IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE. Case No.

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1 Code: 10 Name: Address: Phone: Self-Represented Litigant IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA In the Matter of the Guardianship of The Person only The Estate only The Person and the Estate IN AND FOR THE COUNTY OF WASHOE, (Print the Name of Minor) A Minor. / Case No. Dept. No. INVENTORY, APPRAISAL AND RECORD OF VALUE Attached is the Inventory, Appraisal and Record of Value of the property of and the required Oaths of (Name of Minor) Appraiser and Guardian. 1 Rev 0/01 LWV/SSS 1

2 A. REAL PROPERTY Describe each piece of real property (house or real estate) the minor owns or in which the ward has any kind of interest. Include location and condition of real property Appraised Value: Amount Owed: $ $ 1 Estate s Interest:* % 1 Value of Estate s Interest: $ Appraised Value: $ Amount Owed: $ Estate s Interest: % Value of Estate s Interest: $ If there are additional pieces of real property, attach supplementary pages and clearly mark the pages as a continuation of this inventory. * Designate the percentage of ownership of the minor. Rev 0/01 LWV/SSS

3 B. BANK ACCOUNTS List the last four digits of each bank account number, type of account (savings, checking, money market, etc.), name of bank or other holding institution, location of bank, or other holding institute. List how the account is held, for instance is in minor s name only, or, jointly with (insert additional name), or, jointly with (insert additional name) with right of survivorship. Acct. # Type of Account: Name of Bank / Holding Institute: How Account is Held: Amount in the Account: $ Acct. # Type of Account: Name of Bank / Holding Institute: How Account is Held: Amount in the Account: $ Acct. # Type of Account: Name of Bank / Holding Institute: How Account is Held: Amount in the Account: $ If there are additional accounts, attach supplementary pages and clearly mark the pages as a continuation of this inventory. Rev 0/01 LWV/SSS

4 C. INCOME AND BENEFITS List ALL sources of income and benefits, the frequency such income and benefits are received (once a month, every two weeks, every six months, etc.), the gross amount and the net amount. Source of Income: Frequency Income is Received: Gross Amount: $ Net Amount: $ Source of Income: Frequency Income is Received: Gross Amount: $ Net Amount: $ Source of Income: Frequency Income is Received: Gross Amount: $ Net Amount: $ Source of Income: Frequency Income is Received: Gross Amount: $ Net Amount: $ 1 Source of Income: Frequency Income is Received: Gross Amount: $ Net Amount: $ If there is additional income or benefits, attach supplementary pages and clearly mark the pages as a continuation of this inventory. Rev 0/01 LWV/SSS

5 D. OUTSTANDING COLLECTIBLE DEBTS List all collectible debts the minor may own. Collectible debts are defined as money legally owed (by formal note or contract) to the minor by people or businesses and upon which there are no payments presently being made. If payments are presently being made on the notes or contracts, the payments must be listed in the Income portion of this inventory. Name of Person or Entity Owing: Amount Owed: $ Legal Document: (Promissory Note, Contract, etc.) Re-payment Provisions: Name of Person or Entity Owing: Amount Owed: $ Legal Document: (Promissory Note, Contract, etc.) Re-payment Provisions: Name of Person or Entity Owing: Amount Owed: $ Legal Document: (Promissory Note, Contract, etc.) Re-payment Provisions: If there are additional accounts, attach supplementary pages and clearly mark the pages as a continuation of this inventory. Rev 0/01 LWV/SSS

6 E. VEHICLES List and describe each vehicle in which the minor has any interest, the VIN number, if known, the location of the vehicle, whether the vehicle is currently registered, in whose name the vehicle is registered and the value of the vehicle. Make and Model: Year: Color: VIN # Location: Currently Registered? ( ) Yes ( ) No Date of Last Registration: Name On Registration: Value: $ Amount Owed on Vehicle: $ If money is owed on vehicle, to whom is it owed? If minor s interest is less than 0%, how much interest does minor own? Make and Model: Year: Color: VIN # Location: 1 Currently Registered? ( ) Yes ( ) No Date of Last Registration: 0 1 Name On Registration: Value: $ Amount Owed on Vehicle: $ If money is owed on vehicle, to whom is it owed? If minor s interest is less than 0%, how much interest does minor own? If there are additional vehicles, attach supplementary pages and clearly mark the pages as a continuation of this inventory. Rev 0/01 LWV/SSS

7 *F. MISCELLANEOUS PERSONAL PROPERTY List and describe all other personal property owned by the minor or in which the minor has any interest. Asset Amount Estate s* Value of Description Value Owed Interest Estate s Of Property Interest $ $ % $ If there is additional property to be listed, attach supplementary pages and clearly mark the pages as a continuation of this inventory. * Designate the percentage of ownership of the minor. Rev 0/01 LWV/SSS

8 OATH OF GUARDIAN I/We, the undersigned guardian of the Estate of the above-named minor, solemnly affirm that the foregoing inventory is a true statement of all assets of the Estate having come into my possession or for which I/we have knowledge, and the inventory includes all money and claims of the minor. I/We declare, under penalty of perjury under the law of the State of Nevada, that I/we have read the foregoing document and am/are competent to testify of its contents of my/our own knowledge and the contents are true of my/our own knowledge except for those matters stated therein on information and belief, and, as to those matters, I/we believe them to be true Date: Date: Guardian One Signature: Print Your Name: Guardian Two Signature: Print Your Name: Rev 0/01 LWV/SSS

9 OATH OF APPRAISER Pursuant to NRS 1.0, I, the undersigned, appraiser of the estate of the above-named minor, solemnly affirm that I will truly, honestly, and impartially appraise the inventory of the Estate to the best of my knowledge and ability. 1 Appraiser s Signature Appraiser s Name (print) Appraiser s Address City, State, Zip Code APPRAISAL I, the undersigned appraiser of the Estate of the above-named minor, hereby certify that items of the Inventory of the Estate have been examined by me and that I appraise items on the Inventory at the value shown opposite thereof for a total sum of $. 0 1 Appraiser Date Each Appraiser must attach a separate Oath and Certification. Rev 0/01 LWV/SSS

10 VERIFIED RECORD OF VALUE IN LIEU OF APPRAISEMENT I/We, the undersigned solemnly affirm that items of the Inventory of the Estate have been examined by me/us and that I/we record the value of these items on the Inventory at the value shown opposite thereof for a total sum of $. I/We declare, under penalty of perjury under the law of the State of Nevada, that I/we have read the foregoing document and am/are competent to testify of its contents of my/our own knowledge and the contents are true of my/our own knowledge except for those matters stated therein on information and belief, and, as to those matters, I/we believe them to be true Date: Date: Guardian One Signature: Print Your Name: Guardian Two Signature: Print Your Name: Rev 0/01 LWV/SSS

11 Code: 0 Name: Address: Telephone: Self-Represented Litigant IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE In the Matter of the Guardianship of The Person only The Estate only The Person and the Estate, (Print Name of Minor) A Minor. / Case No. Dept. No It is requested that the REQUEST FOR SUBMISSION (Print the name of document to be submitted to the Court) 1 filed in this matter be submitted to the Court for consideration. This document does not contain the Social Security number of any person. I declare, under penalty of perjury under the law of the State of Nevada, that the foregoing is true and correct. Date: Your Signature: Print Your Name: REV 0/01 GS 1 Request for Submission Minor