Free Inventory and Appraisement of Estate - Kentucky

AOC-841 Doc. Code: INV Rev. 5-04 01/9/2007 11:46 am Page 1 of 2 Ver. 1.01 Commonwealth of Kentucky Court of Justice www.kycourts.net KRS 395.250

Case No. Court INVENTORY AND APPRAISEMENT OF ESTATE County District Probate

IN RE: Estate of __________________________________________________________________________________ Decedent's Date of Death: ___________________ Decedent's SSN: _____________________

Description of Assets

Estimated Value

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AOC-841 Rev. 5-04 Page 2 of 2 Description of Assets Estimated Value

Total Estimated Value:

0.00 $__________________

I submit the foregoing as the Inventory of the above-named Decedent's estate; which Inventory was made on _______________, 2_____. _________________________________________________________ Signature of Executor / Executrix or Administrator / Administratrix Subscribed and sworn before me on ______________, 2____. My commission expires: ______________, 2____. ______________________________________________ Name/Title Attorney's Signature: ___________________________________________________ Phone No.: ___________________ Attorney Name (Printed): ______________________________________________________________________________ Address: ______________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________

CLERK'S CERTIFICATE The foregoing Inventory having been returned to me in duplicate, the original is now filed in my office and the duplicate mailed to the Commissioner of Revenue, Commonwealth of Kentucky this on_____________, 2_____. _________________________________________ Clerk By: ______________________________________ D.C.

Distribution:

Court File (original)

Revenue Cabinet

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