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STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 20TH JUDICIAL CIRCUIT ST. CLAIR COUNTY- IN PROBATE ) In the Matter of the Estate of ) ) Case No. ____________________ ______________________________ ) ) INVENTORY The following is the _______________________________________________________ (original, amended to supplemental) inventory of the real and personal property of the ___________________________________that (Decendent, Minor or Disabled Person) has come to the knowledge of the legal representative of this estate and of any cause of action on which there is a right to sue: Item No. Description and Quality* The approximate value of personal estate at date of death is $__________________. The approximate annual income from real estate is $__________________________. The bond of the individual representative is $_____________ with __________________ ______________________________________________________________________________ (Corporate Surety, Individual Surety or Surety Waived) ____________________________________ Legal Representative Name_______________________________ Attorney for_________________________ Address_____________________________ City________________________________ Telephone___________________________ *See Ill. Rev. Stat. Chapter 3, Paragraph 172 for characterization as "good," "doubtful" or "desperate" American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT __________________________________________on oath states that the foregoing inventory is (Name and Capacity) complete and correct. ____________________________________ Signed and sworn to before me ________________________________, 20_______ __________________________________________ Notary Public American LegalNet, Inc. www.FormsWorkFlow.com