Supplemental Inventory {PC-10.4}

DATE FILEDFORCOURT USE ONLY List additional personal property for Estate:DESCRIPTION OF ASSETVALUE OF ASSET ($)TotalList additional personal property and real estate for Guardianship:DESCRIPTION OF ASSETVALUE OF ASSET ($)TotalName ofFiduciaryName of AppraiserSignatureof FiduciarySignature of AppraiserName ofFiduciaryName of AppraiserSignature of FiduciarySignature of AppraiserNotary:Name of NotaryStateCountyOn day of , 20the petitioner, known to me or proved through satisfactory evidence, signed Signature of Notary PublicDateCommission ID#Commission Expiration DateNotary Seal SUPPLEMENTAL INVENTORYRIGL 33-9-1PC-10.4 (Rev. 07/17) State of Rhode Island and Providence PlantationsProbate CourtPage 1 of 1 STATE OF RHODE ISLANDCounty ofEstate ofAlias PROBATE COURT OF THECity or Town of FIDUCIARY SIGN HERE SIGN HERE SIGN HERE SIGN HERE American LegalNet, Inc. www.FormsWorkFlow.com