INVENTORYFOR DECEDENT222S ESTATEG.S. 28A-15-2, 28A-20-1Name Of Decedent File No. In The General Court Of JusticeSuperior Court DivisionBefore The ClerkIN THE MATTER OF THE ESTATE OF IMPORTANT: File within three (3) months after qualifying. Itemize and give values as of date of decedent222s death. Continue on additional sheet if necessary.I, the undersigned personal representative, being duly sworn, say that to the best of my knowledge the following is a just, true, and perfect inventory of all the real and personal property of the decedent named above, which has come into my hands or into the hands of any person for me as personal representative of the estate.1. Accounts In Sole Name Of Decedent (List bank, etc., each account no., and balance.) 2. Joint Accounts Without Right Of Survivorship (List bank, etc., each account no., balance, and joint owners.)7. Real Estate Willed To The Estate, Directed By The Will To Be Sold, And Not Sold (Attach legal description of each parcel and give fair market value at date of death.)8. Is there a pending lawsuit that involves the decedent? Yes No% Owned By Decedent% Owned By Decedent% Owned By DecedentVALUE$$$$ (Over) 4. Cash And Undeposited Checks On Hand 3. Stocks And Bonds In Sole Name Of Decedent Or Jointly Owned Without Right Of Survivorship (Identify each type of security and give market value of all securities of that type, e.g., 100 shares of XYZ Corp. common stock at 37-1/4...$3,725.)5. All Other Personal Property (e.g., vehicles, household furnishings, farm products, equipment, tools)6. Real Estate Willed To The Estate, Directed By The Will To Be Sold, And Sold (Attach legal description and proceeds of sale for each parcel.)% Owned By Decedent% Owned By Decedent% Owned By Decedent% Owned By Decedent% Owned By Decedent PART I. PROPERTY OF THE ESTATE ADDITIONAL AMOUNT CARRIED OVER FROM ATTACHMENT (if applicable)TOTAL PART I. (Costs apply to this total) STATE OF NORTH CAROLINA County AOC-E-505, Rev. 3/18 American LegalNet, Inc. www.FormsWorkFlow.com 1. Joint Accounts With Right Of Survivorship (List each account; give names of other joint owners and total amount on deposit in each account; attach copy of deposit contract/signature card unless already attached to application.)And Automatically Transferable On Death (Identify each type of security and give market value of all securities of that type, e.g., 100 shares of XYZ Corp. common stock at 37-1/4...$3,725.)4. Real Estate Except Entireties Property, Life Estate And Real Estate Willed To Estate (List legal description and give fair market value of each parcel of decedent222s interest at date of death.)3. Other Personal Property Recoverable (G.S. 28A-15-10)VALUE$ PART II. PROPERTY WHICH CAN BE ADDED TO ESTATE IF NEEDED TO PAY CLAIMS $ TOTAL PART II. PART III. CLAIMS FOR WRONGFUL DEATH There is is not a potential claim for wrongful death arising under G.S. 28A-18-2. The following attorney, if any, has been Telephone No.Signature Of FiduciaryTitleTitleName And Address Of AttorneyCase No.Signature Of Co-Fiduciary, If AnyState And County Or Federal District Court JurisdictionDate My Commission ExpiresDate My Commission ExpiresCounty Where NotarizedCounty Where NotarizedDateDateSignature Of Person Authorized To Administer OathsSignature Of Person Authorized To Administer Oaths Notary Notary Deputy CSC Deputy CSC Assistant CSC Assistant CSC Clerk Of Superior Court Clerk Of Superior CourtSWORN/AFFIRMED AND SUBSCRIBED TO BEFORE MESWORN/AFFIRMED AND SUBSCRIBED TO BEFORE MESEALSEAL AOC-E-505, Side Two, Rev. 3/18 American LegalNet, Inc. www.FormsWorkFlow.com