FORM 65E INVENTORY OF ESTATE CANADA PROVINCE OF PRINCE EDWARD ISLAND SUPREME COURT OF PRINCE EDWARD ISLAND (Estates Section) In the matter of the estate of ___________________________ deceased. 1. 2. 3. INVENTORY OF ESTATE Real Estate: (Describe property by address, property number and acreage) Value Household furniture, goods, jewellery, clothing: Securities and investment: (i) Stocks Name Number of shares (ii) Mutual funds Name Number of shares (iii) Bonds (include accrued interest) Name Face value (iv) Mortgages (include accrued interest) Name of Mortgager and address (v) Promissory notes Name of provisor and and address (vi) Book debts Name of Debtor (vii) Bank account Name of bank Rate of Interest Rate of Interest (viii) Cash on Hand: (ix) 4. 5. 6. 7. 8. Other assets: Name Farming implements: Stock in trade: Life insurance: Company Beneficiary Interest of deceased in trusts or estates: Other personal property: This is Exhibit_______________________referred to in the affidavit of ______________________________________ sworn before me this______day of_______________, 2000. Commissioner for taking Affidavits in the Supreme Court policy #