Part 5. The decedent’s non-Virginia real estate, valued at the date of death.
DESCRIPTION OF PROPERTY VALUE
TOTAL VALUE OF PART 5:
CERTIFICATE OF COMMISSIONER
The Commissioner of Accounts has not independently verified the value of the items on the inventory, or the fact
that they are the only assets of the estate.
Inspected, found to be in proper form, and approved on ...................................................................................................................................
_________________________________________________________________
COMMISSIONER OF ACCOUNTS
Received in the Clerk’s Office and admitted to record on .................................................................................................................................
_________________________________________________________________
[ ] CLERK [ ] DEPUTY CLERK
Page 3 of 4
FORM CC-1670 (MASTER) 10/12
CERTIFICATE OF ACCURACY, COMPLETENESS, AND MAILING
[Must be signed by each fiduciary.]
1. I (we) hereby certify and affirm under penalty of law, that to be best of my (our) knowledge and belief this is an
accurate and complete inventory of this estate made in accordance with my (our) responsibilities under Virginia law.
2. I (we) hereby also certify and affirm that (choose one):
A. [ ] On or before the date of filing this Inventory with the Commissioner of Accounts, I (we) sent a copy of it by
first class mail to every person entitled to a copy, pursuant to Va. Code Section 64.2-1303, who made a
written request therefore. The names and addresses of the persons to whom copies were sent and the dates
they were mailed are shown on page 4.
or
B. [ ] No person entitled to a copy of this Inventory pursuant to Virginia Code Section 64.2-1303 made a written
request therefore.
Date ........................................................... ___________________________________________________________________
SIGNATURE OF FIDUCIARY
Address ......................................................................................................................
Telephone No. .........................................................................................................
Date ........................................................... ___________________________________________________________________
SIGNATURE OF FIDUCIARY
Address: .....................................................................................................................
Telephone No. .........................................................................................................
Date ........................................................... ___________________________________________________________________
SIGNATURE OF FIDUCIARY
Address ......................................................................................................................
Telephone No. .........................................................................................................