INVENTORY FOR TRUST COMMONWEALTH OF VIRGINIA VA. CODE §§ 64.2-1300, 64.2-1308 Court File No. ............................................................................................. Circuit Court of .......................................................................................................................................................................................................................... Name of Trust Beneficiary(ies)............................................................................................................................................................................................ Name of Decedent, if trust under will .............................................................................................................................................................................. Trustee(s) Name(s) ................................................................................................................................................................................................................... Date of Trustee(s)' qualification .............................................................................. Date of creation of Trust ..................................................... This is [ ] the first inventory [ ] an inventory showing after discovered assets [ ] an amended inventory restating all assets. The Trustee(s) filing this inventory is/are [ ] Trustee(s) under will [ ] Trustee(s) under Court Settlement [ ] other. Total value of assets listed in Parts 1 and 2 (value for bond) ..................................................................... Total value of assets listed in Parts 1-4 (gross value of trust) ................................................................... $ ................................................ $ ............................................... ATTACH ADDITIONAL SHEETS IF NEEDED Part 1. Trust assets, not including real estate, under your supervision and control. DESCRIPTION OF PROPERTY VALUE TOTAL VALUE OF PART 1: (Page 1 of 3) FORM CC-1673 MASTER 10/12 American LegalNet, Inc. www.FormsWorkFlow.com Part 2. Real estate in Virginia, over which you have a power of sale. DESCRIPTION OF PROPERTY VALUE TOTAL VALUE OF PART 2: Part 3. Other real estate in Virginia. DESCRIPTION OF PROPERTY VALUE TOTAL VALUE OF PART 3: Part 4. Non-Virginia real estate. DESCRIPTION OF PROPERTY VALUE TOTAL VALUE OF PART 4: (Page 2 of 3) FORM CC-1673 MASTER 07/98 American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF ACCURACY AND COMPLETENESS [Must be signed by each Trustee.] I (we) hereby certify and affirm under penalty of law, that to the best of my (our) knowledge and belief this is an accurate and complete inventory of this trust made in accordance with my (our) responsibilities under Virginia law. Date ...................................................................... Trustee ________________________________________________________ Address .............................................................................................................................................. Telephone No.: ................................................................................................................................ Date ...................................................................... Trustee ________________________________________________________ Address .............................................................................................................................................. Telephone No.: ................................................................................................................................ Date ...................................................................... Trustee ________________________________________________________ Address .............................................................................................................................................. Telephone No.: ................................................................................................................................ CERTIFICATE OF COMMISSIONER The Commissioner of Accounts has not independently verified the value of the items on the inventory, or the fact that they are the only assets of the Trust. Inspected, found to be in proper form, and approved on ........................................................................................................................ _______________________________________________________ Commissioner of Accounts Received in the Clerk's Office and admitted to record on ..................................................................................................................... _______________________________________________________ Clerk (Page 3 of 3) FORM CC-1673 MASTER 11/99 American LegalNet, Inc. www.FormsWorkFlow.com