ND PROBATE CODE FORM 10 - INVENTORY AND APPRAISEMENT 11/03/03 IN THE DISTRICT COURT OF __________________________________ COUNTY, STATE OF NORTH DAKOTA In the Matter of the Estate of ________________________________________________________________, Deceased. INVENTORY AND APPRAISEMENT ___________________________________, the Personal Representative of the Estate of the above-named Decedent, states that the following inventory contains a true statement of all the property owned by the Decedent at the time of death on _________________________, so far as is known to the Personal Representative. Further, the values set forth for each item are the fair market values of the property as of the date of the decedent's death, and the inventory sets forth the type and amount of any encumbrances that exist with reference to any item. REAL PROPERTY OWNED SOLELY BY DECEDENT: (provide legal description) $____________ REAL PROPERTY OWNED JOINTLY BY DECEDENT: (provide legal description) $____________ TOTAL VALUE OF REAL PROPERTY $____________ American LegalNet, Inc. www.FormsWorkflow.com Page 1 - NDPC Form 10 ND PROBATE CODE FORM 10 - INVENTORY AND APPRAISEMENT 11/03/03 PERSONAL PROPERTY OWNED SOLELY BY DECEDENT $____________ PERSONAL PROPERTY OWNED JOINTLY BY DECEDENT $____________ TOTAL VALUE OF PERSONAL PROPERTY GROSS ESTATE Real Property Personal Property $____________ $____________ $____________ $____________ LIENS, MORTGAGES, ENCUMBRANCES $____________ TOTAL VALUE OF NET ESTATE IN NORTH DAKOTA $____________ American LegalNet, Inc. www.FormsWorkflow.com Page 2 - NDPC Form 10 ND PROBATE CODE FORM 10 - INVENTORY AND APPRAISEMENT 11/03/03 Dated this __________ day of ______________________________, 20_____. ______________________________________________ STATE OF COUNTY OF ) ) ) ss. ______________________________, being first duly sworn, says that I am the Personal Representative of the Estate of the above-named Decedent; that the foregoing Inventory and Appraisement contains a true statement of all the estate of Decedent that has come to my knowledge or possession and particularly of all money belonging to the Decedent and of all just claims of the Decedent against me; and of all liens, mortgages, or other encumbrances on the real and personal property of Decedent. ______________________________________________ Personal Representative Subscribed and sworn to before me this _______ day of _____________________________, 20______. ______________________________________________ Notary Public ____________________ County, ___________________ My Commission Expires:_________________________ American LegalNet, Inc. www.FormsWorkflow.com Page 3 - NDPC Form 10