For Clerk’s Use Only SUPERIOR COURT OF ARIZONA MOHAVE COUNTY Case Number: __________________________ FORM FOR SUBMISSION OF ANNUAL ACCOUNTING FOR CONSERVATORSHIPS TODAY’S DATE: ___________________________ INSTRUCTIONS: This form is provided for you to summarize the financial transactions made during a given accounting period. Accounting guidelines are also included in this packet to help you complete this form. Attach this form to the Petition for Approval of the Annual Account. 1. This is the #__________ (1st, 2nd, and so forth) annual accounting for this estate. This accounting covers the time period from __________________________(date) to __________________________(date). 2. The current amount of the bond is $________________. It should be increased to $________________, or decreased to $________________ to cover the unrestricted assets plus the unrestricted income of the next accounting period. ACCOUNT SUMMARY INSTRUCTIONS: Complete Lists A-F first, then enter the total from each list on this summary. A. B. C. D. E. F. 5/19/09 The beginning balance of the ward or protected person account from LIST A, page 2. $________________________________ PLUS the money I received during this period of time on behalf of the ward or protected person from LIST B, page 3. + $________________________________ PLUS the gains on the value of property I sold or otherwise disposed of and other adjustments as itemized in LIST C, page 4. + $________________________________ MINUS the money I have spent during this time period as itemized in LIST D, page 5. - $________________________________ - $________________________________ = $________________________________ MINUS the losses on the value of property I sold or otherwise disposed of and other reductions, as itemized in LIST E, page 6. EQUALS the ending balance of the property of the ward or protected person as itemized in LIST F, page 7. (Total) Page 1 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Case No._______________________________ LIST A—BEGINNING BALANCE Itemization of assets of ward or protected person at the beginning of this account period (Add as many sheets of paper as necessary to describe) Description Value List all checking accounts, savings accounts, money market accounts: (include name of bank, address, account type, name account is under, account number) List all stocks, bonds, mutual funds: (include company name, address, number of shares, value per unit) List all Life Insurance Policies: (include company name, policy number, cash value) List all personal property: Automobiles: (year, make, model) Household property: (total inventory value) Art or jewelry: (attach separate list and describe) Other: (itemize and assign value) List all real property: . 00 0 ENTER TOTAL FROM LIST A HERE AND ON PAGE 1, LINE A $__________________________ Note: If the estate owes debts on any of the property listed above, including credit card debt, then for each debt also indicate the payee, principal balance, interest rate, payoff date. 5/19/09 Page 2 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Case No.______________________________ LIST B—MONEY RECEIVED DURING THIS ACCOUNT PERIOD (Add as many sheets of paper as necessary to describe) PAYER DESCRIPTION TOTAL (ENTER AMOUNT HERE AND AT LINE B ON PAGE 1) 5/19/09 AMOUNT $$ . 00 0 DATE $____________________________ Page 3 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Case No.______________________________ LIST C—SCHEDULE OF GAINS Property of the ward or protected person that was sold or otherwise disposed of during this account period and other adjustments. (Add as many sheet of paper as necessary to describe) DATE OF SALE DESCRIPTION SALE PRICE LESS ANY FEE PAID LESS THE VALUE OF THE ASSET AS REPORTED IN THE PREVIOUS ACCOUNTING OR INVENTORY (if applicable) AMOUNT OF DOLLARS GAINED . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 5/19/09 . 00 0 TOTAL (ENTER AMOUNT HERE AND AT LINE C ON PAGE 1) $_____________________________ Page 4 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Case No.______________________________ LIST D—MONEY SPENT On behalf of the ward or protected person during this account period (Add as many sheets of paper as necessary to describe) CHECK NUMBER PAYEE PURPOSE TOTAL (ENTER AMOUNT HERE AND AT LINE D ON PAGE 1) 5/19/09 AMOUNT $$ SPENT . 00 0 DATE $______________________________ Page 5 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Case No.______________________________ LIST E—SCHEDULE OF LOSSES Losses on the value of property sold or otherwise disposed of, and other reductions in the value of the estate during this account period (Add as many sheets of paper as necessary to describe) DATE OF SALE DESCRIPTION SALE PRICE LESS ANY FEE PAID LESS THE VALUE OF THE ASSET AS REPORTED IN THE PREVIOUS ACCOUNTING OR INVENTORY (if applicable) AMOUNT OF DOLLARS LOST . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 5/19/09 . 00 0 TOTAL (ENTER AMOUNT HERE AND AT LINE E ON PAGE 1) $____________________________ Page 6 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Case No.______________________________ LIST F—VALUE OF THE WARD or PROTECTED PERSON’S PROPERTY AS OF THE END OF THIS ACCOUNT PERIOD Itemization of assets of the ward or protected person at the end of this account period (Add as many sheets of paper as necessary to describe) List all checking accounts, savings accounts, money market accounts: (include name of bank, address, account type, name account is under) Attach Statements * List all stocks, bonds, mutual funds: (include company name, address, number of shares, value per unit) Attach Statements * List all Life Insurance Policies: (include company name, policy number, cash value) List all personal property: Automobiles: (year, make, model) Household property: (total inventory value) Art or jewelry: (attach separate list and describe) Other: (itemize and assign value) List all real property: . 00 0 ENTER TOTAL FROM LIST F HERE AND ON PAGE 1, LINE F $______________________________ If the estate owes debts on any of the property listed above, including any credit card debt, then for each debt also indicate the payee, principal balance, interest rate, payoff date. *Attach photocopies of Financial Statements reconciling the bank and investment account balances to the accounting copy provided for the Court Accountant. The copies will be kept secure and confidential. 5/19/09 Page 7 of 7 American LegalNet, Inc. www.FormsWorkFlow.com