JDF 882 SC R 6 /1 9 S FINANCIAL PLAN WITH INVENTORY AND MOTION FOR APPROVAL Page 1 of 11 District Court Denver Probate Court County, Colorado Court Address: I n the Interest of : Protected Person COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom FINANCIAL PLAN WITH INVENTORY AND MOTION FOR APPROVAL INITIAL REPORT INVENTORY VALUES AS OF DATE OF APPOINTMENT AMENDED REPORT INVENTORY VALUES AS OF DATE ( M M/DD/YYYY) DATE OF APPOINTMENT ( M M/DD/YYYY) FILING DUE DATE (MM/DD/YYYY) I , ( c onservator) , move this c ourt to approve this Initial Amended Financial Plan with Inventory . As grounds therefore, the c onservator states the following: 1. The information contained in the Financial Plan with Inventory is true and complete. The proposed plan is necessary to protect and manage the income and assets of the P rotected P erson. 2. The Financial Plan is based on the actual needs and best interest of the p rotected p erson. I understand that I am re quired to maintain supporting documentation for all receipts and disbursements including detailed billing statements from any professional. The c ourt or any i nterested p erson as identified in the Order Appointing Conservator may request copies at any time. I understand that I must pr ovide copies of this Financial P lan with Inventory to the p rotected p erson and any others as identified in the Order Appointing Conservator , within 10 days of filing with the c ourt and will indicate having done so by completing the c ertificate of s ervice a t the end of this form . (247 15 - 14 - 404(4), C.R.S.) Unless the c ourt receives a timely objection to this m otion, this matter will be considered unopposed and reviewed by the c ourt. Notice to i nterested p ersons. Interested persons have the responsibility to protect their own rights and interests within the time and in the manner provided by the Probate Code, including the appropriateness of disbursements, the compensation of fiduciaries, attorneys, and others, and the distribution of estate assets. Interested persons may file an objection with the c ourt. The c ourt may not review or adjudicate these or other matters unless specifically requested to do so by an interested person. American LegalNet, Inc. www.FormsWorkFlow.com JDF 882 SC R 6 /1 9 S FINANCIAL PLAN WITH INVENTORY AND MOTION FOR APPROVAL Page 2 of 11 PART A: CONTACT INFORMATION Prot Check if u pdated i nformation from p etition Name: Age : (Include Name of Living Center or Nursing Home , if applicable ) Street Address: City: State: Zip Code: Mailing Address, if differnty: City: State: Zip Code: Primary Phone : Alternate Phone: Check if u pdated i nformation from p etition Name: Age: Have you had any criminal charges filed against you or convictions entered since the last report? Yes No If Yes, explain: Occupation: Your Relationship to protected p erson: Street Ad dress: City: State: Z ip Code: Mailing Address, if different: City: State: Zip Code: Primary phone Alternate Telephone: Email a ddress: Co - (if applicable) Check if Updated Information from Petition Name: Age: Have you had any criminal charges filed against you or convictions entered since the last Petition? Yes No If Yes, explain: Occupation: Your Relationship to Protected Person: Street Ad dress: City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Primary phone Alternate Telephone: Email address: PART B: CONSERVATORSHIP ISSUES 1. Are the assets in the estate identified to date sufficient to provide for the present and future care of the Protected Person? Yes No If No , describe why and what steps should be taken. If you would like the Court to take action, you must file a motion with the Court. American LegalNet, Inc. www.FormsWorkFlow.com JDF 882 SC R 6 /1 9 S FINANCIAL PLAN WITH INVENTORY AND MOTION FOR APPROVAL Page 3 of 11 2. Should there be a change in scope of the Conservatorship? Yes No If Yes , describe why and what steps should be taken. If you would like the Court to take action, you must file a motion with the Court. 3. Bond has been set in the amount of $ . Sure t y has been posted. Motion for Approval. The Conservator now requests that bond be set in the amount of $. Bond has been waived by the Court. INSTRUCTIONS ON HOW TO COMPLETE THIS FORM The Financial Plan and Inventory must be filed with the Court pursuant to 247 24715 - 14 - 4 18 and 15 - 14 - 4 19 , C.R.S. Step s 1 and 2 are a projection of the annual income and expenses. Enter both the anticipated monthly and annual amounts in the respective columns. Step 3 Provide a detail ed description of the asset as well as the current fair market value. Step 4 summarizes all costs and expenses incurred by the estate related to this proceeding. Step 5 summarizes all debts of the estate. Provide a detail ed description as well as t he remaining amount due. Step 6 and 7 are a summary. Transfer the respective income and expense totals from Steps 1 and 2 as well as the asset and liability totals in steps 3 through 5 to the appropriate lines in Step 7 to calculate the net income and net worth. PART C: FINANCIAL PLAN List all expected sources of receipts/income and disbursements/expenses in the charts below. If a specific in the projected monthly and annual amounts columns. You will use these Step 1: Projected Receipts/Income Indicate the amount of cash receipts/income received on both a monthly and annual basis. If an income amount (such as wages) is to be received on a monthly basis, multiply the amount by 12 to determine the projected annual amount. If an income amount (suc h as dividends) is to be received on an annual basis, divide the amount by 12 to determine the projected monthly amount. Description of Receipt/Income Category Projected Monthly Amount Projected Annual Amount Asset Not Previously Reported Business Income Court Order Repayment Disability / Unemployment / Distribution Annuity Distribution Pension s /Retirement Plan Distribution - Trust American LegalNet, Inc. www.FormsWorkFlow.com JDF 882 SC R 6 /1 9 S FINANCIAL PLAN WITH INVENTORY AND MOTION FOR APPROVAL Page 4 of 11 Farm/Ranch Income Gifts from Others Inheritance Insurance Settlement/Benefit Interest/Dividends Loan Repayment Oil/Gas/Mineral Royalties Other Public Assistance Other Receipts/Income Proceeds from Sale of Assets Rental Income Reverse Mortgage Payment Social Security Tax Refunds VA Benefits Wages Total Receipts/Income Enter the total projected monthly and annual amounts in Step 6. Step 2: Projected Disbursements/Expenses Indicate the cash disbursement/expense amount on both a monthly and annual basis. If an expense (such as utilities) is to be paid on a monthly basis, multiply the amount by 12 to determine the projected annual amount. If an expense (such as property taxe s) is to be paid on an annual basis, divide the amount by 12 to determine the projected monthly amount. Description of Disbursement/Expense Category Projected Monthly Amount Projected Annual Amount Assisted Living/Care Facility Bank/Investment Account Fees Caregiver/In - Home Provider Charitable Contributions Clothing Collectibles Debt Repayment (excluding CC) Debt Repayment (Credit Card) Distributions - Protected Person Education/Tuition/Student Loan American LegalNet, Inc. www.FormsWorkFlow.com JDF 882 SC R 6 /1 9 S FINANCIAL PLAN WITH INVENTORY AND MOTION FOR APPROVAL Page 5 of 11 Entertainment/Movies Equipment Farm/Ranch Expense Fees Accountant/CPA Fees - Conservator Non Prof Fees Conservator Prof essional Fees Court Visitor Fees - Guardian Non Prof Fees - Guardian Prof essional Fees - Guardian Ad Litem (GAL) Fees - Investment Acct Management Fees - Legal for Conservator Fees - Legal for Guardian Fees Legal for GAL Fees Legal for Protected Person Fees Other Professional Funeral Gifts Groceries/Hygiene/Household Supplies HOA Fees Hobbies Home Furnishings Insurance Home/Renter Insurance Life Insurance Long Term Care Insurance Other Jewelry Livestock Loan Interest Loans Medical - Doctor/Prof/Hospital Medical - Furnishings/Supplies Medical - Insurance Medical - Medicab/Transportation Medical - Medi