STATEMENT OF ACCOUNT Superior Court of the District of Columbia PROBATE DIVISION Washington, D.C. 20001 STATEMENT OF ACCOUNT Estate of Administration No._____________________________ _______________________________________________ Docket ______________________________________ Deceased Date of death _____________________________ Date of Appointment of Personal Representative _________________ ________________________________ ACCOUNT OF ________________________________________________________ First and Final, Second, etc. ______________________________________________________________________________________________________ _______________________________________________________________________________, Personal Representative(s) For period beginning ________________________________, 20____ and ending _____________________________, 20____ (The first accounting period begins at the date of death of the decedent.) CURSORY REVIEW Yes Waivers of formal court audit filed pursuant to D.C. Code §20-732 No Purpose of Account: The personal representative offers this account to comply with the provisions of D.C. Code §20-721 through §20-725, Court Rule 114 or 119 as applicable; and to acquaint interested persons with the transactions that have occurred during his or her administration. It is important that the account be carefully examined. SEE NOTICE TO INTERESTED PERSONS ON SHEET 15 HEREIN. Personal Representative: ______________________________ Counsel: _____________________________ Address: ___________________________________________ Address: _____________________________ ___________________________________________ ______________________________ Telephone No.: ______________________________________ Telephone No.: ________________________ See Instructions For Computing Court Costs On Reverse Updated August 2008 Sheet 1 American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS FOR COMPUTING COURT COSTS Court costs are based on the value of all personal assets reported in Schedule A through E. The court costs are assessed at the following rates: Pursuant to SCR-PD 125 Value of Probate Estate $10,000.01 but less than $25,000.01 but less than $50,000 but less than $75,000 but less than $100,000 but less than $500,000 but less than $750,000 but less than $1,000,000 but less than $2,500,000 but less than $5,000,000 and over $25,000 $50,000 $75,000 $100,000 $500,000 $750,000 $1,000,000 $2,500,000 $5,000,000 Court Costs $100 $150 $250 $350 $575 $825 $1,275 $1,800 $2,300 $2,300 plus 0.02% of excess over $5,000,000 Additional court costs totaling $25.00 are assessed when real property, of whatever value, irrespective of the number of parcels, is carried as a probate asset. Example: Total value of all assets reported on Schedules A-E $145,343.00 Less inventoried value of real property – 65,000.00 80,343.00 Court costs on personal assets of $80,343.00 $300.00 Court costs on real assets of $65,000 + 25.00 Total court costs $325.00 If the real estate is sold by the personal representative, the $25.00 assessment is eliminated, and court costs are assessed against the proceeds of sale, as personalty, as follows: Total value of all assets reported on Schedules A-E (includes proceeds of sale of real estate) $145,343.00 Total court costs on assets of $145,343 $500.00 Court costs are to be paid at the time of filing the first account; in later accounts, it is necessary to pay additional costs resulting from additional assets and increases reported therein. Costs paid are not refunded for later reductions in value of assets. Checks should be made payable to Register of Wills, D.C., and should be dated within 30 days of presentation. Costs should be reported on Schedule “G”. Please complete the following: Decedent’s final income taxes are: paid not paid, because ___________________________________________________ Fiduciary income taxes with respect to income received by the estate are: paid not paid, because ___________________________________________________ Unless otherwise shown in the account, list the name of any beneficiary who: is not an adult, or is under any other legal disability; died after the decedent; predeceased decedent; American LegalNet, Inc. www.FormsWorkflow.com