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Personal Property Inventory (United States)

This is an inventory of personal property. The form provided here is simply a sample of what the actual form looks like.

PERSONAL PROPERTY INVENTORY

TANGIBLE

Personal Property

(Automobiles, boats, jewelry, furs, silverware, china, art work, books, stamp collections, coin collections, household furniture, etc.)

Description __________________________

Date Acquired __________________________

Location __________________________

Current Value __________________________

Insurance __________________________

Other Basic Information __________________________


Description __________________________

Date Acquired __________________________

Location __________________________

Current Value __________________________

Insurance __________________________

Other Basic Information __________________________


Description __________________________

Date Acquired __________________________

Location __________________________

Current Value __________________________

Insurance __________________________

Other Basic Information __________________________


INTANGIBLE PROPERTY

Bonds

Description (Issuer Series, Rate, Date Acquired)

__________________________

Registration of Bonds (Form and Names)

__________________________

Face Amount __________________________

Cost or Other Basis __________________________

Current Value __________________________


Description (Issuer Series, Rate, Date Acquired)

__________________________

Registration of Bonds (Form and Names)

__________________________

Face Amount __________________________

Cost or Other Basis __________________________

Current Value __________________________


Description (Issuer Series, Rate, Date Acquired)

__________________________

Registration of Bonds (Form and Names)

__________________________

Face Amount __________________________

Cost or Other Basis __________________________

Current Value __________________________


Total __________________________

Bond Total __________________________
Stocks

Name of Company and Type of Stock

_____________________________________

Number of Shares __________________________________

Registration of Stock

(Form and Names) ____________________________________________________

Date Acquired ___________________________________

Cost or Other Basis ____________________________

Current Value __________________________________

INSURANCE

Type of Insurance __________________________

Name of Company __________________________

Policy Number __________________________

Expiration Dates __________________________

Name of Broker __________________________


Type of Insurance __________________________

Name of Company __________________________

Policy Number __________________________

Expiration Dates __________________________

Name of Broker __________________________


Type of Insurance __________________________

Name of Company __________________________

Policy Number __________________________

Expiration Dates __________________________

Name of Broker __________________________


LIFE INSURANCE

List all policies under which you are the insured.

Name of Company __________________________

Type of Policy __________________________

Policy Number __________________________

Present Cash Value __________________________

Face Amount __________________________

Owner __________________________

How will Proceeds Be Paid __________________________

Beneficiary __________________________


Name of Company __________________________

Type of Policy __________________________

Policy Number __________________________

Present Cash Value __________________________

Face Amount __________________________

Owner __________________________

How will Proceeds Be Paid __________________________

Beneficiary __________________________


Name of Company __________________________

Type of Policy __________________________

Policy Number __________________________

Present Cash Value __________________________

Face Amount __________________________

Owner __________________________

How will Proceeds Be Paid __________________________

Beneficiary __________________________


Total Present Cash Value __________________________

Total Face Amount __________________________


EMPLOYEE AND RETIREMENT BENEFITS

Employers Pension, Profit-sharing or Stock Bonus Plans

Plan 1 Name of Plan __________________________

Trustee, Insurance Company, or Administrator

__________________________

Amount Contributed by Employee __________________________

Amount Contributed by Employer __________________________

Retirement Benefit __________________________

Death Benefit __________________________

Present Value of Total Contributions __________________________

Amount Vested __________________________

Plan 2 Name of Plan __________________________

Trustee, Insurance Company, or Administrator

__________________________

Amount Contributed by Employee __________________________

Amount Contributed by Employer __________________________

Retirement Benefit __________________________

Death Benefit __________________________

Present Value of Total Contributions __________________________

Amount Vested __________________________

Plan 3 Name of Plan __________________________

Trustee, Insurance Company, or Administrator

__________________________

Amount Contributed by Employee __________________________

Amount Contributed by Employer __________________________

Retirement Benefit __________________________

Death Benefit __________________________

Present Value of Total Contributions __________________________

Amount Vested __________________________

GROUP LIFE, ACCIDENT, HEALTH, DEATH BENEFIT, AND DISABILITY PLANS

Plan 1 Name of Plan __________________________

Insurer of Trustee __________________________

Policy Number __________________________

Benefits __________________________

Beneficiary __________________________

Options Elected __________________________


Plan 2 Name of Plan __________________________

Insurer of Trustee __________________________

Policy Number __________________________

Benefits __________________________

Beneficiary __________________________

Options Elected __________________________


Plan 3 Name of Plan __________________________

Insurer of Trustee __________________________

Policy Number __________________________

Benefits __________________________

Beneficiary __________________________

Options Elected __________________________


SPLIT-DOLLAR LIFE INSURANCE

Enter here all information relating to split-dollar life insurance, e.g., name of company, policy number, form of agreement, face amount, net amount payable to beneficiary.

__________________________

__________________________


STOCK OPTIONS

Enter her all pertinent information relating to stock options held by you, e.g., option price, number of shares to which options extends, number of shares already purchased, price at which purchased, present market value per share, etc.

__________________________

__________________________


TRUSTS

Type of trust: Inter vivos ______________

Testamentary ______________

Name of settlor: _____________________________________________________________

Name and address of trustee:

___________________________________________________

Date trust executed if inter vivos:

_______________________________________________

Date will probated if testamentary:

______________________________________________

Court having supervision of trust:

_______________________________________________

Duration of trust:

____________________________________________________________

Present market value of trust corpus:

_____________________________________________

Rights and interest held by you:

_________________________________________________

Is trust revocable?

___________________________________________________________


ASSETS

Bank Accounts ______________________________

Bonds (Total U.S. Savings Bonds) ___________________________

(and others)___________________________

Stocks ___________________________

Non business receivables ___________________________

Life Insurance on your life ___________________________

Life insurance on lives of others ___________________________

Business interests ___________________________

Death benefits 3/4 Employee and Retirement plans ___________________________

Rights under estates and trusts including powers of appointment ___________________________

Miscellaneous assets ___________________________

ESTIMATED GROSS TOTAL ____________________________

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