1 2 Code: Your name Address 3 4 Telephone __________________________ __________________________ __________________________ __________________________ In Proper Person 5 6 IN THE _______ JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA 7 IN AND FOR THE COUNTY OF ______________________ 8 9 10 11 12 In the Matter of the Guardianship of  the estate,  the person and the estate, ) ) ) ) ____________________________, ) A(n)  Adult /  Minor. ) ____________________________________) CASE NO._______________________ DEPT. NO._______________________ 13 14 VERIFIED INVENTORY 15 16 I. RECORD OF VALUE 17 Note: There are two parts to this verified inventory. Assets should only be listed once, either in the Record of Value section or the Appraised Inventory section. The asset may not appear in both sections. 18 19 **Designate Nature of Ward’s Interest & % of Ownership; (C) Community; (S) Separate; I.E. 50 % (C) or (S) 20 a) Asset Value 21 b) Amount Owed (mortgage, lien, loan) 22 c) Net Asset Value d) Ward’s** Interest [a-b=c] e) Value of Ward’s Interest [cxd=e] 23 A. REAL PROPERTY Description 1 Item 1._______________________ 2._______________________ 3._______________________ 24 25 26 $_______ $_______ $_______ $_______ $_______ $_______ $______ $______ $______ _____% ( ) _____% ( ) _____% ( ) $______ $______ $______ 27 28 1 Real property is real estate, whether it is undeveloped land or developed commercial, industrial, or residential land. The County assessed value is acceptable until the property is to be sold. For All Guardianship Packets Inventory 1 of 6 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com 1 B. PERSONAL PROPERTY 2 Cash, Checking and Savings Accounts, other Accounts (List) 4.________________________ 5.________________________ 6.________________________ $_______ $_______ $_______ $_______ $_______ $_______ $______ $______ $______ _____% ( ) _____% ( ) _____% ( ) $______ $______ $______ Other Interest, Etc. (Describe)2 7.________________________ 8.________________________ $_______ $_______ $_______ $_______ $______ $______ _____% ( ) _____% ( ) $______ $______ $________ $________ $________ $________ $________ $________ $________ $________ $______ $______ $______ $______ ____ %( ____ %( ____ %( ____ %( ) ) ) ) $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $______ $______ $______ ____ %( ) ____ %( ) ____ %( ) $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $______ $______ $______ $______ ____ %( ____ %( ____ %( ____ %( $________ $________ $________ $________ 3 4 5 6 7 Notes, Bonds, Securities, Debts, Etc., (List Name & Address of Debtor, Date Debt Originated, Endorsement W/Date, Estimate As to Amount Collectible)3 9._______________________ 10.______________________ 11.______________________ 12.______________________ Vehicles (Describe) 13.______________________ 14.______________________ 15.______________________ 8 9 10 11 12 13 14 15 Miscellaneous Personal Property (Describe)4 16.______________________ 17.______________________ 18.______________________ 19.______________________ 16 17 18 19 ) ) ) ) 20 21 22 23 24 25 26 27 28 2 Interests in partnerships, LLCs, corporations, joint ventures, trusts, etc. Book value may be acceptable to the court until the interest is to be sold, disposed or transferred. The Guardian may need to request instructions from the court on how the value of the Ward’s interest is to be listed on this document. 3 Additional items to be listed in this category are: deeds of trust, rents, royalties, life insurance policies with cash values. 4 This category includes household items, collectibles and antiques. If the aggregate(total) replacement value exceeds $5,000.00 an appraisal is required. For All Guardianship Packets Inventory 2 of 6 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com 1 VERIFIED RECORD OF VALUE (IN LIEU OF APPRAISEMENT) 2 I, the undersigned, solemnly affirm that Items listed above in section “I. Record of 3 Value” of this Verified Inventory of the Estate have been examined by me and that I have written 4 the value of these items on the Verified Inventory at the value shown opposite thereof. 5 6 I report that the total value of the times listed in this section of this Verified Inventory have a value of $________________________ dollars and cents. ________________________________ Guardian 7 8 ________________________________ Co-Guardian 9 10 11 II. APPRAISED INVENTORY 12 13 15 16 17 18 19 20 21 22 c) Net Asset Value (a-b=c) d) Ward’s** Interest (Mortgage, lien, loan) a) Asset Value 14 e) Value of Ward’s Interest [cxd=e] b) Amount Owed A. REAL PROPERTY Description 1._____________________ 2._____________________ 3._____________________ $______ $______ $______ $_______ $_______ $_______ $________ $________ $________ ____ %( ) ____ %( ) ____ %( ) $_______ $_______ $_______ B. PERSONAL PROPERTY 4.________________________ 5.________________________ 6.________________________ 7.________________________ 8.________________________ 9.________________________ $______ $______ $______ $______ $______ $______ $_______ $_______ $_______ $_______ $_______ $_______ $________ $________ $________ $________ $________ $________ ____ %( ____ %( ____ %( ____ %( ____ %( ____ %( $_______ $_______ $_______ $_______ $_______ $_______ ) ) ) ) ) ) 23 24 **Designate Nature of Ward’s Interest & % of Ownership; (C) Community; (S) Separate; I.E. 50 % (C) or (S) 25 26 27 28 For All Guardianship Packets Inventory 3 of 6 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com 1 2 3 OATH OF APPRAISER, CPA OR EXPERT IN VALUATIONS STATE OF NEVADA ) ) COUNTY OF ____________) 4 5 6 I, the undersigned, appraiser of the estate of the above-named ward, solemnly affirm that I will truly, honestly, and impartially appraise the inventory of the Estate to the best of my knowledge and ability, and the appraisal was completed in compliance with NRS 159.0865. 7 EXECUTED this __________ day of _________, 20____. 8 9 SIGNED and SWORN to before me _____________________________ Appraiser’s signature 10 by (Appraiser’s name) ____________________ 11 on the _____ day of ________________, _____. _____________________________ Appraiser’s name (print) _______________________________ NOTARY PUBLIC _____________________________ Appraiser’s address 12 13 14 _____________________________ 15 APPRAISAL 16 17 18 I, the undersigned appraiser, CPA or expert in valuation of the Estate of the above-named ward, hereby certify that the items listed in the Verified Inventory under section “II. Appraised Inventory” have been personally examined by me or my authorized agent, and that I appraised 19 these items at the value shown opposite thereof. I report that the total value of the times listed in 20 this section of the Verified Inventory have a value of $________________________ dollars and 21 cents. 22 23 ____________________________ Appraiser _____________ Date 24 25 (Repeat Oath & Certification for Each Appraiser; Attach Separate Sheets If Necessary) 26 27 28 For All Guardianship Packets Inventory 4 of 6 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com 1 2 3 4 OATH OF GUARDIAN STATE OF NEVADA ) ) COUNTY OF ____________) I, the undersigned guardian of the Estate of the above-named ward, solemnly affirm that 5 the foregoing Verified Inventory (Record of Value and/or Verified Appraisals) is a true 6 statement of all assets of the Estate having come into my possession or for which I have 7 knowledge, and the inventory includes all money and claims of the ward, including claims, if 8 any, the Ward has against me. ___________________________________ 9 10 11 12 13 Guardian SIGNED and SWORN to before me by (Guardian’s name) ___________________________ on the _____ day of ____________________, _____. ________________________________ NOTARY PUBLIC 14 15 16 17 18 19 20 21 OATH OF CO-GUARDIAN ) STATE OF NEVADA ) COUNTY OF __________ ) I, the undersigned co-guardian of the Estate of the above-named ward, solemnly affirm that the foregoing Verified Inventory (Record of Value and/or Verified Appraisals) is a true statement of all assets of the Estate having come into my possession or for which I have knowledge, and the inventory includes all money and claims of the ward, including claims, if any, the Ward has against me. 22 ___________________________________ Co-Guardian 23 24 SIGNED and SWORN to before me by (Co- Guardian’s name)___________________________ 25 on the _____ day of ____________________, _____. 26 ________________________________ NOTARY PUBLIC 27 28 For All Guardianship Packets Inventory 5 of 6 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com VERIFICATION OF GUARDIAN 1 2 3 4 5 STATE OF NEVADA ) ) COUNTY OF ____________) The above guardian being duly sworn, states that he or she is the guardian of the estate of 6 the above-named ward, has read the above and foregoing Record of Value, know the contents 7 thereof, and it is true of his or her own knowledge, except for those matters therein stated on 8 information and belief, and as for those matters believed them to be true. 9 10 ______________________________________ Guardian 11 SIGNED and SWORN to before me by (Guardian’s name) ___________________________ 12 on the _____ day of ____________________, _____. 13 ________________________________ NOTARY PUBLIC 14 15 VERIFICATION OF CO-GUARDIAN 16 17 18 19 20 21 22 23 STATE OF NEVADA COUNTY OF __________ ) ) ) The above co-guardian being duly sworn, states that he or she is the co-guardian of the estate of the above-named ward, has read the above and foregoing Record of Value, know the contents thereof, and it is true of his or her own knowledge, except for those matters therein stated on information and belief, and as for those matters believed them to be true. ______________________________________ Co-Guardian 24 25 26 SIGNED and SWORN to before me by (Co- Guardian’s name)___________________________ 27 on the _____ day of ____________________, _____. 28 ________________________________ NOTARY PUBLIC For All Guardianship Packets Inventory 6 of 6 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com