) IN CIRCUIT COURT ) COUNTY OF _________________ ) __________ JUDICIAL CIRCUIT ) ****************************************************************************** ) In the Matter of the Conservatorship of ) ____GDN________________ ) ___________________________________, ) ) INITIAL INVENTORY a Minor Protected Person. ) ) ****************************************************************************** I/We, __________________________ , the Conservator(s) for the above-mentioned Individual, being duly sworn upon oath, state and affirm the following: 1. I was appointed conservator of the above-mentioned Individual on __________________ (month), _____ (day), __________ (year). 2. This Initial Inventory of the Individual's real and personal property will be filed with the Court within ninety days of my appointment, as required by SDCL 29A-5-407. If this is a Conservatorship of a Minor, I will request the clerk seal the inventory at the time of filing, pursuant to SDCL 29A-5-207. 3. Within fourteen days of filing this Initial Inventory with the Court, I will mail a copy to all of the following parties who are entitled to receive notice: a. The above-mentioned Individual (if age ten or older); b. The attorneys of record on this case (if any); c. The Individual's relatives whose names and mailing addresses appear in the petition; d. To any facility responsible for the care or custody of the Individual; and e. To other individuals or entities that the Court explicitly orders. 4. Unless the Court has waived or waives the accounting requirement, I will file updated Inventories of the Individual's Estate with each accounting as required by SDCL 29A-5-408. STATE OF SOUTH DAKOTA UJS-140 Initial Inventory Rev. 06/2016 American LegalNet, Inc. www.FormsWorkFlow.com 5. The Initial Inventory of the above-named Individual's estate, as of ____ / _____/ _______ is: Month Day Year ASSETS/PROPERTY (No financial account numbers please.) EST. VALUE $ $ $ $ $ $ $ $ $ $ $ LIENS/DEBT (Type/Amnt., Item) Cash (on hand): Checking/Debit Accounts: Savings Accounts: Certificates of Deposit: Stocks: Bonds: Mutual Funds: Trust Accounts: Money Market Funds/Accounts: Other Securities: Home and Other Real Property (give location, description): Furnishings and Appliances: $ Vehicles: $ Other Personal Property (describe): $ $ $ $ $ $____________ TOTAL PROPERTY VALUE: UJS-140 Initial Inventory Rev. 06/2016 American LegalNet, Inc. www.FormsWorkFlow.com I/We swear or affirm under oath that the information I/we provided in this Initial Inventory and Affidavit is true, correct, and comprehensive to the best of my/our knowledge. I/We affirm that this Initial Inventory and Affidavit is brought in the best interests of the above-named Individual. Dated ______________ ___ , ________ (month) (day) (year) _______________________________________ Conservator's Signature (Sign only in front of Notary or Clerk) ____________________________________ Mailing Address ____________________________________ City, State, and Zip Code ____________________________________ Phone Number ____________________________________ E-mail Address _______________________________________ Co-Conservators' Signature(s) (if any) Signed and sworn to before me on this ______ day of _________________, ________. (SEAL) ___________________________________ Notary Public/Deputy Clerk of Courts Commission Expires: UJS-140 Initial Inventory Rev. 06/2016 American LegalNet, Inc. www.FormsWorkFlow.com ) IN CIRCUIT COURT ) COUNTY OF _________________ ) __________ JUDICIAL CIRCUIT ****************************************************************************** In the Matter of the Conservatorship of ) ____GDN________________ ) __________________________________, ) ) AFFIDAVIT OF MAILING a Minor Protected Person. ) ****************************************************************************** I, ____________________________, being sworn, state that on ___________________, (Full legal name of Conservator) (Month) STATE OF SOUTH DAKOTA _______, ___________, I served the Initial Inventory on the parties by placing true and correct (Day) (Year) copies of the document in envelopes addressed to: Names Mailing Addresses and depositing the envelopes, with sufficient postage, in the United States Mail at ___________, (City) _________________________. (State) Dated this ____ day of ____________, 20__ ____________________________________ Signature of Conservator (Sign only in front of Notary or Clerk) Name: (Printed)___________________________ Sworn/affirmed before me this day of (Notary Public/Clerk of Courts) , . Mailing Address: ______________________ City/State/Zip:________________________ Telephone: ( )_____________________ If Notary, my commission expires: (SEAL) UJS-140 Initial Inventory Rev. 06/2016 American LegalNet, Inc. www.FormsWorkFlow.com