NAME AND ADDRESS OF ATTORNEY: TELEPHONE NO.: FOR COURT USE ONLY ATTORNEY FOR: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO Central District, 351 N. Arrowhead Ave., San Bernardino, CA 92415-0210 West District, 8303 Haven Avenue, Rancho Cucamonga, CA 91730 Desert District, 14455 Civic Drive, Victorville, CA 92392 North Desert District, 235 E. Mountain View, Barstow, CA 92311 IN THE MATTER OF THE ADOPTION PETITION OF: ADOPTING PARENT(S) ACCOUNTING REPORT CASE NUMBER: Date of Hearing IN COMPLIANCE with the provisions of Section 8610 of the Family Code, the petitioners herein submit to the Court a full accounting report: 1. Itemize all disbursements and agreements to disburse money (or anything else of value), paid by or on behalf of petitioners, or either of them, in connection with the birth, placement, medical or hospital care of the natural mother or child; also any other known expenses of either the natural parents of the child in connection with the adoption. 2. Itemize all services and by whom rendered relating to the adoption or placement of the child received by petitioners for adoption. Show by whom said services were received or to be received, i.e. (a) petitioners (b) either natural parent of the child (c) the child ACIS Code 37100 ACCOUNTING REPORT 15-7916-356 Rev 1/99 SB-7916 2002 © American LegalNet, Inc. (d) any other person 3. Show name and address of each attorney, doctor, hospital, licensed adoption agency, or other person or organization who received any funds of the petitioners or participated in any way in the handling of such funds, either directly or indirectly. NOTE: DISBURSEMENTS MUST BE ITEMIZED WITH DATES OF EACH PAYMENT. We declare under penalty of perjury that the foregoing is true and correct. Executed on (Date) at California (Place) Petitioners 2002 © American LegalNet, Inc.