IN THE CHANCERY COURT FOR HAMILTON COUNTY, TENNESSEE PART INVENTORY FILE N0. IN THE MATTER OF WARD I, ________________________________, CONSERVATOR/GUARDIAN Guardian Conservator for the Ward respectfully NAME report that the assets of the Ward’s estate have come into my hands, and are listed as follows: I SOLEMNLY SWEAR that this list is a full, true, and perfect inventory of all the goods, chattels, rights, and credits of the Ward’s estate which have come to my knowledge or possession, or into the hands and possession of any person for me, to the best of my knowledge and belief, so help me God. STATE OF TENNESSEE COUNTY OF HAMILTON } } Sworn to and subscribed before me, ______________________________________ Signature of Conservator/Guardian ______________________________________ Address this _____ day of ______________, 20__. __________________________________ Notary Public ______________________________________ Attorney My commission expires: ____________ ______________________________________ LRCP 3.04 Information Form 037, Rev. 2007.02.26 American LegalNet, Inc. www.FormsWorkflow.com