IN THE PROBATE COURT OF SHELBY COUNTY, TENNESSEE IN THE MATTER OF: ____________________________________________ DOCKET NO: ______________ INVENTORY The undersigned, being first duly sworn, reports to the Court that the following assets have come into his or her hands, and the undersigned further certifies that a copy of this inventory shall be promptly furnished to all interested parties: $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ STATE OF TENNESSEE COUNTY OF SHELBY I do solemnly swear or affirm that the above and foregoing is a full, true and complete inventory of the assets of this estate which have come into my possession or for which I am chargeable, to the best of my knowledge, information and belief. This _______ day of ______________________, 20______. ______________________________________________ SIGNATURE Subscribed and sworn to before me this _______ day of _______________________, 20_____. ________________________________________ Notary Public or Clerk of Court American LegalNet, Inc. www.USCourtForms.com