JDF 942 SC R 6 /1 9 INTERIM/ FINAL ACCOUNTING Page 1 of 3 District Court Denver Probate Court County, Colorado Court Address: I n the Matter of the Estate of : Deceased COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg.#: Case Number: Division Courtroom INTERIM FINAL ACCOUNTING FOR PERIOD: FROM T O PURSUANT TO C .R.P.P. 31 This a ccounting must be typed or prepared by automated data processing. SUMMARY OF RECEIPTS AND EXPENDITURES ONLY Balance on hand at the beginning of this accounting period $ Add: Total funds received or collected during this accounting period from page 2 $ Less: Total payments during this accounting period from page 3 $ Balance on hand at the end of this accounting period $ SUMMARY Schedule Asset Category Value 1 Real Estate 2 Stocks, Bonds, Mutual Funds, Securities , and Investment Accounts 3 Mortgage, Notes, Cash, and bank checking, savings, certificates of deposit and health savings accounts 4 Life Insurance 5 Pension s , Profit Sharing Plans , Annuities , and Retirement Funds 6 Motor and Recreation Vehicles 7 Other Assets Total Gross Value 8 Liens and Encumb rances Total Net Value (Total Gross Value minus Liens and Encumbrances) American LegalNet, Inc. www.FormsWorkFlow.com JDF 942 SC R 6 /1 9 INTERIM/ FINAL ACCOUNTING Page 2 of 3 Detail Listing of Funds Received or Collected During Accounting Period List below each individual item of funds received or collected for th is accounting period. Attach add itional pages , if needed . Date Description of Funds Received or Collected Amount Page of Total $ $ American LegalNet, Inc. www.FormsWorkFlow.com JDF 942 SC R 6 /1 9 INTERIM/ FINAL ACCOUNTING Page 3 of 3 Detail Listing of Payments During Accounting Period List below each item of payments during this accounting period. Attach add itional pages , if needed . Date Description of Payments Amount Page of Total $ $ VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the day of Executed on the day of (date) (date) , , , , (month) (year) (month) (year) at at (city or other location, and state OR country) (city or other location, and state OR country) (printed name) ( printed name) (Signature of Personal Representative) (Signature of Co - Personal Representative , if any) Attorney Signature, (if any) Date American LegalNet, Inc. www.FormsWorkFlow.com