GC-400(A)(1) CONSERVATORSHIP GUARDIANSHIP OF Conservatee Minor CASE NUMBER: (Name): Schedule A, Receipts, Dividends--Standard Account* *Noncapital items (Note returns of principal with the items listed below, but do not include their dollar amounts in the amounts or the total. Report returns of principal on Schedule A1, Return of Principal (there is no form for that schedule), add their dollar amounts to cash assets on hand, and subtract their dollar amounts from the carry values of the securities involved.) Dividends Date of Receipt (mm/dd/yyyy) Description* * (Report dividends from each security separately.) Amounts $ Subtotal, Dividends: $ (Add pages as required. Check the box at the bottom of the last page of this receipt category and total the amount of the category. Include that sum in the total of receipts on line 3 of the Summary of Account (form GC-400(SUM)/GC-405(SUM)). pages Page A of The page total to the right is the number of pages in Schedule A.) Form Approved for Optional Use Judicial Council of California GC-400(A)(1) [New January 1, 2008] SCHEDULE A, RECEIPTS, DIVIDENDS--STANDARD ACCOUNT (Probate--Guardianships and Conservatorships) Probate Code, §§ 1060­1064, 2620; Cal. Rules of Court, rule 7.575 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com