Estate Inventory Page 1 of 5 5/25/16

In the Circuit Court of Davidson County, Tennessee (Probate Division)

ESTATE INVENTORY

IN THE ESTATE OF:

DOCKET NO:

PERSONAL PROPERTY

Except as directed below, list all personal property of the Decedent of whatever kind. If the Decedent owned no interest in any category, place an “x” in the appropriate position in the column labeled “None.” If additional space is needed in any category, attach a separate sheet properly identified with the case name, case number, and the number of the category. If the Decedent was married, state whether the husband, wife, or both own the property by placing an “H,” “W” or “J” in the column labeled “Husband, Wife or Joint.”

If the property is being held for the Decedent by someone else, state that person’s name and address under “Description and Location of Property.”

TYPE OF PROPERTY

N O N E H

US

BA

ND

W

IFE

/ JO

INT

DESCRIPTION AND LOCATION OF PROPERTY (Continuation Sheets May Be Attached)

CURRENT ESTIMATED VALUE OF DECEDENT’S INTEREST IN PROPERTY,

WITHOUT DEDUCTING ANY ENCUMBRANCES

1. Cash on hand. __ __ $

2. Checking, savings or other __ __ $

financial accounts, certifi- __ __ $

cates of deposit or shares __ __ $

in banks, savings and loan, __ __ $

thrift, building and loan, and __ __ $

home-stead associations, __ __ $

or credit unions, brokerage __ __ $

houses or cooperatives. __ __ $

Please itemize each acct __ __ $

and give particulars. __ __ $

3. Security deposits with __ __ $

public utilities, telephone __ __ $

companies, landlords, __ __ $

and others. __ __ $

4. Household goods and __ __ $

furnishings, including __ __ $

audio, video, and __ __ $

computer equipment. __ __ $

5. Books; pictures and other __ __ $

art objects; antiques; __ __ $

stamp, coin, record, and __ __ $

other collectibles. __ __ $

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6. Safety deposit box. __ __ $

Please itemize contents. __ __ $

7. Furs and jewelry. Please __ __ $

itemize and give particulars. __ __ $

8. Firearms and sports, __ __ $

photographic, and other __ __ $

hobby equipment. __ __ $

9. Interests in insurance __ __ $

policies. Name insurance __ __ $

company of each policy __ __ $

and itemize surrender or __ __ $

refund value of each. __ __ $

10. Annuities. Itemize and __ __ $

name each issuer. __ __ $

11. Interests in IRA, ERISA, __ __ $

Keogh, or other pension __ __ $

or profit sharing plans. __ __ $

Please itemize. __ __ $

12. Stock and interests in __ __ $

incorporated and unin- __ __ $

corporated businesses. __ __ $

Please itemize. __ __ $

13. Interests in partnerships __ __ $

or joint ventures. Itemize. __ __ $

14. Government and __ __ $

corporate bonds and __ __ $

other negotiable and non- __ __ $

negotiable instruments. __ __ $

Please itemize. __ __ $

15. Accounts receivable. __ __ $

16. Alimony, maintenance, __ __ $

support, and property __ __ $

settlements to which the __ __ $

Decedent is or may be __ __ $

entitled. Give particulars. __ __ $

17. Other liquidated debts owed __ __ $

to Decedent, including tax __ __ $

refunds. Give particulars. __ __ $

18. Contingent and non- __ __ $

contingent interests in __ __ $

estate of a decedent, __ __ $

death benefit plan, life __ __ $

insurance policy, or trust. __ __ $

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19. Other contingent and __ __ $

unliquidated claims of __ __ $

every nature, including tax __ __ $

refunds, counterclaims of __ __ $

the Decedent, and rights to __ __ $

setoff claims. Give __ __ $

estimated value of each. __ __ $

20. Patents, copyrights, __ __ $

royalties, and other __ __ $

intellectual property. __ __ $

Give particulars. __ __ $

21. Licenses, franchises, and __ __ $

other general intangibles. __ __ $

Give particulars. __ __ $

22. Automobiles, trucks, __ __ $

trailers, and other __ __ $

vehicles and accessories. __ __ $

Please itemize. __ __ $

23. Boats, motors, __ __ $

and accessories. __ __ $

Please itemize. __ __ $

24. Aircraft and accessories. __ __ $

25. Office equipment, __ __ $

furnishings and supplies. __ __ $

26. Machinery, fixtures, __ __ $

equipment, inventory, and __ __ $

supplies used in business. __ __ $

27. Livestock. __ __ $

28. Crops – growing or __ __ $

harvested. Give particulars. __ __ $

29. Farming equipment __ __ $

and implements. __ __ $

30. Farm supplies, __ __ $

chemicals, and feed. __ __ $

31. Other personal property __ __ $

of any kind not already __ __ $

listed. Please itemize. __ __ $

___ continuation sheets attached. Total from attachments > $

TOTAL PERSONAL PROPERTY > $

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REAL PROPERTY

Except as directed below, list all real property in which the Decedent has any legal or equitable interest, including all property owned as a co-tenant or community property. If the Decedent was married, state whether the husband, wife, or both own the property by placing an “H,” “W” or “J” in the column labeled “Husband, Wife or Joint.” If the Decedent held no interest in real property, write “None” under “Description and Address of Property.”

DESCRIPTION AND ADDRESS OF PROPERTY

LIENHOLDER (if applicable)

HU

SB

AN

D

WIF

E /

JOIN

T CURRENT VALUE OF

DECEDENT’S INTEREST IN PROPERTY, WITHOUT

DEDUCTING ANY ENCUMBRANCES

1. $

2. $

3. $

4. $

5. $

6. $

7. $

8. $

9. $

TOTAL REAL PROPERTY > $

The foregoing is a full, true and perfect Inventory of all of the goods and chattels, rights and credits of this Estate which have

come to my knowledge or possession to the best of my knowledge and belief, this ____ day of ______________, 20____.

Signature of PERSONAL REPRESENTATIVE Sworn to and subscribed before me, this _________

day of , 20______.

NOTARY PUBLIC My Commission Expires:

RICHARD R. ROOKER, Clerk By: D.C.

APPROVED FOR RECORDING

By: Probate Judge / Probate Master

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CERTIFICATE OF SERVICE

[YOU MUST MAIL A COPY OF THIS ENTIRE DOCUMENT TO ALL INTERESTED PARTIES AND COMPLETE THIS CERTIFICATE VERIFYING THE DATE MAILED AND PARTIES IT WAS MAILED TO.]

I hereby certify that a true and exact copy of the foregoing Inventory has been served by U.S.

Mail, postage prepaid, upon the interested parties listed below.

(SIGNATURE)

DATE:

NAME:

ADDRESS:

NAME:

ADDRESS:

NAME:

ADDRESS:

NAME:

ADDRESS:

NAME:

ADDRESS:

NAME:

ADDRESS:

NAME:

ADDRESS:

NAME:

ADDRESS:

[ADD ADDITIONAL PAGE(S) FOR LISTING OF INTERESTED PARTIES, IF NECESSARY]