Free Form 3 - Iowa

February 2002

PROBATE PROCEDURE

Ch 7, p.5

Rule 7.11 - Form 3: Initial Report of Conservator and Inventory. rar 002 IN THE IOWA DISTRICT COURT FOR _________________________ COUNTY IN THE MATTER OF THE CONSERVATORSHIP OF _____________________________________ Probate No. ________________________ INITIAL REPORT OF CONSERVATOR AND INVENTORY

The undersigned duly appointed and qualified conservator states as follows: 1. The ward's real and personal property as of the date your conservator was appointed and the valuation of each item is itemized on the schedules attached hereto, and a summary of such schedules is as follows: Conservatorship Assets (Attach Descriptions) A. Real Estate B. Stocks and Bonds C. Mortgages, Notes, Deposits and Cash D. Life Insurance E. Jointly Owned Property F. Miscellaneous Property TOTAL OF ALL SCHEDULES 2.
Total Value

$_____________ $_____________ $_____________ $_____________ $_____________ $_____________ $_____________

3.

4.

5. 6.

The ward resides at: ______________________________________________________________________ Street City State Zip and (check one): ____ A. Does not have a guardian. ____ B. Has a natural guardian whose name is: ________________________________________________ and whose address is: ________________________________________________________________ Street City State Zip C. Has a court-appointed guardian whose name is: _________________________________________ and whose address is: ________________________________________________________________ Street City State Zip Your conservator (has) (hasnot) established a (noninterestbearing) (interestbearing) conservatorship checking account at _____________________________________________________________________ Name of Financial Institution located at______________________________________________________________________________ Street City State Zip The account number is: ___________________________________________________________________. A conservatorship savings account (has) (hasnot) been established at: ______________________________________________________________________________________ Name of Financial Institution located at______________________________________________________________________________ Street City State Zip The account number is: ___________________________________________________________________. Other assets (have) (have not) been changed into conservatorship's name. The ward's sources of income and monthly or annual amounts are: __________________________________________________ Conservator __________________________________________________ Address __________________________________________________ Telephone Number

6

Ch 7, p.6

PROBATE PROCEDURE

February 2002

Initial Report of Conservator and Inventory (cont'd)

I certify under penalty of perjury and pursuant to the laws of the State of Iowa that the preceding is true and correct. ___________________________________ Date __________________________________________________ Conservator __________________________________________________ Address (NOTE: Bank statements, checks, receipts, stubs and other items evidencing receipt of funds and payment must be available to the court on demand.)

[Court Order November 15, 1984, effective December 10, 1984; December 4, 1984, effective December 10, 1984; Report November 9, 2001, effective February 15, 2002]