Inventory (Without Schedules) {MPC 854a}

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) page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com