1 1 1 1 1 1 1 1 0 1 Name Address City, State, Zip Code Telephone number IN PROPER PERSON IN THE TH JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA In the Matter of the Guardianship of the: Estate Person and Estate of:, An Adult. IN AND FOR THE COUNTY OF CLARK Case No. Dept. No. INVENTORY, APPRAISAL AND RECORD OF VALUE I. RECORD OF VALUE *Describe the nature of the Estate s interest and percent of ownership; use (C for Community Property and (S for Separate Property. For example, 0% (C or (S. A. REAL PROPERTY Description 1 1...... 1 a Asset b Amount Owed (mortgage, lien, loan c Net Asset [a - b = c] d Estate s (% owned e of Estate s Real property is real estate, whether it is undeveloped land or developed commercial, industrial, or residential land. The County assessed value is acceptable until the property is to be sold. Page 1 of
B. PERSONAL PROPERTY Cash and Deposits, Checking and Savings Accounts, other Accounts (List..... 1. a Asset b Amount Owed (mortgage, lien, loan c Net Asset [a - b = c] d Estate s (% owned e of Estate s 1 1 1 1 1 1 Other, Etc. (Describe 1. 1. Notes, Bonds, Securities, Debts, Etc. (List Name & Address of Debtor, Date Debt Originated, Endorsement W/Date, Estate As To Amount Collectible 1. 1. 1. 1. 1 1 0 1 Vehicles (Describe 1. 0. 1. Miscellaneous Personal Property (Describe.... TOTAL ESTATE VALUE s in partnerships, LLCs, corporations, joint ventures, trusts, etc. Book value may be acceptable to the Court until the interest is to be sold, disposed or transferred. The Guardian may need to petition for instructions from the Court on how the value of the Ward s interest is to be listed on this document. Additional items to be listed in this category are: deeds of trust, rents, royalties, life insurance policies with cash values. This category includes household items, collectibles and antiques. If the aggregate (total replacement value exceeds $,000.00 an appraisal is required. Page of
1 1 1 1 1 1 1 1 0 1 VERIFIED RECORD OF VALUE IN LIEU OF APPRAISEMENT STATE OF ss: COUNTY OF I,, the undersigned solemnly affirm(s Items listed in section I.RECORD OF VALUE of this Inventory, Appraisal and Record of of the Estate has been examined by me/us and I/we have written the value of these items on the Inventory, Appraisal and Record of at the value shown opposite thereof. I report that the total value of the items listed in this section of this Inventory, Appraisal and Record of value of (written out Dollars (. A. REAL PROPERTY Description 1...... B. PERSONAL PROPERTY Cash and Deposits, Checking and Savings Accounts, other Accounts (List.. 0. 1... II. APPRAISED INVENTORY a Asset b Amount Owed (mortgage, lien, loan (Guardian s Signature (Co-Guardian s Signature; if any c Net Asset [a - b = c] d Estate s (% owned e of Estate s Other, Etc. (Describe.. Page of
1 1 1 1 1 1 1 1 0 1 OATH OF APPRAISER, CPA OR EXPERT IN VALUATIONS STATE OF ss: COUNTY OF I,, the undersigned Appraiser, CPA or expert in valuations solemnly affirm that I will truly, honestly, and impartially appraised the inventory of the Estate of the above-named Ward to the best of my knowledge and ability and the appraisal was completed in compliance with NRS 1.0. DATED this day of, 0. SUBSCRIBED and SWORN to before me this day of, 0. APPRAISAL I,, the undersigned Appraiser, CPA or expert in valuations hereby certify that the items listed in the Inventory, Appraisal and Record of under section II. Appraised Inventory have been personally examined by me or my authorized agent, and that I appraised these items at the value shown opposite thereof. I report that the value of the items listed in this section of the Inventory, Appraisal and Record of have a value of (written out Dollars (. DATED this day of, 0. (Appraiser s Signature (Appraiser s Name Printed (Street Address (City/State/Zip Code (Appraiser s Signature (Repeat Oath & Certification for Each Appraiser; Attach Separate Sheets if Necessary Page of
1 1 1 1 1 1 1 1 0 1 STATE OF ss: COUNTY OF OATH OF GUARDIAN I,, the undersigned Guardian of the Estate of the above-named Ward, solemnly affirm that the foregoing Inventory, Appraisal and Record of is a true statement of all assets of the Estate having come into my possession or for which I have knowledge, and the Inventory, Appraisal and Record of includes all money and claims of the Ward, including claims, if any, the Ward has against me. GUARDIAN SUBSCRIBED and SWORN to before me by this day of, 0. STATE OF ss: COUNTY OF VERIFICATION OF GUARDIAN I,, the above Guardian being duly sworn, state that I am the Guardian of the Estate of the above-named ward, have read the foregoing Inventory, Appraisement and Record of, know the contents thereof, and it is true to my own knowledge, except for those matters therein stated on information and belief, and as for those matters I believe them to be true. GUARDIAN SUBSCRIBED and SWORN to before me by this day of, 0. (Repeat Oath & Verification for Each Guardian; Attach Separate Sheets if Necessary Page of
1 1 1 1 1 1 1 1 0 1 STATE OF ss: COUNTY OF OATH OF CO-GUARDIAN I,, the undersigned Co-Guardian of the Estate of the above-named Ward, solemnly affirm that the foregoing Inventory, Appraisal and Record of is a true statement of all assets of the Estate having come into my possession or for which I have knowledge, and the Inventory, Appraisal and Record of includes all money and claims of the Ward, including claims, if any, the Ward has against me. CO-GUARDIAN SUBSCRIBED and SWORN to before me by this day of, 0. STATE OF ss: COUNTY OF VERIFICATION OF CO-GUARDIAN I,, the above Co-Guardian being duly sworn, state that I am the Co-Guardian of the Estate of the above-named ward, have read the foregoing Inventory, Appraisement and Record of, know the contents thereof, and it is true to my own knowledge, except for those matters therein stated on information and belief, and as for those matters I believe them to be true. CO-GUARDIAN SUBSCRIBED and SWORN to before me by this day of, 0. (Repeat Oath & Verification for Each Guardian; Attach Separate Sheets if Necessary Page of