Rule 5.910 Inventory
Part V: Forms
Rule Text
__________________ Judicial Circuit,
in and for ____________________
County, Florida
Probate Division
Case No. ___________________________
Judge: _____________________________
Amended Form? ____ Yes* ____ No
*If yes, version of the Amended
Form: ______
In Re: Guardianship of
______________________________
______________________________ ______________________________
INITIAL INVENTORY
Date of letters of guardianship: ______________________________
Property guardianship type: ______________________________
______________________________
SUMMARY
Section A: Value of Real Property Assets $ __________
Section B: Cash Assets/Cash Equivalent Assets $ __________
Section C: Intangible Assets/Stocks/Bonds $ __________
Section D: Tangible Personal Property $ __________
Section E: Debts/Encumbrances/Liabilities/Liens $ __________
Total $ __________
______________________________
Section A: Real Property Assets
Do you have entries for Section A? ________ Yes _______ No
| Number | Description and Address | Full Value | Is There Another Owner? Yes or No |
| 1. | |||
| 2. | |||
| 3. |
Total for Section A $ __________
Attach a copy of the property appraiser’s information or a copy of the deed for all real property.
______________________________
Section B: Cash Assets/Cash Equivalent Assets (checking account, savings account, money market account, certificate of deposit (CD))
Do you have entries for Section B? ______ Yes _______ No
Are any of the entries held in a depository account? _________ Yes _______ No
| Number | Institution Name | Last 4 Digits of Account Number | Type of Asset | Full Value | Is There Another Owner? Yes or No | Is this a Depository Account? Yes or No |
| 1. | ||||||
| 2. | ||||||
| 3. |
Total for Section B $ __________
Attach a copy of the institution’s statement for each account from the creation date of the guardianship.
______________________________
Section C: Intangible Assets/Stocks/Bonds
Do you have entries for Section C? ________ Yes _______ No
Are any of the entries held in a depository account? _________ Yes _______ No
| Number | Issuer Name and Address | Type of Asset | Full Value | Last 4 Digits of Account Number | Is There Another Owner? Yes or No |
| 1. | |||||
| 2. | |||||
| 3. |
Total for Section C $ __________
Attach a copy of the institution’s statement for each account from the creation date of the guardianship.
______________________________
Section D: Tangible Personal Property Assets (motor vehicles, jewelry, household furnishings, collectibles, fine art)
Do you have entries for Section D? _______ Yes _______ No
| Number | Description and Location | Full Value | Is There Another Owner? Yes or No |
| 1. | |||
| 2. | |||
| 3. |
Total for Section D $ __________
Attach a copy of the title for any motor vehicle.
______________________________
Section E: Debts/Encumbrances/Liens/Liabilities
Do you have entries for Section E? ________ Yes _______ No
Instructions: List each liability equal to or greater than $1,000.
| Number | Creditor | Full Amount of Liability | Last 4 Digits of Account Number | Is there Another Person who Owes on the Debt? Yes or No |
| 1. | ||||
| 2. | ||||
| 3. |
Total for Section E $ __________
A copy of documents detailing each listed liability.
______________________________
Section F: Sources of Income
Do you have entries for Section F? ________ Yes _______ No
| Number | Type | Payor | Estimated Monthly Amount |
| 1. | |||
| 2. | |||
| 3. |
Total for Section F $ __________
Is the guardian the representative payee of Social Security benefits? ____ Yes
____ No
If no, who is the representative payee for the Social Security benefits? _________
______________________________
Section G: Lawsuits Against the Ward
Do you have entries for Section G? _______ Yes _______ No
| Number | Description of Lawsuit or Claim | Estimated Amount of Claim | Court Address | Plaintiff’s Name and Address | Describe Cause of Action | Date of Debt Occurrence |
| 1. | ||||||
| 2. | ||||||
| 3. |
______________________________
Section H: Pending Litigation and/or Lawsuits the Ward May Bring if Court Approval Is Received
Do you have entries for Section H? _______ Yes _______ No
| Number | Description of Lawsuit or Claims | Case Number and Court Address | Defendant Name and Address | Describe Cause of Action | Attorney for Ward |
| 1. | |||||
| 2. | |||||
| 3. |
______________________________
Section I: Assets the Ward, as of the Date of the Letters of Guardianship, Was Entitled to Receive, but Has Not Received
Do you have entries for Section I? ________ Yes _______ No
Instructions: If the guardian has knowledge of assets the ward was entitled to receive as of the date of letters, but were not received the assets should be listed here. Examples: insurance policies, benefits, inheritance, or settlements from litigation.
| Number | Description | Estimated Date of Receipt | Estimated Amount |
| 1. | |||
| 2. | |||
| 3. |
______________________________
Section J: Trusts
Do you have entries for Section J? ________ Yes _______ No
| Number | Name of Current Trustee and Address | Ward’s Interest | Estimated Date Trust was Created | Value of the Ward’s Interest in the Trust |
| 1. | ||||
| 2. | ||||
| 3. |
______________________________
Section K. Safe-Deposit Box
Does the ward lease a safe-deposit box? ________ Yes _______ No
If yes, location and number of safe-deposit box: ______________________________
Does the ward lease a safe-deposit box with another individual or individuals?
______ Yes _______ No
Who is the joint lessee with the ward? ______________________________
Was an inventory of the safe-deposit box filed with the court as required by section 744.365, Florida Statutes? ________ Yes _______ No
Has the safe-deposit box been opened? _________ Yes _______ No
[A certificate of service as required by Florida Rule of Judicial Administration 2.516 must be included if the incapacitated person is not a minor under 14 years of age and is not totally incapacitated.]
I certify that the foregoing document has been furnished to .....(name, address used for service, mailing address, and e-mail address)..... by .....(e- mail) (delivery) (mail) (fax)..... on .....(date)…...
______________________________
Guardian’s Signature
Guardian’s Printed Name: __________
______________________________
Guardian’s Address: _______________
______________________________
Guardian’s Phone Number: _________
Guardian’s E-mail Address: ________