Fill and Sign the Being Sworn I Verify that the Attached Schedules Contain a Complete and Accurate Inventory of the Real and Personal Property Form

CPC 20 R7/00 INVENTORY Page 1 of 4This form conforms in substance to CPC 20. District Court  Denver Probate Court_________________________________________ County, ColoradoCourt Address:IN THE MATTER OF THE ESTATE OF: Deceased  Protected Person COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail:FAX Number: Atty. Reg.#:Case Number:Division Courtroom INVENTORY Being sworn, I verify that the attached schedules contain a complete and accurate inventory of the real and personal property of this estate to the best of my knowledge, information and belief. ___________________________________________Signature of  Personal Representative  Conservator Subscribed and sworn to before me on ____________________.My commission expires ________________________________. ___________________________________________ Notary public/(Deputy) Clerk of Court INSTRUCTIONS Both decedent’s estates and conservatorship:Within three months after appointment, a personal representative or conservator shall list and value the estate’s assets and liabilities, clearly identifying each item and the decedent’s or protected person’s interest in the item. If additional space is needed, separate sheets may be used. If additional items are discovered after the initial inventory has been completed, a supplemental inventory listing those additional item(s) shall be completed.Decedent’s estates:Assets shall be listed and the fair market value given as of the date of the decedent’s death. The inventory shall be sent to interested persons who request it or the original inventory may be filed with the Court. (Sections 15-12-706, 15-12-707 & 15-12-708, C.R.S., and Rules 28 & 30, C.R.P.P.)Conservatorship:Assets shall be listed and the fair market value given as of the date of the conservator’s appointment. The inventory must be filed with the Court. A copy must also be provided to the protected person, if 14 years of age or older, and to any parent or guardian with whom the protected person resides. (Section 15-14-418, C.R.S. and Rule 28, C.R.P.P.) SUMMARY Schedule AReal Estate…………………………………………………………………………..$________________________Schedule BStocks and Bonds…………………………………………………………………….________________________Schedule CMortgages and Notes……………………………._____________________ Cash……………………………………………….._____________________Total Mortgages, Notes and Cash………………………………………………….________________________ Schedule DInsurance, Annuities, Pension & Profit Sharing Plans……………………………________________________Schedule E(Conservatorship only) Property Held In Joint Tenancy…………………………….________________________Schedule FMiscellaneous Property………………………………………………………………________________________Total Gross Value………………………………………………………………………………………...$________________________ Encumbrances on Inventoried Assets………………………………………………………………..(_______________________)Total Net Value……………………………………………………………………………………………$________________________ CPC 20 R7/00 INVENTORY Page 2 of 4This form conforms in substance to CPC 20.Schedule AReal Estate (State Name in which Title is Held) Value Total Schedule A $____________________ Schedule BStocks and Bonds (State Name in which Title is Held) Value Total Schedule B $____________________ Schedule CMortgages, Notes and Cash (State Name in which Title is Held) ValueMortgages and Notes Mortgages and Notes $____________________ CPC 20 R7/00 INVENTORY Page 3 of 4This form conforms in substance to CPC 20.Cash Cash $____________________Total Schedule C $____________________ Schedule DInsurance, Annuities, Pension and Profit Sharing Plans Value(Decedent’s estate should include only those items payable to the estate. Conservatorship should include all items in which the protected person has an ownership or beneficial interest.) Total Schedule D $____________________ Schedule E(Conservatorship only) Property Held in Joint Tenancy Value Total Schedule E $____________________ CPC 20 R7/00 INVENTORY Page 4 of 4This form conforms in substance to CPC 20.Schedule FMiscellaneous Property (If Titled, State Name in which Title is Held) Value Total Schedule F $____________________ Encumbrances on Inventoried AssetsSchedule and Item Number Description Amount Total Encumbrances $____________________