RULE 5.910. INVENTORY

RULE 5.910. INVENTORY

Judicial Circuit, in and for

County, Florida

Probate Division Case No.

Judge:

Amended Form? Yes* No *If yes, version of the Amended Form:

In Re: Guardianship of

INITIAL INVENTORY

Date of letters of guardianship:

Property guardianship type:

SUMMARY

Section A: Value of Real Property Assets

$

Section B: Cash Assets/Cash Equivalent Assets

$

Section C: Intangible Assets/Stocks/Bonds

$

Section D: Tangible Personal Property

$

Section E: Debts/Encumbrances/Liabilities/Liens

$

Total

$

Section A: Real Property Assets

Do you have entries for Section A? Yes No

Number Description and Address

Full Value Is There Another Owner? Yes or No

1.

2.

3.

Total for Section A

$

Attach a copy of the property appraiser’s information or a copy of the deed for all real property.

Section B: Cash Assets/Cash Equivalent Assets (checking account, savings account, money market account, certificate of deposit (CD))

Do you have entries for Section B? Yes No

Are any of the entries held in a depository account?

Yes No

Number Institution Name

Last 4 Digits of Account Number

Type of Asset

Full Value

Is There Another Owner? Yes or No

Is this a Depository Account? Yes or No

1.

2.

3.

Total for Section B

$

Attach a copy of the institution’s statement for each account from the creation date of the guardianship.

Section C: Intangible Assets/Stocks/Bonds

Do you have entries for Section C? Yes No

Are any of the entries held in a depository account?

Yes No

Number Issuer Name and Address

Type of Asset

Full Value Last 4 Digits of Account Number

Is There Another Owner? Yes or No

1.

2.

3.

Total for Section C

$

Attach a copy of the institution’s statement for each account from the creation date of the guardianship.

Section D: Tangible Personal Property Assets (motor vehicles, jewelry, household furnishings, collectibles, fine art)

Do you have entries for Section D? Yes No

Number Description and Location

Full Value Is There Another Owner? Yes or No

1.

2.

3.

Total for Section D

$

Attach a copy of the title for any motor vehicle.

Section E: Debts/Encumbrances/Liens/Liabilities

Do you have entries for Section E? Yes No

Instructions: List each liability equal to or greater than $1,000.

Number Creditor Full Amount of Liability

Last 4 Digits of Account Number

Is there Another Person who Owes on the Debt? Yes or No

1.

2.

3.

Total for Section E

$

A copy of documents detailing each listed liability.

Section F: Sources of Income

Do you have entries for Section F? Yes No

Number Type Payor Estimated Monthly Amount

1.

2.

3.

Total for Section F

$

Is the guardian the representative payee of Social Security benefits? Yes No

If no, who is the representative payee for the Social Security benefits?

Section G: Lawsuits Against the Ward

Do you have entries for Section G? Yes No

Number Description of Lawsuit or Claim

Estimated Amount of Claim

Court Address

Plaintiff’s Name and Address

Describe Cause of Action

Date of Debt Occurrence

1.

2.

3.

Section H: Pending Litigation and/or Lawsuits the Ward May Bring if Court Approval Is Received

Do you have entries for Section H? Yes No

Number Description of Lawsuit or Claims

Case Number and Court Address

Defendant Name and Address

Describe Cause of Action

Attorney for Ward

1.

2.

3.

Section I: Assets the Ward, as of the Date of the Letters of Guardianship, Was Entitled to Receive, but Has Not Received

Do you have entries for Section I?

Yes No

Instructions: If the guardian has knowledge of assets the ward was entitled to receive as of the date of letters, but were not received the assets should be listed here. Examples: insurance policies, benefits, inheritance, or settlements from litigation.

Number Description Estimated Date of Receipt

Estimated Amount

1.

2.

3.

Section J: Trusts

Do you have entries for Section J? Yes No

Number Name of Current Trustee and Address

Ward’s Interest

Estimated Date Trust was Created

Value of the Ward’s Interest in the Trust

1.

2.

3.

Section K. Safe-Deposit Box

Does the ward lease a safe-deposit box? Yes No

If yes, location and number of safe-deposit box:

Does the ward lease a safe-deposit box with another individual or individuals?

Yes No

Who is the joint lessee with the ward?

Was an inventory of the safe-deposit box filed with the court as required by section 744.365, Florida Statutes? Yes No

Has the safe-deposit box been opened?

Yes No

[A certificate of service as required by Florida Rule of Judicial Administration 2.516 must be included if the incapacitated person is not a minor under 14 years of age and is not totally incapacitated.]

I certify that the foregoing document has been furnished to .....(name, address used for service, mailing address, and e-mail address)..... by .....(e- mail) (delivery) (mail) (fax)..... on .....(date)…...

Guardian’s Signature Guardian’s Printed Name:

Guardian’s Address:

Guardian’s Phone Number:

Guardian’s E-mail Address: