Fill and Sign the 11 Form 3 Initial Report of Conservator and Inventory

Rule 7.11 — Form 3: Initial Report of Conservator and Inventory  If filing electronically, you must provide any protected information in full on form 6, according to Division VI of Chapter 16 of the Iowa Court Rules.  If filing in paper, you may use form 6 to provide any protected information in full. In the Iowa District Court for County In the Matter of the c onservatorship of: Full name: first, middle, last If the Ward is a minor, use initials only Ward. Probate no. Initial Report of Conservator and Inventory The undersigned duly appointed and qualified C onservator states as follows: 1. The Ward's real and personal property as of the date Conservator was appointed, and the valuation of each item, is itemized on the attached schedules. A summary of the schedules follows: Conservatorship assets Attach descriptions Total value A. Real estate $ B. Stocks and b onds $ C. Mortgages, notes, deposits, and cash $ D. Life insurance $ E. Jointly ow ned property $ F. Miscellaneous property $ Total of all schedules $ 2. The Ward resides at: Street address City State ZIP code and check one A.  does not have a Guardian. B.  has a natural Guardian. If you check B , you must fill in the following information. (1) The name and residency of the natural Guardian: Full name: first, middle, last Street address City State ZIP code C.  has a court-appointed Guardian . If you check C , you must fill in the following information. (1) The name and residency of the court -appointed Guardian : Full name: first, middle, last Street address City State ZIP code May 2014 Rule 7.11 — Form 3 Page 1 of 2 Rule 7.11 — Form 3 : Initial Report of Conservator and Inventory , continued 3. T he Conservator :  has  has not established an  interest -bearing  non -interest -bearing conservatorship checking account at Name of financial institution located at Street address City State ZIP code The (partial) account number is: 4. A conservatorship savings account :  has  has not been established at Name of financial institution located at Street address City State ZIP code The (partial) account number is: 5. Other assets :  have  have not been changed into conservatorship’s name. 6. The Ward ’s sources of income and monthly or annual amounts are: 7. Oath and Signature I, , have read this Initial Report and Inventory , and I certify Print Conservator’s name under penalty of perjury and pursuant to the laws of the State of Iowa that the information I have provided in this Initial Report and Inventory is true and correct. , 20 Month Day Year Conservator’s signature* Mailing address City State ZIP code ( ) . Phone number Email address Additional email address, if applicable * Whether filing electronically or in paper, you must handwrite your signature on this form. If you are filing electronically, scan the form after signing it and then file electronically. Note: Bank statements, checks, receipts, stubs, and other items evidencing receipt of funds and payment must be available to the court on demand. May 2014 Rule 7.11 — Form 3 Page 2 of 2