Superior Court of the District of Columbia PROBATE DIVISION Estate of _______________________________ __________ __________ __________ Case Year Case Type Case No. _______________________ Accounting of ______________________________________________________ (First, Second, etc.) (Name of Fiduciary) (Fiduciary Capacity) For period beginning ______________________ 20______, and ending ______________________ 20______ Debit(s) (Receipts) SUMMARY OF TRANSACTIONS Receipts: Total from Schedule “A” Beginning Balance………………………………………………. Credit(s) (Disbursements) $ Total from Schedule “B” Dividend Balance.………………………………………………… Total from Schedule “C” Interest Income……………………….…………………………. Total from Schedule “D” Annuity Income…………………………………………………… Total from Schedule “E” Rental Income………………………...…………………………. Total from Schedule “F” Other Collections……………………..…………………………. Total from Schedule “G” Gain…………………………………………………………………….. Disbursements: Total from Schedule “G” Losses…………………………………………………………………… $ Total from Schedule “H” Administrative Expenses…………………………………….. Total from Schedule “I” Rental Property Expenses…………………………………… Total from Schedule “J” Other Disbursements…………………………………………… Total from Schedule “K” Maintenance and Care Expenses – Distributions Total from Schedule “L” Ending Balance……………………………………………………. Totals (Columns must agree) ……………………………………………. Jan. 2010 $ $ Sheet 1 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE “A” BEGINNING BALANCE List below the assets held at the beginning of the accounting. In the First Accounting, these would be the assets held or in existence on the date of Appointment or Qualification. Each asset must be listed separately and described fully. In Guardianship, Conservatorship and Trust cases, include all personal property. Example: 600 shares XYZ Co., common stock Carrying value $8,000.00 Carrying Value $ If continuation sheet(s) are used, enter total here…………………………. $ Total (carry forward to summary) ……………………………………………………….. $ Jan. 2010 Sheet 2 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE “B” DIVIDEND INCOME List below the source of each dividend received, the amount, and the date of payment. Example: 100 shares common stock of XYZ Co. March 30, 19____ $30.00 June 30, 19____ 30.00 Sept. 30, 19____ 35.00 Dec. 31, 19____ 35.00 130.00 Receipts $ If continuation sheet(s) are used, enter total here………………………. $ Total (carry forward to summary) ……………………….……………………… $ SCHEDULE “C” INTEREST INCOME List below the source of each interest payment received, the amount, and the date of payment. Example: ABC Bank: March 30, 19____ $30.00 June 30, 19____ 30.00 Sept. 30, 19____ 30.00 Dec. 31, 19____ 40.00 130.00 Receipts $ If continuation sheet(s) are used, enter total here………………………. $ Total (carry forward to summary) ……………………….……………………… $ Jan. 2010 Sheet 3 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE “D” ANNUITY INCOME List below each annuity, pension, etc., identifying each as to source, period or months covered and the rate. Example: Social Security benefits for the calendar months of June 19____ through May 19____ 12 months as follows: 5 at $130.00 (136.70 Less 6.70 Insurance Premium) $650.00 7 at 140.00 (146.70 Less 6.70 Insurance Premium) 980.00 $1630.00 Receipts $ If continuation sheet(s) are used, enter total here………………………. $ Total (carry forward to summary) ……………………….……………………… $ SCHEDULE “E” RENTAL INCOME List below each parcel of real estate or rental unit, the period covered, the gross rent collection and the amount. If the property is not rented or was only partially rented, please indicate and explain the reason(s) therefore: Example: ABC Bank: 1111 – 99th Street, for the months of June 19____ through May 19____, at $300.00 $3,600.00 Receipts $ If continuation sheet(s) are used, enter total here………………………. $ Total (carry forward to summary) ……………………….……………………… $ Jan. 2010 Sheet 4 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE “F” OTHER COLLECTIONS List in detail below, the source(s) and amount(s) of all other collections not appropriate for inclusion in Schedules “B”, “C”, “D”, “E”, or “G”. This would include insurance, reimbursements, refunds, additional assets, proceeds from sale of real estate, etc. Receipts $ If continuation sheet(s) are used, enter total here…………………………. $ Total (carry forward to summary) ……………………………………………………….. $ Jan. 2010 Sheet 5 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE “G” GAINS AND LOSSES List in detail below, all security or other transaction(s). If the transaction resulted in a gain or loss, the amount of such gain or loss should be extended to the appropriate column. Example: 19____ 9/30 100 shares XYZ Co., common sold for $3,000.00 100 shares XYZ Co., common carried at $2,500.00 Net Gain $500.00 Gains Losses $ $ If continuation sheet(s) are used, enter total here…………… $ $ Total (carry forward to summary) ………………………………............ $ $ Jan. 2010 Sheet 6 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE “H” ADMINISTRATIVE EXPENSES List in detail below each expenditure of an administrative nature. This would include attorney’s fees, audit fees, bond premiums, bank charges, court costs, etc. Disbursements $ If continuation sheet(s) are used, enter total here…………….………. $ Total (carry forward to summary) ……………………….……………………… $ SCHEDULE “I” RENTAL PROPERTY EXPENSES List in detail below, all expenditures related to rental property(ies). If the expenses relate to more than one property, the expenses should be grouped as to each property. Disbursements $ If continuation sheet(s) are used, enter total here………………………. $ Total (carry forward to summary) ……………………….……………………… $ Jan. 2010 Sheet 7 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE “J” OTHER DISBURSEMENTS List in detail below all other disbursements or credits which cannot properly be included in Schedules “G”, “H”, “I”, or “K”. Disbursements $ If continuation sheet(s) are used, enter total here………………………. $ Total (carry forward to summary) ……………………….……………………… $ SCHEDULE “K” MAINTENANCE AND CARE EXPENSES List in detail below, all expenditures for the maintenance and care of Ward in Guardianship and Conservatorship cases. In Trust cases, list all distributions to beneficiaries. Disbursements $ If continuation sheet(s) are used, enter total here………………………. $ Total (carry forward to summary) ……………………….……………………… $ Jan. 2010 Sheet 8 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE “L” List below the assets held at the end of the accounting period. Each asset must be listed separately and described fully. In Guardianship, Conservatorship and Trust cases, include all personal property. In Trusteeship cases, include all personal and real property. The Fair Market Value should be as of the closing date of the accounting. Carrying Fair Market Example Value Value 500 shs., XYZ Co., common stock $5,000.00 $10,000.00 Cert No. 177253 100 shs. Dated 11-1-66 187644 200 shs. Dated 9-5-69 197223 200 shs. Dated 12-2-70 ________ ________ Fair Market Value Carrying Value $ $ If continuation sheet(s) are used, enter total here ………….. $ $ Total (carry forward to summary) ………………………………............ $ Jan. 2010 $ Sheet 9 American LegalNet, Inc. www.FormsWorkFlow.com REAL ESTATE Lot 4008, Square 42, improved by premises 722 Easy Lane, Washington, DC Rented for $250.00 per month (IF NOT INCLUDED IN SCHEDULE “L”) $10,000 COMPLETE LOCATION AND DESCRIPTION Assessed Value $ None Encumbrance (Mortgage Lien, Etc.) $ Unknown Market Value if Known $ COLUMN TOTALS……………………………………. $ $ $ The foregoing securities are kept or deposited at _______________________ ___________________________________________________________________ in the name of ______________________________________________________ The penalty of my undertaking is $__________________ The original undertaking was filed on the _____day of____________, 20____ The surety is __________________________________________________ District of Columbia. to wit: I ____________________________________________, being first duly (Type or Print Plainly) sworn, on oath, depose and say that I have read the foregoing account by me subscribed and that the facts therein stated are true to the best of my knowledge, information, and belief. _____________________________ ____________________________ Signature Address (Actual address/ not Post Office Box) ___________________________________________ Typed Name __________________________________________ ___________________________________________ Telephone Number __________________________________________ E-mail address (optional) Subscribed and sworn to before me this ____day of______________, A.D. 20____ _____________________________ Notary Public/Deputy Superior Court of the District of Columbia PROBATE DIVISION On this __________ day of _______________________, A.D. 20_________ the foregoing account, being presented for approval, the account is, after examination by the Court, approved and passed. ______________________________________________ Judge Jan. 2010 Sheet 10 American LegalNet, Inc. www.FormsWorkFlow.com