IN THE PROBATE COURT OF SHELBY COUNTY, TENNESSEE IN THE MATTER OF THE GUARDIANSHIP/CONSERVATORSHIP OF NO._______________ __________________________ Minor/Disabled Person __________________________ Fiduciary INVENTORY The undersigned Guardian or Conservator, under oath, submits the following inventory of the estate of the minor or disabled person for whom I have been appointed: 1. The following is a list of the Property: FAIR MARKET VALUE DESCRIPTION OF ASSET _______________________________________ ____________ _______________________________________ ____________ _______________________________________ ____________ _______________________________________ ____________ _______________________________________ ____________ 2. The following is a list of the source, amount and frequency of each item of income, pension, social security benefit or other revenue of the minor or disabled person: INVENTORY OF INCOME SOURCE ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ AMOUNT _________ _________ _________ _________ _________ _________ _________ FREQUENCY _____________ _____________ _____________ _____________ _____________ _____________ _____________ ___________________________________ Guardian/Conservator American LegalNet, Inc. www.USCourtForms.com State of ____________________________ County of__________________________ Before me this date personally appeared __________________________________, the guardian or conservator in the above case, who being duly sworn, made oath that the foregoing constitutes a full, complete, and true inventory of the estate of the person for whom he/she is the guardian or conservator. This ____________ day of _____________________, __________________. ____________________________ Notary Public My Commission Expires: ____________________ American LegalNet, Inc. www.USCourtForms.com