PROPERTY Description 1. 2. 3. B. PERSONAL PROPERTY Cash and deposits (list) 4. 5. 6. Partnership interests, etc. (describe) 7. 8. $ $ $ $ $ $ ( ( ( ) ) ) $ $ $ *Designate nature of estate's interest & % of ownership (C) community; (S) separate; i.e. 50% (C) or (S). Inven_Prob.doc/5/6/2005 American LegalNet, Inc. www.FormsWorkflow.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 (1) Gross Asset Value (2) Amount of Encumbrance Estate's Interest* (1 Less 2) Net VALUE of Estate's Interest Notes, bonds, securities, debts, etc. (list name & address of debtor, date debt originated, endorsement w/ date, estimate as to amount collectible) 9. 10. 11. 12. Vehicles (describe) 13. 14. 15. Misc. Personal Property (describe) 16. 17. $ $ %( ) $ *Designate nature of estate's interest & % of ownership (C) community; (S) separate; i.e. 50% (C) or (S). STATE OF COUNTY OF ) ) ) ss: OATH OF APPRAISER I, the undersigned, appraiser of the Estate of the above-named Decedent, solemnly affirm that I will truly, honestly, and impartially appraise the inventory of the 22 23 24 25 26 27 28 estate to the best of my knowledge and ability. I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. EXECUTED this day of , 20 . ______________________________ Appraiser 2 Inven_Prob.doc5/6/2005 American LegalNet, Inc. www.FormsWorkflow.com 1 2 3 4 5 6 7 8 9 10 APPRAISAL I, the undersigned appraiser of the Estate of the above-named Decedent, hereby certify that items ________________________________________________________ ______________________________________________________________________ of the inventory of the estate have been examined by me and that I appraised these items on the inventory at the value shown opposite thereof for a total sum of _________ _____________________________________________________ ($_______) Dollars. I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. EXECUTED this day of , 20 . 11 12 13 14 15 16 17 18 19 20 21 22 23 ______________________________ Appraiser (Repeat Oath & Certification for each Appraiser, attach separate sheets if necessary) STATE OF COUNTY OF __ ) ) ) ss: OATH OF PERSONAL REPRESENTATIVE I, the undersigned Personal Representative of the Estate of the above-named Decedent, solemnly affirm that the foregoing inventory is a true statement of all assets of the Estate which have come into my possession or of which I have knowledge and includes all money and claims of the Deceased. 24 25 26 27 28 I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. EXECUTED this day of , 20 . ______________________________ Personal Representative 3 Inven_Prob.doc5/6/2005 American LegalNet, Inc. www.FormsWorkflow.com 1 2 3 4 VERIFIED RECORD OF VALUE IN LIEU OF APPRAISEMENT I, the undersigned, solemnly affirm that items ____________________________ ______________________________________________________________________ of the inventory of the Estate have been examined by me and that I recorded the value 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 of these items on the inventory at the value shown opposite thereof for a total sum of ______________________________________________________($ ) dollars. ______________________________ Personal Representative STATE OF COUNTY OF ) ) ) ss: The undersigned being duly sworn states that he/she is the Personal Representative of the Estate of the above-named ward; that he/she has read the above and foregoing Record of Value, knows the contents thereof, and that the same is true of his/her own knowledge, except for those matters therein stated on information and belief, and as for those matters he/she believes them to be true. I declare under penalty of perjury under the law of the State of Nevada that the 20 21 22 23 24 25 26 27 28 foregoing is true and correct. EXECUTED this day of , 20 . ______________________________ Personal Representative 4 Inven_Prob.doc5/6/2005 American LegalNet, Inc. www.FormsWorkflow.com