Fill and Sign the New Hampshire Inventory of Fiduciary Form

NHJB-2125-P (01/01/2014) Page 1 of 3 THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) INVENTORY OF FIDUCIARY Executor/Administrator Guardian/Conservator Trustee Original Amended (Attach written explanation) 1. Fiduciary Name Fiduciary Name 2. Attorney name Bar ID # 3. BOND AMOUNT ORDERED BY THE COURT $ 4. Answer the following questions only if processing the estate of a deceased person. If you have an attorney, have attorney fee arrangements been discussed? Yes No Have fiduciary fee arrangements been considered? Yes No 5. ESTATE SUMMARY For decedent estates, all values should be as of the date of death. For all other case types, values should be as of the date of the fiduciary’s appointment. A. TOTAL VALUE OF R EAL ESTATE ..................................................... $ On a sheet of paper (Attachment A), list each piece of real estate including its street address, city/town where real estate is located, county where deed is recorded, book and page of deed, and the value of each piece of real estate. B. TOTAL VALUE OF PERSONAL ESTATE ( from total on second page) ...... $ C. TOTAL VALUE OF ENTIRE ESTATE (Add A and B above) ..................... $ 6. PERSONAL ESTATE DETAIL Enter the total value of the personal property for each catego ry below, and list the specific items and their value for each category on the appropriate attachment. For decedent estates, all values should be as of the date of death. For all other case types, values should be as of the date of the fiduciary’s appointment. A. Cash On Hand (No attachment is required.) .............................................. $ B. Attachment B – Household Furnishings and Effects ............................ $ On a sheet of paper (Attachment B), list the contents of the household and their values. Do not list wearing apparel, Bibles, family pictures, photographs, or other personal trinkets of sentimental rather than intrinsic value. Case Name: Case Number: INVENTORY OF FIDUCIARY NHJB-2125-P (01/01/2014) Page 2 of 3 C. Attachment C – Other Tangible Personal Property .............................. $ On a sheet of paper (Attachment C), list all other tangible personal property including motor or recreational vehicles, farmers' utensils, mechanics tools and livestock. For each motor or recreational vehicle, list the year, make, model and vehicle identification number (VIN). D. Attachment D – St ocks and Bonds ...................................................... $ On a sheet of paper (Attachment D), list stock or bond name, number of shares and value per share. See additional information in the ‘Personal Estate Detail’ box above. E. Attachment E – Deposited in Banks/Financial Institut ions ................... $ On a sheet of paper (Attachment E), list the name and address of the bank or financial institution, the account or ce rtificate number, the date of the last interest/dividend paid and the account balance. F. Attachment F – Business Assets ......................................................... $ On a sheet of paper (Attachment F), lis t all business assets and their values. G. Attachment G – Notes Receivable and Other Written Evidence of Debt Owed to the Deceased or Ward ........................................................... $ On a sheet of paper (Attachment G), list debtor and/or payor, the amount owed, the date of the note and terms of payment. H. Attachment H– Other Miscellane ous Personal Property ...................... $ On a sheet of paper (Attachment H), list any personal property not listed above and the individual values.) TOTAL VALUE OF PERSONAL ESTATE ..................................................... $ Add amounts on lines 6A through 6H (Cash on Hand plus Attachments B through H). Copy the ‘total value of personal estate’ am ount to page 1, line 5B of the Estate Summary. 7. The inventory value was determined by: (check all applicable boxes) appraisal tax information bank statement other source 8. This section must be completed by the fiduciary completing the form. I/We, the fiduciary, of the estate of , swear that I/we have acted faithfully, impartially and according to my best judgment. I believe that if I have knowledge or possession of any further estate of the deceased, I will immediately amend my inventory. I swear that the foregoing information is true and correct to the best of my knowledge. I understand that making a false statement on this Inventory will subject me to criminal penalties. Case Name: Case Number: INVENTORY OF FIDUCIARY NHJB-2125-P (01/01/2014) Page 3 of 3 I certify that on this date I provided this document(s) to the parties who have filed an appearance for this case or who are otherwise interested parties by: Hand-delivery OR US Mail OR Email (E-mail only by prior agreement of the parties based on Circuit Court Administrative Order) . Date Fiduciary Signature Date Fiduciary Signature ATTENTION BENEFICIALLY INTERESTED PARTIES This Inventory may be accepted by the Probate Division unless a written objection, containing the specific factual or legal basis for the objection, is filed within 10 days after the date the Inventory is filed in the Probate Division. Failur e to file an objection may forfeit your right to a hearing concerning the Inventory or your objection, and the Probate Division may then act w\ ithout a hearing or any further notice to you.