Fill and Sign the Itemize and Give Values as of Date of Decedents Death Form

INVENTORY FOR DECEDENT’S ESTATE G.S. 28A-15-2, 28A-20-1 Name Of Decedent File No. In The General Court Of Justice Superior Court DivisionBefore The Clerk IN THE MATTER OF THE ESTATE OF: IMPORTANT: File within three (3) months after qualifying. Itemize and give values as of date of decedent’s death. Continue on additional sheet if necessary. I, the undersigned personal representative, being duly sworn, say that to the best of my knowledge the following is a just, true, and perfect inventory of all the real and personal property of the decedent named above, which has come into my hands or into the hands of any person for me as personal representative of the estate. 1. Accounts In Sole Name Of Decedent (List bank, etc., each account no., and balance.) 2. Joint Accounts Without Right Of Survivorship (List bank, etc., each account no., balance, and joint owners.) 4. Cash And Undeposited Checks On Hand 3. Stocks And Bonds In Sole Name Of Decedent Or Jointly Owned Without Right Of Survivorship (Identify each type of security and give market value of all securities of that type, e.g., 100 shares of XYZ Corp. common stock at 37-1/4...$3,725.) 5. All Other Personal Property (See preliminary inventory on application for checklist of types of property to list.) 6. Real Estate Willed To The Estate, Directed By The Will To Be Sold, And Sold (Attach legal description and proceeds of sale for each parcel.) 7. Real Estate Willed To The Estate, Directed By The Will To Be Sold, And Not Sold (Attach legal description of each parcel and give fair market value at date of death.) % Owned By Decedent % Owned By Decedent % Owned By Decedent % Owned By Decedent % Owned By Decedent % Owned By Decedent % Owned By Decedent % Owned By Decedent% Owned By Decedent VALUE $ $ $ $ $ (Over) PART I. PROPERTY OF THE ESTATE TOTAL FROM ADDITIONAL SHEET IF ANY SUBTOTAL (Costs apply to this total) TOTAL PART I. STATE OF NORTH CAROLINA County AOC-E-505, Rev. 2/15 © 2015 Administrative Of�ce of the Courts 1. Joint Accounts With Right Of Survivorship (List each account; give names of other joint owners and total amount on deposit in each account; attach copy of deposit contract unless already attached to application.) 2. Stocks/Bonds/Securities Jointly Owned With Right Of Survivorship Or Registered In Bene�ciary Form And Automatically Transferable On Death (Identify each type of security and give market value of all securities of that type, e.g., 100 shares of XYZ Corp. common stock at 37-1/4...$3,725.) 4. Real Estate Except Entireties Property, Life Estate And Real Estate Willed To Estate (List legal description and give fair market value of each parcel of decedent’s interest at date of death.) 3. Other Personal Property Recoverable (G.S. 28A-15-10) VALUE $ PART II. PROPERTY WHICH CAN BE ADDED TO ESTATE IF NEEDED TO PAY CLAIMS $ TOTAL PART II. PART III. CLAIMS FOR WRONGFUL DEATH There is is not a potential claim for wrongful death arising under G.S. 28A-18.2. The following attorney, if any, has been retained to �le the action, and the civil action, if any, has been �led in the following court or jurisdiction: Telephone No. Signature Of Fiduciary Title Title Name And Address Of Attorney Case No.Signature Of Co-Fiduciary, If Any State And County Or Federal District Court Jurisdiction Date My Commission Expires Date My Commission Expires County Where Notarized County Where Notarized Date Date Signature Of Person Authorized To Administer Oaths Signature Of Person Authorized To Administer Oaths Notary Notary Deputy CSC Deputy CSC Assistant CSC Assistant CSC Clerk Of Superior Court Clerk Of Superior Court SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME SEAL SEAL AOC-E-505, Side Two, Rev. 2/15 © 2015 Administrative Of�ce of the Courts