Form CC-GN-011 "Inventory and Information Report" - Maryland

What Is Form CC-GN-011?

This is a legal form that was released by the Maryland Circuit Courts - a government authority operating within Maryland. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2021;
  • The latest edition provided by the Maryland Circuit Courts;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CC-GN-011 by clicking the link below or browse more documents and templates provided by the Maryland Circuit Courts.

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CIRCUIT
ORPHANS’ COURT FOR
, MARYLAND
City/County
Located at
Case No.
Court Address
In the Matter of
Name of Minor or Disabled Person
Docket Reference
INVENTORY AND INFORMATION REPORT
(Md. Rule 10-707)
NOTE: Guardians of the property must complete and file this form each year within 60 days of
appointment or as the court otherwise directs. Attach copies of statements that show fair market values
and balances as of the date of your appointment and documents that describe assets, if available.
If a section of this form does not apply, write “Not applicable” or “N/A.” Attach additional sheets if needed.
Minor or Disabled Person’s
Date of Birth:
Gender:
☐ Female
☐ Male
Part I. Fiduciary estate
List property solely or jointly owned by the minor or disabled person.
A. REAL ESTATE
Attach documentation that shows fair market values as of the date of your appointment (from a
state department of assessments and taxation, real estate website or listing, etc.) or the most recent.
Location:
Fair market value: $
Address
City, state, zip
Lender (if any):
Mortgage balance: $
Ownership type (select one):
☐ Sole owner ☐ Joint tenant ☐ Tenant in common with
% interest
☐ Tenants by the entirety
☐ Other (describe):
Joint tenant/in common/by
Relationship to minor or
the entirety/other name
disabled person
Address
Location:
Fair market value: $
Address
City, state, zip
Lender (if any):
Mortgage balance: $
INRFI
CC-GN-011 (Rev. 07/2021)
Page 1 of 8
CIRCUIT
ORPHANS’ COURT FOR
, MARYLAND
City/County
Located at
Case No.
Court Address
In the Matter of
Name of Minor or Disabled Person
Docket Reference
INVENTORY AND INFORMATION REPORT
(Md. Rule 10-707)
NOTE: Guardians of the property must complete and file this form each year within 60 days of
appointment or as the court otherwise directs. Attach copies of statements that show fair market values
and balances as of the date of your appointment and documents that describe assets, if available.
If a section of this form does not apply, write “Not applicable” or “N/A.” Attach additional sheets if needed.
Minor or Disabled Person’s
Date of Birth:
Gender:
☐ Female
☐ Male
Part I. Fiduciary estate
List property solely or jointly owned by the minor or disabled person.
A. REAL ESTATE
Attach documentation that shows fair market values as of the date of your appointment (from a
state department of assessments and taxation, real estate website or listing, etc.) or the most recent.
Location:
Fair market value: $
Address
City, state, zip
Lender (if any):
Mortgage balance: $
Ownership type (select one):
☐ Sole owner ☐ Joint tenant ☐ Tenant in common with
% interest
☐ Tenants by the entirety
☐ Other (describe):
Joint tenant/in common/by
Relationship to minor or
the entirety/other name
disabled person
Address
Location:
Fair market value: $
Address
City, state, zip
Lender (if any):
Mortgage balance: $
INRFI
CC-GN-011 (Rev. 07/2021)
Page 1 of 8
Ownership type (select one):
☐ Sole owner ☐ Joint tenant ☐ Tenant in common with
% interest
☐ Tenants by the entirety
☐ Other (describe):
Joint tenant/in common/by
Relationship to minor or
the entirety/other name
disabled person
Address
Location:
Fair market value: $
Address
City, state, zip
Lender (if any):
Mortgage balance: $
Ownership type (select one):
☐ Sole owner ☐ Joint tenant ☐ Tenant in common with
% interest
☐ Tenants by the entirety
☐ Other (describe):
Joint tenant/in common/by
Relationship to minor or
the entirety/other name
disabled person
Address
B. CASH & CASH EQUIVALENTS
Checking, savings, or certificates of deposit (CDs).
Attach statements that show balances as of the date of your appointment or the most recent.
Account number
Joint owner(s)
Financial institution
Type
(last 4 digits only)
Balance
(if any)
$
$
$
$
$
$
$
TOTAL: $
INRFI
CC-GN-011 (Rev. 07/2021)
Page 2 of 8
C. BROKERAGE ACCOUNTS, STOCKS, BONDS, AND OTHER SECURITIES
Attach statements that show values as of the date of your appointment or the most recent.
Account number
Joint owner(s)
Name of company
Type
(last 4 digits only)
Value
(if any)
$
$
$
$
$
TOTAL: $
D. RETIREMENT ACCOUNTS
IRAs, Roth IRAs, 401(k), 403(b), etc.
Attach statements that show values as of the date of your appointment or the most recent.
Account number
Name of company
Type
(last 4 digits only)
Value
Beneficiary name(s)
$
$
$
$
$
TOTAL: $
E. VEHICLES
Cars, boats, off-road vehicles, airplanes, etc.
Attach valuations for each vehicle as of the date of your appointment as guardian or the most recent.
Year, make,
Fair Market
Lien
Co-owner(s)
Type of vehicle
model
Value
(if any)
(if any)
$
$
$
$
$
$
$
$
TOTAL: $
F. PERSONAL PROPERTY
List each item with a value over $2,500 (fine jewelry, artwork, valuable collectables, etc.).
Describe property if the collective value is less than $2,500. For example, if the total value of the
person’s property is $900, do not describe each item or list the value of each piece. Describe it as
one category, “furniture.”
CC-GN-011 (Rev. 07/2021)
Page 3 of 8
INRFI
If available, attach appraisals or any documents that show values or balances owed.
Lien amount
Description
Location
Value
(if any)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
TOTAL: $
G. OTHER
List annuities, burial accounts, burial plots, pre-paid burial plans, college 529 plans, cash values
of life insurance policies. Also list judgments, loans, promissory notes, etc., owed to the minor or
disabled person.
Attach copies of policies or contracts.
Account number
Name of institution
Type of account
(last 4 digits only)
Value
$
$
$
$
$
$
$
TOTAL: $
SUMMARY OF THE FIDUCIARY ESTATE:
The following is a summary of the fiduciary estate (enter totals from above)
Type
Value
A.
Real estate
$
B.
Cash & cash equivalents
$
C.
Brokerage accounts, stocks, bonds, and other securities
$
D.
Retirement accounts
$
E.
Vehicles
$
F.
Personal property
$
G.
Other
$
TOTALS:
$
INRFI
CC-GN-011 (Rev. 07/2021)
Page 4 of 8
Part II. Liabilities
List debts owed, other than mortgage or liens listed above.
A. LOANS
Attach account statements, or other documents that show amounts owed as of the date of
your appointment or the most recent.
Lender name
Purpose (loan type)
Loan number
Balance due
$
$
$
$
$
$
TOTAL: $
B. CREDIT CARDS
Attach statements that show balances as of the date of your appointment or the most recent.
Account number
Company
Card
(last 4 digits only)
Balance due
$
$
$
$
$
$
TOTAL: $
C. JUDGMENTS/LIENS
Attach copies of court orders or other documents that show balances owed.
Description
Balance due
$
$
$
$
$
$
TOTAL: $
CC-GN-011 (Rev. 07/2021)
Page 5 of 8
INRFI
Page of 8