New Mexico Forms Library
Decision Information
Rule Set 1 - Rules of Civil Procedure for the District Courts - cited by 4,520 documents
Rule Set 4 - Civil Forms - cited by 854 documents
Decision Content
4-997. Conservator’s inventory.
[For use with Rule 1-140 NMRA]
STATE OF NEW MEXICO
COUNTY OF _______________
_________ JUDICIAL DISTRICT
In the matter of _____________________, No. __________
a Protected Person.
CONSERVATOR’S INVENTORY
Please note: Fill out this net asset summary after you have completed this entire inventory. Use the information that you enter in Sections II and III of this inventory. |
NET ASSET SUMMARY |
Total Amount |
A. Total Assets (SECTION II TOTAL) |
$ |
B. Total Debts (SECTION III TOTAL) |
– $ |
Net Asset Value (A – B) |
$ |
Instructions.
You must use this form, Form 4-997 NMRA, when you file a Conservator’s Inventory. The purpose of a Conservator’s Inventory is to give the court as complete a picture as possible of the financial situation of the person under conservatorship, also called the Protected Person.
|
SECTION I – Information about the Protected Person.
- Protected Person’s name: ___________________________________________
- Protected Person’s age: ____________________________________________
- Protected Person’s physical address: __________________________________
Mailing address (if different): _________________________________________
- Protected Person’s telephone number(s) and other contact information:
Home: _________________________ Cell: __________________________
Work: __________________________ Fax: __________________________
Email: _________________________________________________________
- Has a guardian also been appointed for the Protected Person?
c Yes c No
If yes, name of guardian ____________________________________________
Address _________________________________________________________
Phone number of guardian __________________________________________
- What date were you appointed conservator? ____________________________
- Is the Protected Person the beneficiary of a trust? c Yes c No
If yes, what is the name of the trust? ___________________________________
What is the current value of the trust? __________________________________
Who is the trustee? ________________________________________________
What is the trustee’s contact information? _______________________________
________________________________________________________________
Please note: The information you fill out in Sections II through IV below will show the value of the Protected Person’s estate on the date you were appointed. |
SECTION II – Assets.
Please provide information about all of the assets of the Protected Person as of the date of your appointment as conservator. Assets are anything of value owned by the Protected Person. Attach additional pages if necessary. |
- Are you holding cash on hand on behalf of the Protected Person?
c Yes c No Amount $ _________________
If yes, why is cash kept on hand? _____________________________________
________________________________________________________________
- Bank Accounts.
Name of Bank/Institution |
Type of Account (Examples: checking, savings, certificates of deposit, etc.) |
Value on Date of Appointment |
|
|
$ |
|
|
$ |
|
|
$ |
TOTAL |
$ |
- Investment Accounts.
Name of Bank/Institution |
Type of Account (Examples: brokerage, investment, money market, stocks, bonds, IRAs, 401(k) plan, etc.) |
Value on Date of Appointment |
|
|
$ |
|
|
$ |
TOTAL |
$ |
- Life Insurance Policies.
Name Of Company |
Type of Insurance (Examples: whole, term or universal, etc.) |
Cash Value on Date of Appointment |
|
|
$ |
|
|
$ |
TOTAL |
$ |
- Real Estate.
Address of Property (List all land and buildings) |
Method for Determining Value (Examples: appraisal, tax assessment, market value, etc.) |
Value |
|
|
$ |
|
|
$ |
TOTAL |
$ |
- Vehicles.
Make, Model, and Year (List all cars, boats, ATVs, etc.) |
Value |
|
$ |
|
$ |
|
$ |
TOTAL |
$ |
- Other Property Not Listed Above. (Attach additional pages if necessary.)
Detailed Description of Item or Collection (Only list items or collections that are worth more than $500.00) |
Method for Determining Value (Examples: appraisal, market value) |
Value |
|
|
$ |
|
|
$ |
|
|
$ |
TOTAL |
$ |
- Total value of assets listed above. (The sum of all “Totals” reported in Section II.)
SECTION II TOTAL |
$ |
Section III – Debts.
- Real Estate Debts.
Address of Property and Name of Lender |
Amount Owed on Date of Appointment |
|
$ |
|
$ |
TOTAL |
$ |
- Other Loans.
Lender/Creditor Name |
Purpose of Loan (Examples: automobile loan or personal payday loan, etc.) |
Amount Owed on Date of Appointment |
|
|
$ |
|
|
$ |
TOTAL |
$ |
- Credit Cards.
Company Name and Address |
Amount Owed on Date of Appointment |
|
$ |
|
$ |
|
$ |
TOTAL |
$ |
- Judgments/Liens.
Judgment/Lien Description |
Amount Owed On Date Of Appointment |
|
$ |
|
$ |
TOTAL |
$ |
- Other Liabilities/Debts.
Description |
Amount Owed On Date Of Appointment |
|
$ |
|
$ |
|
$ |
TOTAL |
$ |
- Total amount of debts listed above. (The sum of all “TOTALS” reported in Section III.)
SECTION III TOTAL |
$ |
- Explain any personal or professional relationship between the conservator and any lender/creditor listed in any section above: ___________________________
________________________________________________________________
- Explain any personal or professional relationship between the Protected Person and any lender/creditor listed in any section above: _______________________
________________________________________________________________
SECTION IV – Management of estate.
- What are the Protected Person’s expected sources of income? (e.g., Pension, Social Security, SSI, etc.)
________________________________________________________________
________________________________________________________________
________________________________________________________________
- What are the Protected Person’s expected expenses? (e.g., housing, care, household, etc.)
________________________________________________________________
________________________________________________________________
________________________________________________________________
- If expected expenses will exceed expected income, what is your plan to meet the basic needs of the Protected Person?
________________________________________________________________
________________________________________________________________
________________________________________________________________
- Do you anticipate significant one-time income over the next 12 months? (e.g., sale of house or car, back payment of social security, insurance proceeds, etc.)
c Yes c No
If yes, list and describe each income source and amount separately: _________
________________________________________________________________
If yes, what do you plan on doing with this income? (e.g., pay off debt, invest)
________________________________________________________________
________________________________________________________________
- Do you anticipate significant one-time expenses over the next 12 months? (e.g., major home or car repair, medical expenses, gifts) c Yes c No
If yes, list and describe the nature and amount of each expense: _____________
________________________________________________________________
________________________________________________________________
If yes, how do you plan on paying for this expense? _______________________
________________________________________________________________
________________________________________________________________
Are the assets in the estate sufficient to provide for the ongoing care of the Protected Person? c Yes c No
If no, describe why and what steps should be taken to provide for the Protected Person: __________________________________________________________
________________________________________________________________
________________________________________________________________
AFFIRMATION UNDER PENALTY OF PERJURY
I, _____________________, am the conservator of _____________________, and I affirm under penalty of perjury under the laws of the State of New Mexico that the information in this report is true and correct.
Date Submitted: _________________ _____________________________________
Conservator’s Signature
_____________________________________
Typed/Printed Name
_____________________________________
Street or Post Office Address
_____________________________________
City, State and Zip Code
_____________________________________
Telephone Number(s)
_____________________________________________
Fax Number
_____________________________________________
Is this address different from your address in the order of appointment?
c Yes c No
CERTIFICATE OF SERVICE
I certify that on (date) ______________ I served a copy to the following individuals:
c Protected Person ___________________________ ___________________________ ___________________________ ___________________________
c Person(s) designated by court order (name and address): ___________________________ ___________________________ ___________________________ ___________________________
___________________________ ___________________________ ___________________________ ___________________________
___________________________ ___________________________ ___________________________ ___________________________
___________________________ ___________________________ ___________________________ ___________________________
|
c By mail or other delivery service c By fax (number) ______________ c By hand delivery c By e-mail
c By mail or other delivery service c By fax (number) ______________ c By hand delivery c By e-mail
c By mail or other delivery service c By fax (number) ______________ c By hand delivery c By e-mail
c By mail or other delivery service c By fax (number) ______________ c By hand delivery c By e-mail
c By mail or other delivery service c By fax (number) ______________ c By hand delivery c By e-mail |
_________________________________ Typed/Printed Name |
_______________________________ Conservator’s Signature |
[Approved by Supreme Court Order No. 18-8300-005, effective for all cases on or after July 1, 2018.]