251 2018 Nevada Supreme Court Page 1 of 5 226 Inventory COURT CODE: Your Name: Address: City, State, Zip: Telephone: Email Address: Self-Represented DISTRICT COURT COUNTY, NEVADA INVENTORY, APPRAISAL AND RECORD OF VALUE FINANCIAL ACCOUNTS: retirement/pensions, cash value life insurance policies, interests in trusts, etc. Financial Institution Name and Last 4 Digits of Account Number Current Balance Estate222s Interest (% owne d)* Name of Co-Owner (if applicable) Value of Estate222s Interest *Add additional pages if there are more accountsREAL ESTATE: List all houses / real estate, land, and commercial/industrial properties. Address Current Value Mortgage / Loan Balance Name of Co - Owner (if applicable) Net Value (Value 226 Loans) Estate222s Interest* (% owned) Value of Estate222s Interest *Describe the nature of the Estate222s interest and percent of ownership; use (C) for Community Property and (S) for SeparateProperty. For example, 50% (C) or (S). In the Matter of the Guardianship of the: EstatePerson and Estate of: CASE NO.: DEPT: ( name of person who has a guardian ) A Protected Person. American LegalNet, Inc. www.FormsWorkFlow.com 251 2018 Nevada Supreme Court Page 2 of 5 226 Inventory VEHICLES List all automobiles, motorcycles, motor homes, boats, etc. Year, Make, Model Current Value Loan Balance Name of Co - Owner (if applicable) Net Value (Value 226 Loans) Estate222s Interest* (% owned) Value of Estate222s Interest *Describe the nature of the Estate222s interest and percent of ownership; use (C) for Community Property and (S) for SeparateProperty. For example, 50% (C) or (S). MISCELLANEOUS PERSONAL PROPERTY List valuable household goods, artwork, jewelry, safe deposit boxes, storage unit contents, etc. Description Current Value Loan Balance Name of Co - Owner (if applicable) Net Value (Value 226 Loans) Estate222s Interest* (% owned) Value of Estate222s Interest *Describe the nature of the Estate222s interest and percent of ownership; use (C) for Community Property and (S) for SeparateProperty. For example, 50% (C) or (S).*If personal property exceeds $5000 in value, an appraisal is required. TRUSTS Is the Protected Person a current beneficiary or entitled to receive benefits from a trust? NoYesI don222t know Is the Guardian requesting the Court to take jurisdiction over the trust? NoYesNot applicable American LegalNet, Inc. www.FormsWorkFlow.com 251 2018 Nevada Supreme Court Page 3 of 5 226 Inventory TOTAL ESTATE VALUE DEBTS/CLAIMS Can the Protected Person assert any claims against you? NoYes: (describe) Does anyone legally owe money to the protected person but is not paying? NoYes: (describe who owes money and how much) *add the sums of all the values American LegalNet, Inc. www.FormsWorkFlow.com 251 2018 Nevada Supreme Court Page 4 of 5 226 Inventory VERIFIED RECORD OF VALUE IN LIEU OF APPRAISEMENT I, (guardian222s name) , solemnly affirm the items listed in this Inventory, Appraisal and Record of Value of the Estate has been examined by me and I have written the value of these items on the Inventory, Appraisal and Record of Value at the value shown opposite thereof. I report that the total value of the items listed in this section of this Inventory, Appraisal and Record of value of $ . GUARDIAN222S SIGNATURE OATH OF GUARDIAN I, (guardian222s name) , the Guardian of the Estate of the above-named Protected Person, solemnly affirm that the foregoing Inventory, Appraisal and Record of Value is a true statement of all assets of the Estate having come into my possession or for which I have knowledge, and includes all money and claims of the Protected Person, including claims, if any, the Protected Person has against me. GUARDIAN222S SIGNATURE VERIFICATION OF GUARDIAN I state that I am the Guardian of the Estate of the above-named protected person, have read the foregoing Inventory, Appraisement and Record of Value, know the contents thereof, and it is true to my own knowledge, except for those matters therein stated on information and belief, and as for those matters I believe them to be true. I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. GUARDIAN222S SIGNATURE American LegalNet, Inc. www.FormsWorkFlow.com 251 2018 Nevada Supreme Court Page 5 of 5 226 Inventory CERTIFICATE OF SERVICE BY MAIL: I deposited copies of the Inventory in the U.S. mail in (write the name ofthe city you mailed from) , Nevada, addressed to the persons listed below on (date you mailed) . Protected Person: Name: Address: Protected Person222s Attorney: Name: Address: Protected Person222s Guardian Ad Litem: Name: Address: ELECTRONIC: I served the following persons pursuant to the court222s electronicservice rules on (date) : Protected Person: Name: Email Address: Protected Person222s Attorney: Name: Email Address: Protected Person222s Guardian Ad Litem: Name: Email Address: I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. DATED (month) (day) , 20 . Submitted By: (your signature) (print your name) American LegalNet, Inc. www.FormsWorkFlow.com