Free Inventory, CC 16:2 - Nebraska

STATE OF NEBRASKA FORM NO. CC 16:2 3/91 rev. IN THE MATTER OF THE GUARDIANSHIP/CONSERVATORSHIP OF

INVENTORY

CASE NUMBER

INVENTORY
(Ward) 1. PERSONAL PROPERTY: Checking Accounts

Bank Name Account no. Bank Name Account no. Bank Name Account no. Bank Name Account no. Bank Name Account no. Bank Name Account no. Bank Name Account no. Bank Name Account no. Bank Name Account no.

$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TOTAL: $

Savings Accounts

Certificates of Deposit

Stocks and Bonds Vehicles Household goods and furnishings Other:

2. JOINTLY HELD PROPERTY: With whom What Continued $

With whom What TOTAL: 3. INCOME (Monthly): Social Security Supplemental Security Income Veterans Administration Benefits Company Pension Interest From where Dividends From where Other: TOTAL: 4. REAL PROPERTY (List location by address and value): $ $ $ $ $ $ $ $ $ $

STATE OF NEBRASKA COUNTY OF

) ) ss. )

The undersigned Conservator of this estate, on oath states that this inventory contains all property owned by the above-named ward as of the date below and that said inventory is complete and accurate so far as the undersigned is informed.

DATE:

GUARDIAN/CONSERVATOR: Subscribed and sworn to before me this day of , .

(Notary Public)