The Simple Estate Inventory Form Page 2

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G) MISCELLANEOUS PROPERTY
(Collectibles, guns, antiques,
stamps, coins, etc.)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Home furnishings/furniture__________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Automobiles_______________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Other Property_____________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Total miscellaneous property
Subtotal from this page________________________________________________________________
Subtotal from previous page____________________________________________________________
Total current value of estate
PERSONAL HISTORY
COMPLETED BY: _________________________________________ ON _______ /_______ /_______
(Full legal name)
Mo
Day
Year
ADDRESS: ______________________________________________ TEL ________ (B) _________ (H)
SPOUSE: ________________________________________ Anniversary _______ /_______ /_______
(Full legal name)
DOB (SELF) _______ /_______ /_______
DOB (SPOUSE) ________ /_______ /______
Mo
Day
Year
Mo
Day
Year
SOCIAL SECURITY NUMBER: (SELF) _____________________ (SPOUSE) ________________________
BANK DEPOSIT BOX: LOCATION ________________________NO. __________ ACCESS: ___________
DOCUMENTS INVENTORY
LOCATION
YES
NO
BIRTH CERTIFICATE (SELF) _________________________________________________
YES
NO
BIRTH CERTIFICATE (SPOUSE) _______________________________________________
YES
NO
MARRIAGE CERTIFICATE____________________________________________________
YES
NO
PASSPORT (Self) ________________/_____________Spouse__________/___________
Number
Exp. date
Number
Exp. Date
YES
NO
WILL (SELF) ______________________________________________________________
YES
NO
WILL (SPOUSE) ___________________________________________________________
YES
NO
DURABLE POWER OF ATTORNEY (SELF) ______________________________________
YES
NO
DURABLE POWER OF ATTORNEY (SPOUSE) ___________________________________
YES
NO
MEDICAL POWER OF ATTORNEY (SELF) ______________________________________
YES
NO
MEDICAL POWER OF ATTORNEY (SPOUSE) ___________________________________
YES
NO
PHYSICIANS DIRECTIVE (SELF) ______________________________________________
YES
NO
PHYSICIANS DIRECTIVE (SPOUSE) ___________________________________________
ADIVSORS
ATTORNEY
NAME _________________________________________________________________________
ADDRESS ______________________________________________________________________
TELEPHONE ____________________________________________________________________
TAX ACCOUNTANT
NAME _________________________________________________________________________
ADDRESS ______________________________________________________________________
TELEPHONE ____________________________________________________________________
FINANCIAL ADVISOR
NAME _________________________________________________________________________
ADDRESS ______________________________________________________________________
TELEPHONE ____________________________________________________________________
Agape Child & Family Services * 111 Racine Street, Memphis, TN 38111 * (901) 323-3600 *

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