"The Simple Estate Inventory Form - Agape"

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THE SIMPLE ESTATE INVENTORY FORM
A Tool Designed to Assist Individuals and Families
In Determining Estate Value and Will Preparation
This form is designed as a guideline for calculating the current value of an Estate, and is useful in preparing
a more complete Estate Plan. This form is not presented as 100 percent inclusive. There may be assets or
categories of assets not mentioned here which will be required to be noted on IRS Form 706. For the most
accurate and effective plan possible, list all assets within the Estate, and seek the advice and counsel of a
qualified professional.
____________________________________________________________________________________
Fair Market Value
Original Cost
Current Yield
A) REAL ESTATE
Home
____________________________________________________________________________________
Other (rentals, land, oil leases):
1.__________________________________________________________________________________
2.__________________________________________________________________________________
3.__________________________________________________________________________________
4._____________________________
Total value of property
B) STOCKS, BONDS, ANNUITIES
1.___________________________________________________________________________________
2.___________________________________________________________________________________
3.___________________________________________________________________________________
4.___________________________________________________________________________________
5.___________________________________________________________________________________
Total value of stocks and bonds
C) CASH, MORTGAGES, NOTES
RECEIVABLE (CDs, Savings, etc.)
1.___________________________________________________________________________________
2. __________________________________________________________________________________
3.___________________________________________________________________________________
4.___________________________________________________________________________________
5.___________________________________________________________________________________
Total cash, mortgages, notes
D) LIFE INSURANCE
Death Benefit
Current Cash Value
Current Yield
1.___________________________________________________________________________________
2.___________________________________________________________________________________
3.___________________________________________________________________________________
4.__________________________________________________________________________________
Total life insurance
E) JOINTLY OWNED PROPERTY
Value of Share
Original Investment
Current Yield
1.___________________________________________________________________________________
2.___________________________________________________________________________________
Total jointly owned property
F) IRAs/QUALIFIED PLANS
Fair Market Value
Original Cost
Current Yield
1.___________________________________________________________________________________
2. __________________________________________________________________________________
3.___________________________________________________________________________________
4.___________________________________________________________________________________
Total IRAs/Qualified plans
CONTINUED ON BACK
THE SIMPLE ESTATE INVENTORY FORM
A Tool Designed to Assist Individuals and Families
In Determining Estate Value and Will Preparation
This form is designed as a guideline for calculating the current value of an Estate, and is useful in preparing
a more complete Estate Plan. This form is not presented as 100 percent inclusive. There may be assets or
categories of assets not mentioned here which will be required to be noted on IRS Form 706. For the most
accurate and effective plan possible, list all assets within the Estate, and seek the advice and counsel of a
qualified professional.
____________________________________________________________________________________
Fair Market Value
Original Cost
Current Yield
A) REAL ESTATE
Home
____________________________________________________________________________________
Other (rentals, land, oil leases):
1.__________________________________________________________________________________
2.__________________________________________________________________________________
3.__________________________________________________________________________________
4._____________________________
Total value of property
B) STOCKS, BONDS, ANNUITIES
1.___________________________________________________________________________________
2.___________________________________________________________________________________
3.___________________________________________________________________________________
4.___________________________________________________________________________________
5.___________________________________________________________________________________
Total value of stocks and bonds
C) CASH, MORTGAGES, NOTES
RECEIVABLE (CDs, Savings, etc.)
1.___________________________________________________________________________________
2. __________________________________________________________________________________
3.___________________________________________________________________________________
4.___________________________________________________________________________________
5.___________________________________________________________________________________
Total cash, mortgages, notes
D) LIFE INSURANCE
Death Benefit
Current Cash Value
Current Yield
1.___________________________________________________________________________________
2.___________________________________________________________________________________
3.___________________________________________________________________________________
4.__________________________________________________________________________________
Total life insurance
E) JOINTLY OWNED PROPERTY
Value of Share
Original Investment
Current Yield
1.___________________________________________________________________________________
2.___________________________________________________________________________________
Total jointly owned property
F) IRAs/QUALIFIED PLANS
Fair Market Value
Original Cost
Current Yield
1.___________________________________________________________________________________
2. __________________________________________________________________________________
3.___________________________________________________________________________________
4.___________________________________________________________________________________
Total IRAs/Qualified plans
CONTINUED ON BACK
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 * www.agapemeanslove.org
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