Free Inventory of Conservator - West Virginia

IN THE CIRCUIT COURT OF _______________ COUNTY, WEST VIRGINIA
For Clerk's Use Only IN RE: ___________________________________________, DATE FILED: ____________________________________ A PROTECTED PERSON CASE NUMBER ___________ - G - __________

INVENTORY OF CONSERVATOR
[West Virginia Code: § 44A-3-8]

INSTRUCTIONS FOR COMPLETION OF REPORT
A. This form is a required submission under West Virginia Code: § 44A-3-8 and must be filed within ninety (90) days of the appointment of a conservator. The law requires that the inventory include, with reasonable detail, a listing of each item in the estate of the Protected Person, each item's approximate fair market value and the type and amount of any lien or encumbrance against such item. The conservator must include all items which come into the conservator's possession and all items the conservator knows are part of the Protected Person's estate. The inventory, and any subsequent amended inventories, must be filed with the Circuit Court Clerk. If the conservator discovers or comes into possession of any real or personal property of the Protected Person after the filing of this inventory, the conservator is required to file either an amended inventory including the property or the conservator must list such property, its value and any encumbrances against such property, in the next accounting required to be filed by the conservator under West Virginia Code: § 44A-3-9. Not later than fourteen (14) days following presentation of this inventory with the Circuit Court Clerk, the conservator must mail a copy of the inventory to each individual and entity receiving notice of the hearing on the petition to appoint the conservator in the manner specified by West Virginia Code: § 44A-2-6. If a fiduciary supervisor or commissioner has been appointed or is serving to oversee the conservator's reports and accountings, the conservator shall also file a copy of this inventory, and any amended inventory, with such fiduciary supervisor or commissioner. If you need additional space to list assets, attach additional pages as needed and identify the schedule supplemental for each item appearing on any attached page(s). Be sure you include the value of any such asset to the total value in the particular schedule.

B.

C.

D.

SCA-CG-916-1/ 6-00

Inventory of Conservator Page 1 of 6 Pages

Name of Protected Person: ___________________________________________

Court Case Number __________-G-___________

Name of Conservator: _________________________________________ Date of Appointment: ______________________________ This report is an [check any applicable category]: __________ initial inventory __________ amended inventory ___________________

Date of this inventory: _____________________ If this is an amended inventory, date of initial inventory:

SCHEDULE A: Describe any real estate, or any interest in any real estate. Provide a complete legal description of each parcel owned and the percentage of interest owned in each parcel.

ASSESSED VALUE

FAIR MARKET VALUE

TOTAL (enter total here and in Schedule H, Line 1)

SCHEDULE B: List items of tangible personal property of every kind in as much detail as is reasonable.

FAIR MARKET VALUE

TOTAL (enter total here and in Schedule H, Line 2)

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Inventory of Conservator Page 2 of 6 Pages

SCHEDULE C: List bonds and securities of every kind

FAIR MARKET VALUE

TOTAL (enter total here and in Schedule H, Line 3

SCHEDULE D: Corporate Stock of every kind NAME OF COMPANY CLOSELY HELD NUMBER OF SHARES MARKET VALUE PER SHARE TOTAL MARKET VALUE

TOTAL (enter total here and in Schedule H, Line 4)

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Inventory of Conservator Page 3 of 6 Pages

SCHEDULE E: Money, bank accounts, certificates of deposit, notes, accounts receivable.

FAIR MARKET VALUE

TOTAL (enter total here and in Schedule H, Line 5)

SCHEDULE F: List any other assets not mentioned above.

FAIR MARKET VALUE

TOTAL (enter total here and in Schedule H, Line 6)

SCHEDULE G: Liens and Encumbrances. Provide a complete list of any and all liens and encumbrances against any of the property listed in this inventory. NAME AND ADDRESS OF HOLDER OR BENEFICIAL OWNER OF LIEN OR ENCUMBRANCE ITEM OF PROPERTY AGAINST WHICH THE LIEN OR ENCUMBRANCE EXISTS BALANCE OF LIEN OR ENCUMBRANCE

TOTAL LIENS AND ENCUMBRANCES (enter total here and in Schedule H, Line 8) SCA-CG-916-4/ 6-00 Inventory of Conservator Page 4 of 6 Pages

SCHEDULE H: INVENTORY SUMMARY Line 1: Schedule A Total Line 2: Schedule B Total Line 3: Schedule C Total Line 4: Schedule D Total Line 5: Schedule E Total Line 6: Schedule F Total Line 7: Subtotal of all Assets (Total of Lines 1 through 6) Line 8: LESS Schedule G Total of all Liens and Encumbrances LINE 9: TOTAL INVENTORY (Line 7 minus Line 8)

SCHEDULE I - List of Valueless property the Conservator intends to abandon. [West Virginia Code: § 44A-38(a)] The within named conservator believes the following property of the Protected Person is valueless and, therefore, intends to abandon the same. [List with reasonable detail, each item of property believed to be valueless which you intend to abandon.] __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ [attach additional pages as needed]

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Inventory of Conservator Page 5 of 6 Pages

STATE OF ___________________________________

COUNTY OF ________________________________, to-wit:

I, ________________________________________________, the conservator named in this inventory, do hereby certify that the information provided in this INVENTORY OF CONSERVATOR, including any additional pages annexed hereto, is true, correct and complete to the best of my knowledge, information and belief. I further certify that I have conducted a diligent effort to ascertain the real and personal property of the estate of the above named Protected Person and that I have made answers to each of the questions and schedules of this inventory as required by law and believe the answers contained herein to be correct and that the foregoing is a complete and true inventory of ALL of the real and personal property of the Protected Person. Given under my hand this ________ day of _______________________________, 20 ___________.

_________________________________________________________ CONSERVATOR'S SIGNATURE

The foregoing was taken, sworn and subscribed to before me this ________ day of ______________________, 20 ______.

[AFFIX NOTARIAL SEAL]

_________________________________________________________ NOTARY PUBLIC My Commission Expires: _________________________________________.

SCA-CG-916-6/ 6-00

Inventory of Conservator Page 6 of 6 Pages