ESTATE NO.
Ward:
Conservator(s):
Estimated Duration of Conservatorship:
The following is a true and complete inventory of the estate, both real and personal.
REAL PROPERTY (Indicate if property is jointly owned and with whom)
REAL ESTATE
APPROXIMATE VALUE
Parcel One:
Parcel Two:
Parcel Three:
Parcel Four:
TOTAL APPROXIMATE EQUITY IN REAL ESTATE
(RECEIPTS) INCOME FROM ALL SOURCES
P
r
ojected Yearly Total
Social Security per year
If the Ward is a beneficiary
of a Trust, please show
the name of the Trust, the
Trustee, his/her address,
telephone number, and
attach an outline showing
when and how payments
are required to be made
under the Trust and the
criteria for payment:
SSI (Supplemental Security Income) per year
Retirement benefits per year (give source)
Retirement benefits per year (give source)
VA benefits per year
Other income per year, including, e.g., alimony,
annuity, or trust distributions (give source)
Dividends
Rent from Investment Properties
Other Income (specify)
TOTAL
Is Social Security income received as representative payee? Yes _____ No _____
ADU
LT CONSERVATORSHIP
INVENTORY AND ASSET MANAGEMENT PLAN
Probate Court
136 Pryor Street SW, Suite C-230
Atlanta, Geor
gia, 30303
404-613-4070
PROPERTY ADDRESS OR DESCRIPTION
Interest
ADULT CONSERVATORSHIP
INVENTORY AND ASSET MANAGEMENT PLAN
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Bank/Financial Institution/Broker
Account Type
Acct. No.
Joint Owner (if any)
APPROXIMATE VALUE
T
OTAL VALUE OF ACCOUNTS
2. STOCKS/BONDS/INVESTMENTS (including retirement and profit-sharing accounts):
a. held by brokers:
Brokerage Firm or Institution Investment Type
Acct. No.
Joint Owner (if any)
APPROXIMATE VALUE
TOTAL APPROXIMATE VALUE OF SECURITIES HELD BY B
ROKER
b. privately held:
Company/Issuer
No. of Shares
Acct. No.
Joint Owner (if any)
APPROXIMATE VALUE
TOTAL APPROXIMATE VALUE OF SECURITIES
3. AUTOMOBILES:
Year/Make/Model V.I.N Joint Owner (if any)
APPROXIMATE VALUE
TOTAL APPROXIMATE VALUE OF AUTOMOBILES
4. OTHER ASSETS OF SIGNIFICANT VALUE:
Description
Joint Owner (if any)
APPROXIMATE VALUE
TOTAL APPROXIMATE VALUE
5. MISCELLANEOUS: List all other non-cash assets in this section.
PERSONAL AND INTANGIBLE PROPERTY
(Indicate if property is jointly owned and with whom)
VALUES ON THIS PAGE SHOULD REFLECT BALANCES AS OF THE DATE LETTERS OF
CONSERVATORSHIP ARE ISSUED
I. CHECKING/SAVINGS/MONEY MARKET/CERTIFICATES OF DEPOSIT/LIQUID ACCOUNTS:
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COMMENTS/EXPLANATIONS ABOUT ANYTHING ON THIS INVENTORY:
DEBTS AND OTHER LIABILITIES
The ward owes the following debts/liabilities:
1. Secured debts:
Obligor/Payee Collateral
Solely/Jointly Owned
Approx. Current Balance
TOTAL APPROXIMATE B
ALANCE OF SECURED DEBTS
2. Unsecured debts:
Obligor/Payee Account No.
S
olely/Jointly Owned
Approx. Current Balance
T
OTAL APPROXIMATE BALANCE OF UNSECURED DEBTS
TOTAL DEBTS AND OTHER LIABILITIES OF WARD
Current Amount of Bond:
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PROJECTED DISBURSEMENTS (EXPENSES)
You will also give a projected monthly and a projected yearly approximation of expenses to
be incurred during the first reporting period. The projected expenses for the next
reporting period may be approximations based on current average monthly and yearly expenditures.
Household
Projected
MONTHLY
Expenditures
Projected YEARLY
Expenditures
Care Facility
Type of Facility: _______________
Facility:
Rent (Payee):
Mortgage
Company:
Property taxes
Property Insurance
Electricity/Gas
Water/Sewer
Garbage
Telephone
Repairs and Maintenance
Lawn Care/Pest Control
Cable TV
Internet
Groceries
Miscellaneous household
Meals outside home
Total credit account payments
Other monthly debt payments
Other (specify)
Automotive/Transportation
Car Note (Payee):
Gasoline and Oil
Repairs
Tags and license fees
Insurance (Payee):
Bus/train/taxi fares
Minors or Other Dependents of the Ward
Child Care (Payee):
School Tuition/Supplies/Expenses/Lunches
Clothing/Diapers/Grooming/Hygiene
Medical/Dental/Prescription
Entertainment/Activities
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CONTINUED FROM P
REVIOUS PAGE
P
rojected
M
ONTHLY
Expenditures
P
rojected
YEARLY
Expenditures
Other Insurance for the Ward
Health Insurance
Payee:
Life Insurance
Payee: ________________
Date established:______________
Beneficiary: ______________
Disability Insurance
Payee:
Other (specify)
Ward’s Other Expenses
Dry Cleaning/Laundry
Clothing/grooming/hygiene
Medical/Dental
Prescriptions/medications
Entertainment/Vacations
Publications/Subscriptions/Dues/Clubs
Personal Caretakers/cleaning personnel
Other (specify)
Miscellaneous (specify)
TOTAL EXPENSES
Note: If the projected expenditures exceed the projected income for the ward, you must
provide the Court written justification for the encroachment on the corpus. You may
attach additional pa
ges if necessary.
Is the ward behind in any debt payments? Yes No
If yes, please provide the Court the name of the payee(s), nature of the debt(s) and amount(s):
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PROJECTED BUDGET SUMMARY
MONTHLY
YEARLY
1. Average Income
2. Average Expenses
3. Income Less Total Expenses (positive or negative figure)
ASSET MANAGEMENT PLAN
Signature of Attorney:
Typed/Printed Name:
Phone:
State Bar Number:
Please describe how you plan to manage the Ward’s assets, including details regarding sale,
refinancing, reallocation, investments, or other actions, if any:
Therefore, based upon the income and expenses shown above, the Conservator(s) hereby
request(s) leave to disburse from the ward's estate the sum of $ ___________________ per month for the
support, care, education, health, and welfare of the ward and those persons who are entitled to be
supported by the ward. To the extent that such sum exceeds, in any month, current income, authority to
encroach is hereby requested; to the extent that current income, in any month, exceeds such sum, the
Conservator(s) shall be limited to expending such sum.
AFFIDAVIT
I/We, ____________________________________________________ Conservator(s) of the
above ward, do swear that the foregoing Inventory and Asset Management Plan contains a
just, true, and complete inventory and budget of all property belonging to said ward within my/our
possession, control, or knowledge. This Inventory and Asset Management Plan has been provided to
the Guardian of the ward, if any, by first class mail.
CERTIFICATE OF MAILING
I/We hereby certify that I/we have mailed a copy of this inventory by first class mail to the ward's guardian,
if any
Address:
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Sworn to and subscribed before me this
day of ,
Co-Conservator, if any
Notary Public/Clerk of Probate Court
Printed Name
Sworn to and subscribed before me this
day of , 20 .
Conservator
Notary Public/Clerk of Probate Court
Printed Name
20
ADULT CONSERVATORSHIP
INVENTORY AND ASSET MANAGEMENT PLAN
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IN THE PROBATE COURT OF FULTON COUNTY
STATE OF GEORGIA
IN RE:
______________________________,
WARD
______________________________,
CONSERVATOR(S)
)
)
)
)
)
)
)
ESTATE NO. __________
ADULT CONSERVATORSHIP
INVENTORY & ASSET MANAGEMENT PLAN
ORDER
The Conservator filed the above-referenced Inventory and attached documents
and no objection was filed by any interested party within 30 days of the filing, and the
Court has reviewed the Inventory and Asset Management Plan and found nothing failing
to comply with applicable law which warrants a hearing or any further action by the Court.
Wherefore it is Ordered that the Inventory and Asset Management Plan shall be filed
in the confidential estate file.
It is further Ordered that:
____ a. Since the expenditures on the proposed annual budget for next year do
not exceed the expected income and interest earned, the Court approves the type of
expenditures shown on the budget as being for the benefit of the Ward and the Ward’s
dependents, if any.
____ b. Since the expenditures on the proposed annual budget for next year
exceed the expected income and interest earned, the Court approves the type and
amounts of expenditures shown on the budget as being for the benefit of the Ward and the
Ward’s dependents, if any.
It is further Ordered that the Conservator show in the following year’s Annual
Return how such funds actually were spent.
Date Probate Judge
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