Free Superior Court of the District of Columbia - District of Columbia

Superior Court of the District of Columbia
PROBATE DIVISION In Re: _________________________ GDN. ______________ TRP. ______________ CON. ______________ INT. ______________ IDD. _____________ INVENTORY REPORT The report of ____________________________________________________________, Guardian, Conservator, Committee, Trustee, Receiver (strike all except one) who qualified as such on the ________ day of ________________, ________, respectfully shows that the estate consists of the following: REAL ESTATE LOCATION AND DESCRIPTION $
Assessed Value Encumbrances (Mortgages, etc.) Market Value (if known)

$

$

COLUMN TOTALS

$

$

$

BANK DEPOSITS AND OTHER MONEY
Account No. Amount Deposited In (Name of Depository) In Name of (Registration on Account)

$

TOTAL $

NOTES SECURED BY MORTGAGE OR DEED OF TRUST ON REAL ESTATE (Do Not Include Encumbrances Listed Under Real Estate Above)
Location and Description of Property Amount (Balance Due) Interest Rate Maker's Name and Name of Present Payor Maturity (Month, Day and Year)

Terms of Repayment

TOTAL $

STOCKS (LIST EACH CERTIFICATE SERAPATELY)
Class (common, preferred) Shares Name of Company Certificate Nos. Issued Date Carrying Value Fair Market Value

$

$

TOTALS

$

$

BONDS
Issued by (Name of Company or Agency Issue Purchase of Maturity Date Int. Rate Carrying Value Fair Market Value

Certificate Nos.

Face Value

$

$

$

TOTALS

$

$

$

OTHER SECURITIES (LIST EACH SEPARATELY AND IN DETAIL)

The foregoing securities are kept or deposited at ______________________________________
(Explain fully)

______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ in the name of __________________________________________________________________

AUTOMOBILES, JEWELRY, HOUSEHOLD EFFECTS AND ALL OTHER PERSONAL ASSETS

Attach additional page(s) if necessary The penalty of my undertaking is $ ___________________ It was filed on the ________ day of ___________________________________, __________ The surety is ________________________________________________________________ When the undertaking was filed, the value of the estate was $ ___________________

I/We ______________________________________________________________________
(Type or print plainly)

______________________________________________________________________________ do swear that I/we have read the foregoing report signed by me/us and know the contents thereof, and that the facts therein stated are true.

____________________________________ Signature ____________________________________ Full address: ____________________________________ ____________________________________ Subscribed and sworn to before me this _________ day of _____________________, ________

DEPUTY REGISTER OF WILLS/NOTARY PUBLIC