THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) INVENTORY OF FIDUCIARY DATE OF FIDUCIARY APPOINTMENT Original 1. Amended (Attach written explanation) Fiduciary Name Capacity Fiduciary Name Capacity 2. Attorney name 3. Court-appointed appraiser name 4. BOND AMOUNT ORDERED BY COURT 5. ANSWER THE FOLLOWING QUESTIONS ONLY IF PROCESSING ESTATE OF DECEASED PERSON. If you have an attorney, have attorney fee arrangements been discussed? Yes No $ Have fiduciary fee arrangements been considered? Yes No ESTATE SUMMARY A. TOTAL VALUE OF REAL ESTATE ....................................... Attachment 1 $ Attach a listing (Attachment 1) which includes street address, city/town where real estate is located, county where deed is recorded, book and page of deed, and the value of each piece of real estate.) B. TOTAL VALUE OF PERSONAL ESTATE (from total on second page) $ TOTAL VALUE OF ENTIRE ESTATE (Add A and B above) $ Examined and accepted by court, Date Judge PERSONAL ESTATE DETAIL Enter the total value of the personal property for each category below, and list the specific items and their value for each category on the appropriate attachment. For decedent estates, values should be as of the date of death. CASH ON HAND .................................................................................................. $ HOUSEHOLD FURNISHINGS AND EFFECTS .............................. Attachment 2 $ (If items are listed in a separate appraisal, enter total value and attach a copy of the appraisal to Attachment 2. Do not list wearing apparel, Bibles, family pictures, photographs, or other personal trinkets of sentimental rather than intrinsic value.) OTHER TANGIBLE PERSONAL PROPERTY ................................ Attachment 3 $ (On Attachment 3, list all other tangible personal property including motor vehicles, farmers' utensils, mechanics tools and livestock. For each motor vehicle, list the year, make, model and vehicle identification number (VIN). If items are listed in a separate appraisal, enter the total value and attach a copy of the appraisal to Attachment 3.) STOCKS AND BONDS ................................................................... Attachment 4 $ (On Attachment 4, list stock or bond name, number of shares and value per share.) NHJB-2125-P (10/01/2006) (formerly AOC 044-003) Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Case Name: Case Number: INVENTORY OF FIDUCIARY DEPOSITED IN BANKS / FINANCIAL INSTITUTIONS .................. Attachment 5 $ (On Attachment 5, list the name and address of the bank or financial institution, the account or certificate number, the date of the last interest/dividend and the account balance.) BUSINESS ASSETS ...................................................................... Attachment 6 $ NOTES RECEIVABLE AND OTHER WRITTEN EVIDENCE OF DEBT OWED TO THE DECEASED OR WARD ............................. Attachment 7 $ (On Attachment 7, list debtor and/or payor, date of note and terms of payment.) OTHER MISCELLANEOUS PERSONAL PROPERTY ................... Attachment 8 $ (On Attachment 8, list any personal property not listed above and the individual values.) TOTAL VALUE OF PERSONAL ESTATE $ (Add Cash on Hand plus Attachments 2 through 8. Copy total to line B of Estate Summary on first page.) , County of State of I, , the appraiser of the estate of , swear that I have acted faithfully, impartially and according to my best judgment. Date Appraiser State of , County of by This instrument was acknowledged before me on My Commission Expires Affix Seal, if any Signature of Notarial Officer / Title , County of State of , I, the fiduciary(ies) of the estate of , swear that I have shown the appraiser the total estate of the ward/deceased of which I have knowledge or possession. I further swear that if I have knowledge or possession of any further estate of the ward/deceased, I will immediately amend my inventory. Date Fiduciary Date Fiduciary State of , County of by This instrument was acknowledged before me on My Commission Expires Affix Seal, if any Signature of Notarial Officer / Title ATTENTION BENEFICIALLY INTERESTED PARTIES This Inventory may be approved by the probate court unless a written objection, containing the specific factual or legal basis for the objection, is filed within 10 days after the date the Inventory is filed in the probate court. Failure to file an objection may forfeit your right to a hearing concerning the Inventory or your objection, and the probate court may then act without a hearing or any further notice to you. NHJB-2125-P (10/01/2006) (formerly AOC 044-003) Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com