1 Form 4-997. Conservator222s inventory. [For use with Rule 1-140 NMRA] STATE OF NEW MEXICO COUNTY OF JUDICIAL DISTRICT In the matter of , No. a Protected Person. CONSERVATOR222S INVENTORY NET ASSET SUMMARY Total Amount A.Total Assets (SECTION II TOTAL)$ B.Total Debts (SECTION III TOTAL)226$ Net Asset Value (A 226 B) $ Please note: Fill out this net asset summary after you have completed this entire inventory. Use the information that you enter in Sections II and III of this inventory. American LegalNet, Inc. www.FormsWorkFlow.com 2 SECTION I 226 Information about the Protected Person. 1.Protected Person222s name: 2.Protected Person222s age: 3.Protected Person222s physical address: Mailing address (if different): 4.Protected Person222s telephone number(s) and other contact information:Home: Cell: Work: Fax: Email: Instructions. You must use this form, Form 4-997 NMRA, when you file a Conservator222s Inventory. The purpose of a Conservator222s Inventory is to give the court as complete a picture as possible of the financial situation of the person under conservatorship, also called the Protected Person. 1.This Conservator222s Inventory is due within ninety (90) days of your appointmentas conservator.2.As conservator you will also be required to complete and file a Conservator222sReport using Form 4-998 NMRA as follows:a.Every year within thirty (30) days after the anniversary date of yourappointment.b.Within sixty (60) days after your resignation, removal, or termination asconservator.3.Please type or print clearly using ink.4.Complete all sections of this inventory.5.Attach additional pages if necessary.6.After completing this inventory, you must sign it under penalty of perjury.7.Copies of this inventory must be given to the Protected Person, the ProtectedPerson222s guardian if one has been appointed, and any other persons specified bythe court.8.Keep a copy of this inventory for your records.9.You must keep a copy of ALL of the Protected Person222s financial records forseven (7) years and make them available to the court upon request. American LegalNet, Inc. www.FormsWorkFlow.com 3 5.Has a guardian also been appointed for the Protected Person?001 Yes 001 NoIf yes, name of guardian Address Phone number of guardian 6.What date were you appointed conservator? 7.Is the Protected Person the beneficiary of a trust? 001 Yes001 No If yes, what is the name of the trust? What is the current value of the trust? Who is the trustee? What is the trustee222s contact information? SECTION II 226 Assets. A.Are you holding cash on hand on behalf of the Protected Person?001 Yes 001 No Amount $ If yes, why is cash kept on hand? Please note: The information you fill out in Sections II through IV below will show the value of the Protected Person222s estate on the date you were appointed. Please provide information about all of the assets of the Protected Person as of the date of your appointment as conservator. Assets are anything of value owned by the Protected Person. Attach additional pages if necessary. American LegalNet, Inc. www.FormsWorkFlow.com 4 B.Bank Accounts.Name of Bank/Institution Type of Account (Examples: checking, savings, certificates of deposit, etc.) Value on Date of Appointment $ $ $ TOTAL $ C.Investment Accounts.Name of Bank/Institution Type of Account (Examples: brokerage, investment, money market, stocks, bonds, IRAs, 401(k) plan, etc.) Value on Date of Appointment $ $ TOTAL $ D.Life Insurance Policies.Name Of Company Type of Insurance (Examples: whole, term or universal, etc.) Cash Value on Date of Appointment $ $ TOTAL $ American LegalNet, Inc. www.FormsWorkFlow.com 5 E.Real Estate.Address of Property (List all land and buildings) Method for Determining Value (Examples: appraisal, tax assessment, market value, etc.) Value $ $ TOTAL $ F.Vehicles.Make, Model, and Year (List all cars, boats, ATVs, etc.) Value $ $ $ TOTAL $ G.Other Property Not Listed Above. (Attach additional pages if necessary.)Detailed Description of Item or Collection (Only list items or collections that are worth more than $500.00) Method for Determining Value (Examples: appraisal, market value) Value $ $ $ TOTAL $ American LegalNet, Inc. www.FormsWorkFlow.com 6 H.Total value of assets listed above. (The sum of all 223Totals224 reported in Section II.)SECTION II TOTAL $ Section III 226 Debts. A.Real Estate Debts.Address of Property and Name of Lender Amount Owed on Date of Appointment $ $ TOTAL $ B.Other Loans.Lender/Creditor Name Purpose of Loan (Examples: automobile loan or personal payday loan, etc.) Amount Owed on Date of Appointment $ $ TOTAL $ C.Credit Cards.Company Name and Address Amount Owed on Date of Appointment $ $ $ TOTAL $ American LegalNet, Inc. www.FormsWorkFlow.com 7 D.Judgments/Liens.Judgment/Lien Description Amount Owed On Date Of Appointment $ $ TOTAL $ E.Other Liabilities/Debts.Description Amount Owed On Date Of Appointment $ $ $ TOTAL $ F.Total amount of debts listed above. (The sum of all 223TOTALS224 reported in Section III.)SECTION III TOTAL $ G.Explain any personal or professional relationship between the conservator and anylender/creditor listed in any section above: H.Explain any personal or professional relationship between the Protected Person and anylender/creditor listed in any section above: American LegalNet, Inc. www.FormsWorkFlow.com 8 SECTION IV 226 Management of estate. A.What are the Protected Person222s expected sources of income? (e.g., Pension, SocialSecurity, SSI, etc.) B.What are the Protected Person222s expected expenses? (e.g., housing, care, household, etc.) C.If expected expenses will exceed expected income, what is your plan to meet the basicneeds of the Protected Person? D.Do you anticipate significant one-time income over the next 12 months? (e.g., sale ofhouse or car, back payment of social security, insurance proceeds, etc.)001 Yes 001 NoIf yes, list and describe each income source and amount separately: If yes, what do you plan on doing with this income? (e.g., pay off debt, invest) American LegalNet, Inc. www.FormsWorkFlow.com 9 E.Do you anticipate significant one-time expenses over the next 12 months? (e.g., majorhome or car repair, medical expenses, gifts) 001 Yes 001 NoIf yes, list and describe the nature and amount of each expense: If yes, how do you plan on paying for this expense? F.Are the assets in the estate sufficient to provide for the ongoing care of the ProtectedPerson? 001 Yes 001 NoIf no, describe why and what steps should be taken to provide for the Protected Person: American LegalNet, Inc. www.FormsWorkFlow.com 10 AFFIRMATION UNDER PENALTY OF PERJURY I, , am the conservator of , and I affirm under penalty of perjury under the laws of the State of New Mexico that the information in this report is true and correct. Date Submitted: Conservator222s Signature Typed/Printed Name Street or Post Office Address City, State and Zip Code Telephone Number(s) Fax Number Email Is this address different from your address in the order of appointment? 001 Yes 001 No American LegalNet, Inc. www.FormsWorkFlow.com 11 CERTIFICATE OF SERVICE I certify that on (date) I served a copy to the following individuals: 001 Protected Person 001 Person(s) designated by court order (name and address): 001 By mail or other delivery service 001 By fax (number) 001 By hand delivery 001 By e-mail 001 By mail or other delivery service 001 By fax (number) 001 By hand delivery 001 By e-mail 001 By mail or other delivery service 001 By fax (number) 001 By hand delivery 001 By e-mail 001 By mail or other delivery service 001 By fax (number) 001 By hand delivery 001 By e-mail 001 By mail or other delivery service 001 By fax (number) 001 By hand delivery 001 By e-mail Typed/Printed Name Conservator222s Signature [Approved by Supreme Court Order No. 18-8300-005, effective for all cases on or after July 1, 2018.] American LegalNet, Inc. www.FormsWorkFlow.com