Free STATE OF MINNESOTA - Minnesota

M.S. § 524.5-419

State of Minnesota County of __________________

District Court ________________ Judicial District Probate / Mental Health Division Court File No. ___________________ Case Type: 14, Conservatorship

In Re: Conservatorship of

INVENTORY
______________________________, Protected Person Date of Appointment: _______________

The Inventory is summarized on these pages. Pursuant to General Rule of Practice for District Courts, Rule 11, restricted identifiers and financial source documents are confidential. See Forms 11.1 and 11.2. Do not list financial account numbers or social security numbers on this form. List such information on Form 11.1. CLASS I PROPERTY: Real Estate Real Estate Specify plat or survey description. Specify encumbrances, liens, etc., and respective sums for each. a. Homestead: located in the County of ______________; Legally described as:

Amount

Total

b. Non-homestead real property: located in the County of ___________, legally described as:

Total Class I Property: Real Estate

GAC 13

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www.courts.state.mn.us/forms

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M.S. § 524.5-419

CLASS II PROPERTY: Personal Property a. Furniture and Household Goods (attach statement if needed) 1. 2. 3. 4. a. Total Furniture, Fixtures and Household Goods: b. Wearing Apparel (attach statement if needed) 1. 2. 3. 4. b. Total Wearing Apparel: c. Corporate Stocks (attach statement if needed)
Corporate name, number of shares and value per share

Amount

Total

Amount

Total

Amount

Total

1. 2. 3. 4. c. Total Corporate Stock: d. Bank Accounts ­ Certificates of Deposit (attach statement if needed)
Specify Institutions and Balances ­ List Account Numbers on Confidential Form 11.1

Amount

Total

1. 2. 3. 4. d. Total Bank Accounts and Certificates of Deposit: Other Personal Property (attach statement if needed) 1. Attach statement if needed 2. 3. 4. e. Total Other Personal property: Amount Total

Total Class II Property: Personal Property
Subtotal of Class II items: a, b, c, d and e (List this amount on Line 1 of the First Annual Account, Form 14)

GAC 13

State

ENG

Rev 3/06-D

www.courts.state.mn.us/forms

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M.S. § 524.5-419

Total Real and Personal Property
Total Class I Property: Real Estate Total Class II Property: Personal Property

Total Class I and Class II Property
STATE OF MINNESOTA COUNTY OF ___________ ______________________________ being duly sworn/affirmed hereby swears that s/he is the conservator of the estate for the above-entitled protected person, that s/he has read the inventory and knows its contents, including the confidential provisions herein, that the same is a true and correct Inventory of the protected person's estate that has come into the conservator's possession, and that s/he has given notice of the filing of this inventory, together with a copy of the inventory, to the protected person.

Dated:_____________, 20___

_________________________________ Signature of Conservator Name: ___________________________ Address: ___________________________ ___________________________ ___________________________ Telephone: ___________________________

Subscribed and Sworn to before me this ___________, 20___. _________________________________ Signature of Notary Name of Petitioner's Attorney: Name: ___________________________ License No.: ___________________________ Address: ___________________________ ___________________________ ___________________________ Telephone: ___________________________

GAC 13

State

ENG

Rev 3/06-D

www.courts.state.mn.us/forms

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Gen.Rul.Prac.Dist.Ct. Rule 11

State of Minnesota County of _______________

District Court ________________ Judicial District Probate / Mental Health Division Court File No. ___________ Case Type: 14, Conservatorship

In Re: Conservatorship of ______________, Protected Person

CONSERVATORSHIP INVENTORY FINANCIAL SOURCE DOCUMENTS FORM 11.2
(Provided in Accordance With Rule 11 of the Minnesota General Rules of Practice)

THIS LISTING OF SEALED FINANCIAL SOURCE DOCUMENTS IS ACCESSIBLE TO THE PUBLIC BUT THE SOURCE DOCUMENTS SHALL NOT BE ACCESSIBLE TO THE PUBLIC EXCEPT AS AUTHORIZED BY COURT RULE OR ORDER Bank statements Periods covered: Credit card statement Periods covered: Verification of Funds on Deposit Verification of Stocks and Other Securities Other: _______________________________

Information supplied by: ______________________________________ Dated: ____________ Name of Petitioner's Attorney: Name: _____________________ License No.: _____________________ Address: _____________________ _____________________ City/State/Zip: _____________________ Telephone: _____________________

11.2-C

State

ENG

Rev 3/06-D

www.courts.state.mn.us/forms

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Gen.Rul.Prac.Dist.Ct. Rule 11

State of Minnesota County of _______________

District Court ________________ Judicial District Probate / Mental Health Division Court File No. ___________ Case Type: 14, Conservatorship

In Re: Conservatorship of ______________, Protected Person The information on this form is confidential and shall not be placed in a publicly accessible portion of a file.

CONSERVATORSHIP INVENTORY CONFIDENTIAL INFORMATION FORM 11.1
(Provided in Accordance With Rule 11 of the Minnesota General Rules of Practice)

SOCIAL SECURITY NUMBER NAME BANK ACCOUNT NUMBERS OTHER FINANCIAL ACCOUNT NUMBERS 1. 2. 3. 4. 5. 6. 7. 8. 9. ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________

10. ______________________________________ 11. ______________________________________ 12. ______________________________________ * Add supplemental information if needed

Information supplied by: ______________________________________ Dated: ____________ Name of Petitioner's Attorney: Name: _____________________ License No.: _____________________ Address: _____________________ _____________________ City/State/Zip: _____________________ Telephone: _____________________

11.1-C

State

ENG

Rev 3/06-D

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