Estate Inventory Document

ESTATE INVENTORY DOCUMENT

This Estate Inventory Document is executed by the undersigned parties for the administration of the Estate of Decedent Name: , Date of Death: , Case Number (if any):

First Party (Personal Representative): — Address:

Second Party (Beneficiary / Co-Executor): — Address:

RECITALS

WHEREAS, Decedent Name was domiciled at at the time of death; and

WHEREAS, First Party has been appointed or has assumed the responsibilities of Personal Representative for the estate and is charged with gathering, valuing, and reporting all assets and liabilities of the estate; and

WHEREAS, the parties desire to prepare and attest to a complete and accurate inventory of estate assets and liabilities as of the Inventory Date: .

NOW, THEREFORE

In consideration of the mutual covenants set forth herein and for other good and valuable consideration, the parties agree as follows:

1. DEFINITIONS

For purposes of this document: "Estate" means all property, real and personal, and other interests of the decedent that are subject to probate administration. "Inventory Date" means the date specified above and the date on which values are to be reported. "Personal Representative" means the person administering the Estate.

2. GENERAL INSTRUCTIONS

The Personal Representative shall compile a complete listing of all assets and liabilities of the Estate as of the Inventory Date. Values reported should reflect reasonable fair market values as of the Inventory Date, or book value where applicable. Each listed asset must include sufficient description to permit identification and, where available, supporting documentation or appraisal references shall be identified.

3. INVENTORY OF ASSETS

3.1 Real Property

Parcel 1 — Description:

Estimated Market Value: — County/Jurisdiction:

Parcel 2 — Description:

Estimated Market Value:

Total Real Property Value

3.2 Personal Property (Vehicles, Collectibles, Household, Jewelry)

Total Personal Property Value

3.3 Financial Accounts and Securities

Institution / Account Type: Account Number (last 4): Balance:

Institution / Account Type: Account Number (last 4): Balance:

Total Financial Accounts Value

4. BUSINESS INTERESTS

If the decedent held ownership or an interest in any business entities, identify each below with percentage ownership, entity type, and estimated value.

Entity 1 — Name: Ownership Percentage:

Estimated Value:

5. DEBTS AND LIABILITIES

List known secured and unsecured liabilities of the Estate. Include creditor name, account reference, and outstanding balance as of the Inventory Date.

Creditor 1: Account/Reference: Balance:

Creditor 2: Account/Reference: Balance:

Total Known Liabilities

6. APPRAISALS, DOCUMENTATION, AND EXHIBITS

The Personal Representative shall attach or list at least the following supporting documentation for items requiring professional valuation: appraisal reports, vehicle titles, account statements, deeds, stock certificates, and insurance policies. Identify attachments below and indicate whether the attachment is on file with the Estate.

Appraisal Attached? Yes No

7. POSSESSION AND CUSTODY

Indicate current physical possession or custodian of significant assets and the location where those assets are stored.

8. NOTICE TO CREDITORS

This inventory does not substitute for formal notice to creditors as required by applicable probate statutes. The Personal Representative is responsible for providing such notices and for reporting claims against the Estate in accordance with governing procedures.

9. CERTIFICATION

The undersigned Personal Representative certifies under penalty of perjury under the laws of the applicable jurisdiction that, to the best of the Personal Representative's knowledge and after reasonable inquiry, the foregoing inventory is true, correct, and complete as of the Inventory Date identified above.

Acknowledgment by Beneficiary / Co-Executor: The Secondary Party acknowledges receipt of a copy of this inventory and has had an opportunity to review or request further documentation or clarification regarding listed items.

Acknowledgment of Certification: Personal Representative certifies Secondary Party acknowledges

10. MISCELLANEOUS PROVISIONS

Governing Law: This Inventory Document shall be governed by and construed in accordance with the laws of the jurisdiction where the decedent was domiciled at death.

Entire Agreement: This document, together with attached exhibits and schedules identified herein, constitutes the entire agreement between the parties with respect to the matters addressed and supersedes all prior statements and understandings, whether oral or written.

Severability: If any provision of this Inventory Document is determined to be invalid, illegal or unenforceable in any respect, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired.

Amendments and Waiver: No amendment, modification, or waiver of this instrument shall be effective unless in writing and signed by both parties. No waiver by either party of any breach or default shall be deemed a waiver of any subsequent breach or default.

Counterparts: This Inventory Document may be executed in counterparts, each of which shall be deemed an original, and such counterparts together shall constitute one and the same instrument.

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