Inventory {P1-PR-016}

IN THE CIRCUIT COURT OF THE SIXTEENTH JUDICIAL CIRCUIT KANE COUNTY, ILLINOIS Case No. IN THE MATTER OF THE ESTATE OF (DECEDENT): (Decedent/Minor/Disabled Person) Name: Address: City, State, Zip: File Stamp INVENTORY First Inventory Amended Inventory Supplemental Inventory The undersigned certifies that all information identified on the reverse side of this form is true and is a full, true and correct inventory of the real and personal estate of the above identified case so far as the same has come to my knowledge and of any cause of action on which there is a right to sue. Value of Personal Property Value of Real Property Amount of Bond Bond not required Surety Surety waived Under penalties as provided by law pursuant to 735 ILCS 5/1-109, the undersigned certifies that the statements set forth in this petition are true and correct, except as to matters stated to be on information and belief and as to such matters the S undersigned certifies that he/she verily believes the same to be true. Executor Administrator Guardian Other (if officer of corporate fiduciary, state position) Attorney/Pro Se: Address: City, State, Zip: Telephone No.: Atty. Registration No.: Attorney E-mail: P1-PR-016 (11/12) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case No. ITEM NUMBER DESCRIPTION P1-PR-016B (11/12) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com