INVENTORY

Judicial Circuit, in and for County, Florida Probate Division Case No. Judge: Amended Form? Yes* No *If yes, version of the Amended Form: In Re: Guardianship of INITIAL INVENTORY Date of letters of guardianship: Property guardianship type: SUMMARY Section A: Value of Real Property Assets $ Section B: Cash Assets/Cash Equivalent Assets $ Section C: Intangible Assets/Stocks/Bonds $ Section D: Tangible Personal Property $ Section E: Debts/Encumbrances/Liabilities/Liens $ Total $ Section A: Real Property Assets Do you have entries for Section A? Yes No Number Description and Address Full Value Is There Another Owner? Yes or No 1. 2. 3. Total for Section A $ Attach a copy of the property appraiser’s information or a copy of the deed for all real property. Section B: Cash Assets/Cash Equivalent Assets (checking account, savings account, money market account, certificate of deposit (CD)) Do you have entries for Section B? Yes No Are any of the entries held in a depository account? Yes No Number Institution Name Last 4 Digits of Account Number Type of Asset Full Value Is There Another Owner? Yes or No Is this a Depository Account? Yes or No 1. 2. 3. Total for Section B $ Attach a copy of the institution’s statement for each account from the creation date of the guardianship. Section C: Intangible Assets/Stocks/Bonds Do you have entries for Section C? Yes No Are any of the entries held in a depository account? Yes No Number Issuer Name and Address Type of Asset Full Value Last 4 Digits of Account Number Is There Another Owner? Yes or No 1. 2. 3. Total for Section C $ Attach a copy of the institution’s statement for each account from the creation date of the guardianship. Section D: Tangible Personal Property Assets (motor vehicles, jewelry, household furnishings, collectibles, fine art) Do you have entries for Section D? Yes No Number Description and Location Full Value Is There Another Owner? Yes or No 1. 2. 3. Total for Section D $ Attach a copy of the title for any motor vehicle. Section E: Debts/Encumbrances/Liens/Liabilities Do you have entries for Section E? Yes No Instructions: List each liability equal to or greater than $1,000. Number Creditor Full Amount of Liability Last 4 Digits of Account Number Is there Another Person who Owes on the Debt? Yes or No 1. 2. 3. Total for Section E $ A copy of documents detailing each listed liability. Section F: Sources of Income Do you have entries for Section F? Yes No Number Type Payor Estimated Monthly Amount 1. 2. 3. Total for Section F $ Is the guardian the representative payee of Social Security benefits? Yes No If no, who is the representative payee for the Social Security benefits? Section G: Lawsuits Against the Ward Do you have entries for Section G? Yes No Number Description of Lawsuit or Claim Estimated Amount of Claim Court Address Plaintiff’s Name and Address Describe Cause of Action Date of Debt Occurrence 1. 2. 3. Section H: Pending Litigation and/or Lawsuits the Ward May Bring if Court Approval Is Received Do you have entries for Section H? Yes No Number Description of Lawsuit or Claims Case Number and Court Address Defendant Name and Address Describe Cause of Action Attorney for Ward 1. 2. 3. Section I: Assets the Ward, as of the Date of the Letters of Guardianship, Was Entitled to Receive, but Has Not Received Do you have entries for Section I? Yes No Instructions: If the guardian has knowledge of assets the ward was entitled to receive as of the date of letters, but were not received the assets should be listed here. Examples: insurance policies, benefits, inheritance, or settlements from litigation. Number Description Estimated Date of Receipt Estimated Amount 1. 2. 3. Section J: Trusts Do you have entries for Section J? Yes No Number Name of Current Trustee and Address Ward’s Interest Estimated Date Trust was Created Value of the Ward’s Interest in the Trust 1. 2. 3. Section K. Safe-Deposit Box Does the ward lease a safe-deposit box? Yes No If yes, location and number of safe-deposit box: Does the ward lease a safe-deposit box with another individual or individuals? Yes No Who is the joint lessee with the ward? Was an inventory of the safe-deposit box filed with the court as required by section 744.365, Florida Statutes? Yes No Has the safe-deposit box been opened? Yes No [A certificate of service as required by Florida Rule of Judicial Administration 2.516 must be included if the incapacitated person is not a minor under 14 years of age and is not totally incapacitated.] I certify that the foregoing document has been furnished to .....(name, address used for service, mailing address, and e-mail address)..... by .....(e-mail) (delivery) (mail) (fax)..... on .....(date)…... Guardian’s Signature Guardian’s Printed Name: Guardian’s Address: Guardian’s Phone Number: Guardian’s E-mail Address: