Inventory {MPC 854}

Docket No. INVENTORY Estate of: Conservatorship of: Other: Commonwealth of Massachusetts The Trial Court Probate and Family Court Division After completing attached Schedules of Personal Property and Real Estate, insert the total from each Schedule on the line below. I am the Conservator who is Temporary Permanent Personal Representative Special Personal Representative Public Administrator Receiver Other: appointed on accurate report of the estate's personal property and real estate. FOR CONSERVATORSHIPS I have delivered a copy of this Inventory by delivery in hand first class mail postage prepaid to the Protected Person (if over 14) and to any parent or guardian who lives with the Protected Person (date) and I certify that this Inventory contains a complete and SUMMARY OF ATTACHED SCHEDULES (If you are completing this on-line, the totals will auto-fill.) SCHEDULE OF PERSONAL PROPERTY: SCHEDULE OF REAL ESTATE: TOTALS SIGNED UNDER THE PENALTIES OF PERJURY I certify under the penalties of perjury that the foregoing statements are true to the best of my knowledge and belief. Date: Signature of Fiduciary Date: Signature of Co-Fiduciary (if applicable) Information on Attorney for Fiduciary Signature of Attorney (Print name) (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Primary Phone #: B.B.O. # Email: MPC 854 (3/19/12) American LegalNet, Inc. www.FormsWorkFlow.com page 1 of 3 SCHEDULE OF PERSONAL PROPERTY Item No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Total Account and Number Description of Personal Property Value Note: LIST CURRENT BALANCE (IF ANY) OF ANY LOAN OR LIEN ON EACH ITEM. If necessary, attach additional pages and continue with Item No. 15 etc. until completed. Enter total values of all Personal Property items above, and insert same amount on "Schedule of Personal Property" line on front page of this Inventory. MPC 854 (3/19/12) American LegalNet, Inc. www.FormsWorkFlow.com page 2 of 3 SCHEDULE OF REAL ESTATE Item No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Total Note: INCLUDE THE STREET ADDRESS, TITLE REFERENCE, AND CURRENT BALANCE (IF ANY) OF ANY MORTGAGE OR LIEN FOR EACH ITEM OF REAL ESTATE. "Value" in the right column means fair market value without deduction for any mortgage or lien on the property. If necessary, attach additional pages, continuing with Item No. 15 etc. until completed. Enter total values of all Real Estate items above, and insert same amount on "Schedule of Real Estate" line on front page of this Inventory. Description of Real Estate Value MPC 854 (3/19/12) American LegalNet, Inc. www.FormsWorkFlow.com page 3 of 3