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IN THE PROBATE COURT OF SHELBY COUNTY, TENNESSEE IN RE: ____________________________________________ No. ___________________________ INVENTORY The undersigned, being first duly sworn, reports to the Court that the following assets have come into his or her hands, and the undersigned further certifies that a copy of this inventory shall be promptly furnished on all interested parties: STATE OF TENNESSEE COUNTY OF SHELBY I do solemnly swear or affirm that the above and foregoing is a full, true and complete inventory of the assets of this Estate which have come into my possession or for which I am chargeable, to the best of my knowledge, information and belief. This ________ day of ____________________, 20 _____. _____________________________________________________________ SIGNATURE Subscribed and sworn to before me this _________ day of ___________________, 20 _____. _____________________________________________________________ NOTARY PUBLIC/CLERK OF COURT PROBATE_07_MAR00