File No.
STATE OF NORTH CAROLINA
                                                                                                         In The General Court Of Justice
                                                County                                                   Superior Court Division
                                                                                                                 Before The Clerk
IN THE MATTER OF THE ESTATE OF
Name Of Decedent                                                                                         INVENTORY
                                                                                  FOR DECEDENT’S ESTATE
                                                                                                                                      G.S. 28A-15-2, 28A-20-1
IMPORTANT:         File within three (3) months after qualifying. Itemize and give values as of date of decedent’s death. Continue on additional sheet if necessary.
I, the undersigned personal representative, being duly sworn, say that to the best of my knowledge the following is a just, true, and perfect 
inventory of all the real and personal property of the decedent named above, which has come into my hands or into the hands of any 
person for me as personal representative of the estate.
                                          PART  I.PROPERTY OF THE ESTATE
1.  Accounts In Sole Name Of Decedent (List bank, etc., account type, and balance. Do not list account nos.)                          VALUE
                                                                                                                                     $

2.  Joint Accounts Without Right Of Survivorship (List bank, etc., account type, balance, and joint owners. Do not list account nos.)
                                                                                     % Owned By Decedent
                                                                                     % Owned By Decedent
                                                                                     % Owned By Decedent
3.   Stocks And Bonds In Sole Name Of Decedent Or Jointly Owned Without Right Of Survivorship (Identify 
each type of security and give market value of all securities of that type, e.g., 100 shares of XYZ Corp. common 
stock at 37-1/4...$3,725.)
                                                                                     % Owned By Decedent
                                                                                     % Owned By Decedent
                                                                                     % Owned By Decedent
                                                                                     % Owned By Decedent
                                                                                     % Owned By Decedent
4.  Cash And Undeposited Checks On Hand

5.   All Other Personal Property (e.g., vehicles, household furnishings, farm products, equipment, tools)

6.   Real Estate Willed To The Estate, Directed By The Will To Be Sold, And Sold (Attach legal description and 
proceeds of sale for each parcel.)

                          ADDITIONAL AMOUNT CARRIED OVER FROM ATTACHMENT (if applicable)                                             $
                                                            TOTAL PART   I. (Costs apply to this total)                              $
7.   Real Estate Willed To The Estate, Directed By The Will To Be Sold, And Not Sold (Attach legal description 
of each parcel and give fair market value at date of death.)
                                                                                  $
8.   There        is      is not     a pending lawsuit that involves the decedent.
                                                            (Over)
AOC-E-505, Rev. 8/21
© 2021 Administrative Office of the Courts

                  PART II. PROPERTY WHICH CAN BE ADDED TO ESTATE IF NEEDED TO PAY CLAIMS
1.  Joint Accounts With Right Of Survivorship (List each account and give names of other joint owners and total amount on                       VALUE
 deposit in each account. Do not list account nos. Attach copy of deposit contract/signature card unless already attached to application.)
                                                                                                                                          $

2.  Stocks/Bonds/Securities Jointly Owned With Right Of Survivorship Or Registered In Beneficiary Form
 And Automatically Transferable On Death (Identify each type of security and give market value of all securities
 of that type, e.g., 100 shares of XYZ Corp. common stock at 37-1/4...$3,725.)

3.  Other Personal Property Recoverable (G.S. 28A-15-10)

4.  Real Estate Except Entireties Property, Life Estate And Real Estate Willed To Estate (List legal description
 and give fair market value of each parcel of decedent’s interest at date of death.)

                                                                                                TOTAL PART II.                            $
                                          PART III. CLAIMS FOR WRONGFUL DEATH
There      is           is not     a potential claim for wrongful death arising under G.S. 28A-18-2. The following attorney, if any, has been 
retained to file the action, and the civil action, if any, has been filed in the following court or jurisdiction:
Name And Address Of Attorney                                              State And County Or Federal District Court Jurisdiction

                                                                          Case No.

Signature Of Fiduciary                    Title                           Signature Of Co-Fiduciary, If Any                                Title

SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME                                SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME
Date                   Signature Of Person Authorized To Administer Oaths Date                  Signature Of Person Authorized To Administer Oaths

      Deputy CSC        Assistant CSC      Clerk Of Superior Court                   Deputy CSC      Assistant CSC                          Clerk Of Superior Court
          Date My Commission Expires                                      Date My Commission Expires
 Notary                                                                                                                                               Notary
          County Where Notarized                                          County Where Notarized
SEAL                                                                                                                                                 SEAL
AOC-E-505, Side Two, Rev. 8/21
© 2021 Administrative Office of the Courts