Rule text
[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. This Conservator's Inventory is due within ninety (90) days of your appointment as 1. conservator. As conservator you will also be required to complete and file a Conservator's Report 2. using Form 4-998 NMRA as follows: a. Every year within thirty (30) days after the anniversary date of your appointment. b. Within sixty (60) days after your resignation, removal, or termination as conservator. 3. Please type or print clearly using ink. 4. Complete all sections of this inventory. 5. Attach additional pages if necessary. 6. After completing this inventory, you must sign it under penalty of perjury. Copies of this inventory must be given to the Protected Person, the Protected Person's 7. guardian if one has been appointed, and any other persons specified by the court. 8. Keep a copy of this inventory for your records. You must keep a copy of ALL of the Protected Person's financial records for seven (7) 9. years and make them available to the court upon request.
SECTION I - Information about the Protected Person.
1. Protected Person's name: ___________________________________________
2. Protected Person's age: _____________________________________________
3. Protected Person's physical address: __________________________________
Mailing address (if different): _________________________________________
4. Protected Person's telephone number(s) and other contact information: Home: __________________________ Cell: _____________________________ Work: __________________________ Fax: _____________________________ Email: ____________________________________________________________
5. Has a guardian also been appointed for the Protected Person?
[ ] Yes [ ] No
If yes, name of guardian ____________________________________________
Address _________________________________________________________
Phone number of guardian __________________________________________
6. What date were you appointed conservator? ____________________________
7. Is the Protected Person the beneficiary of a trust? [ ] Yes [ ] 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.
A. Are you holding cash on hand on behalf of the Protected Person?
[ ] Yes [ ] No Amount $ ________________
If yes, why is cash kept on hand? _____________________________________
________________________________________________________________ B. Bank Accounts.
Type of Account (Examples: checking, Value on Date of Name of Bank/Institution savings, certificates of Appointment deposit, etc.) $ $ $ TOTAL $
C. Investment Accounts.
Type of Account (Examples: brokerage, Value on Date of Name of Bank/Institution investment, money Appointment market, stocks, bonds, IRAs, 401(k) plan, etc.) $ $ $ TOTAL $
D. Life Insurance Policies.
Type of Insurance Cash Value on Date of Name Of Company (Examples: whole, term Appointment or universal, etc.) $ $ TOTAL $
E. Real Estate.
Method for Determining Value (Examples: Address of Property appraisal, tax Value (List all land and buildings) assessment, market value, etc.) $ $ TOTAL $
F. Vehicles.
Make, Model, and Year Value (List all cars, boats, ATVs, etc.) $ $ $ TOTAL $
G. Other Property Not Listed Above. (Attach additional pages if necessary.)
Detailed Description of Item or Method for Determining Collection Value (Examples: Value (Only list items or collections that appraisal, market are worth more than $500.00) value) $ $ $ TOTAL $
H. Total value of assets listed above. (The sum of all "Totals" reported in Section II.)
SECTION II TOTAL $
Section III - Debts.
A. Real Estate Debts.
Amount Owed on Date Address of Property and Name of Lender of Appointment $ $ TOTAL $
B. Other Loans. Purpose of Loan (Examples: automobile Amount Owed on Date Lender/Creditor Name loan or personal of Appointment payday loan, etc.) $ $ TOTAL $
C. Credit Cards.
Amount Owed on Date Company Name and Address of Appointment $
$ TOTAL $
D. Judgments/Liens.
Amount Owed On Date Judgment/Lien Description Of Appointment $ $ TOTAL $
E. Other Liabilities/Debts.
Amount Owed On Date Description Of Appointment $ $ $ TOTAL $
F. Total amount of debts listed above. (The sum of all "TOTALS" reported in Section III.) SECTION III TOTAL $
G. Explain any personal or professional relationship between the conservator and any lender/creditor listed in any section above: _________________________________
___________________________________________________________________
H. Explain any personal or professional relationship between the Protected Person and any lender/creditor listed in any section above: _____________________________
___________________________________________________________________
SECTION IV - Management of estate.
A. What are the Protected Person's expected sources of income? (e.g., Pension, Social Security, SSI, etc.) ____________________________________________________
___________________________________________________________________
___________________________________________________________________
B. What are the Protected Person's expected expenses? (e.g., housing, care, household, etc.) ______________________________________________________
___________________________________________________________________
___________________________________________________________________
C. If expected expenses will exceed expected income, what is your plan to meet the basic needs of the Protected Person? ____________________________________
___________________________________________________________________
___________________________________________________________________
D. 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.)
[ ] Yes [ ] 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) __
________________________________________________________________
________________________________________________________________
E. Do you anticipate significant one-time expenses over the next 12 months? (e.g., major home or car repair, medical expenses, gifts) [ ] Yes [ ] No
If yes, list and describe the nature and amount of each expense: _______________
___________________________________________________________________
___________________________________________________________________
If yes, how do you plan on paying for this expense? __________________________
___________________________________________________________________
___________________________________________________________________
F. Are the assets in the estate sufficient to provide for the ongoing care of the Protected Person? [ ] Yes [ ] 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
___________________________________ Email
Is this address different from your address in the order of appointment? [ ] Yes [ ] No
CERTIFICATE OF SERVICE
I certify that on (date) ______________________ I served a copy to the following individuals:
[ ] Protected Person _____________________________________ [ ] By mail or other delivery service _____________________________________ [ ] By fax (number) _________________ _____________________________________ [ ] By hand delivery _____________________________________ [ ] By e-mail [ ] Person(s) designated by court order (name and address): _____________________________________ [ ] By mail or other delivery service _____________________________________ [ ] By fax (number) _________________ _____________________________________ [ ] By hand delivery _____________________________________ [ ] By e-mail
_____________________________________ [ ] By mail or other delivery service _____________________________________ [ ] By fax (number) _________________ _____________________________________ [ ] By hand delivery _____________________________________ [ ] By e-mail
_____________________________________ [ ] By mail or other delivery service _____________________________________ [ ] By fax (number) _________________ _____________________________________ [ ] By hand delivery _____________________________________ [ ] By e-mail _____________________________________ [ ] By mail or other delivery service _____________________________________ [ ] By fax (number) _________________ _____________________________________ [ ] By hand delivery _____________________________________ [ ] 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.]