Form PC-10.4 Supplemental Inventory - Rhode Island

Form PC-10.4 or the "Supplemental Inventory" is a form issued by the Rhode Island Probate Court.

Download a PDF version of the Form PC-10.4 down below or find it on the Rhode Island Probate Court Forms website.

ADVERTISEMENT
State of Rhode Island and Providence Plantations
DATE FILED
Probate Court
SUPPLEMENTAL INVENTORY
RIGL 33-9-1
FOR
COURT USE ONLY
STATE OF RHODE ISLAND
Select County
County of
PROBATE COURT OF THE
Select City or Town
Estate of
City or Town of
Alias
No.
List additional personal property for Estate:
DESCRIPTION OF ASSET
VALUE OF ASSET ($)
Total
List additional personal property and real estate for Guardianship:
DESCRIPTION OF ASSET
VALUE OF ASSET ($)
Total
Name of
Name of
Fiduciary
Appraiser
Signature
Signature
FIDUCIARY SIGN HERE
APPRAISER SIGN HERE
of Fiduciary
of Appraiser
Name of
Name of
Fiduciary
Appraiser
Signature
Signature
FIDUCIARY SIGN HERE
APPRAISER SIGN HERE
of Fiduciary
of Appraiser
Notary:
Name of Notary
State
County
On
day of
, 20
the petitioner, known to me or proved through satisfactory evidence, signed
the document in my presence and swore or affirmed the statement(s) in the documents is/are truthful and accurate.
Signature of Notary Public
Date
NOTARY SIGN HERE
Commission ID#
Commission Expiration Date
Notary Seal
PC-10.4 (Rev. 07/17)
Page 1 of 1
State of Rhode Island and Providence Plantations
DATE FILED
Probate Court
SUPPLEMENTAL INVENTORY
RIGL 33-9-1
FOR
COURT USE ONLY
STATE OF RHODE ISLAND
Select County
County of
PROBATE COURT OF THE
Select City or Town
Estate of
City or Town of
Alias
No.
List additional personal property for Estate:
DESCRIPTION OF ASSET
VALUE OF ASSET ($)
Total
List additional personal property and real estate for Guardianship:
DESCRIPTION OF ASSET
VALUE OF ASSET ($)
Total
Name of
Name of
Fiduciary
Appraiser
Signature
Signature
FIDUCIARY SIGN HERE
APPRAISER SIGN HERE
of Fiduciary
of Appraiser
Name of
Name of
Fiduciary
Appraiser
Signature
Signature
FIDUCIARY SIGN HERE
APPRAISER SIGN HERE
of Fiduciary
of Appraiser
Notary:
Name of Notary
State
County
On
day of
, 20
the petitioner, known to me or proved through satisfactory evidence, signed
the document in my presence and swore or affirmed the statement(s) in the documents is/are truthful and accurate.
Signature of Notary Public
Date
NOTARY SIGN HERE
Commission ID#
Commission Expiration Date
Notary Seal
PC-10.4 (Rev. 07/17)
Page 1 of 1
ADVERTISEMENT