Select County Indicate Filing Type: AnnualName of Ward: [entering the Ward's Name here will auto-populate this document]GID: [see below]Case Number: [entering the Case Number here will auto-populate this document] www.jud6.org Amended Form? [Place 'Yes' in this box.] NoFromToRevision 12/06/2017Attorney for GuardianType of GuardianshipThe purpose of this accounting is to report the assets on hand at the beginning of the accounting period, all transactions that have occurred during the period covered by the accounting, and the assets that remain on hand at the end of the accounting period. It consists of a SUMMARY sheet and SCHEDULES showing all Receipts, all Disbursements, all Capital Transactions and Adjustments (the effect of which are also reflected in other schedules, if appropriate), and assets on hand at the end of the accounting period. For the Period Case Number: [this Case Number is auto-populated from the "Case Number" box, above]0GuardianPart I REQUIRED INFORMATIONIN RE: GUARDIANSHIP OF: [this Name is auto-populated from the "Name of Ward" box, above]0Social Security Number Enter all amounts in this document in numbers, e.g., 2500.50 or -2500.50. Each entry will be automatically converted into dollars and cents: $2,500.50 or ($2,500.50). Does the ward have sibling(s), spouses or other relatives with his or her own guardianship? 205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205 List case number(s) here: IN THE CIRCUIT COURT, SIXTH JUDICIAL CIRCUIT, FLORIDA For Official Use Only: ANNUAL ACCOUNTING INSTRUCTIONS This signed Annual Accounting is DUE on the FIRST Day of the FOURTH month after the ward222s Fiscal Year-end, pursuant to FS 744.367. The Guardianship Inception Date ("GID ") is the date the Letters of Guardianship were signed. The first page of each schedule of this Annual Accounting is to be submitted, even if there are NO assets/liabilities listed on the schedule.The assets and liabilities included herein must be valued as of the Ward's Fiscal Year-End. ADDITIONAL INSTRUCTIONS may be found by clicking on this link: American LegalNet, Inc. www.FormsWorkFlow.com Name of Ward:0Case Number: (insert date) 01/00/000 and includes a statement of the ward's assets at the close of said period. I also certify that any and all annual investigatory forms and fees have been filed and paid, unless exempt by Florida Statute or Court Order. 01/00/00 (insert date) from205205205205205.205.. through205205205205205205205205205205205... UNDER PENALITIES OF PERJURY, I declare that l have read and examined the foregoing return and that, to the best of my knowledge and belief, it constitutes a full and correct account of all the ward's property of which this guardian has control, and is a complete report of all cash and property transactions and of all receipts and any disbursements by me .......................................................................... *** Failure to pay the statutory audit fee may result in an Order Disapproving Guardian222s Report.*** In excess of $500,000From $100,000.01 up to and including $500,000From $25,000.01 up to and including $100,000Part IIThe undersigned guardian certifies that said guardian has obtained a receipt or canceled check for all expenditures and disbursements made on behalf of the ward, which said guardian will preserve along with other substantiating papers for a three (3) year period after discharge and will upon request make available for inspection as the court may order. (As per F.S.744.3678 (3).)Guardian CertificationIN THE CIRCUIT COURT, SIXTH JUDICIAL CIRCUIT, FLORIDAANNUAL ACCOUNTINGFiling TypeAnnualAudit Fee ScheduleAudit Fees 226 Annual Accountings per FS 744.3678AmountGuardian #1's SignatureDateGuardian #1's NameAnnual Accounting Estates with value of: $25,000 or less$250.00$170.00$85.00$20.00 Only the guardian222s signature must be original. Part III0 SSN / EIN Street Address Phone Number City / State / Zip Code Co-Guardian #2's Signature Date Co-Guardian #2's Name SSN / EIN Street Address Phone Number City / State / Zip Code Summary(continued) SSN / EIN Street Address Phone Number City / State / Zip Code Co-Guardian #3's Signature Date Co-Guardian #3's Name American LegalNet, Inc. www.FormsWorkFlow.com Name of Ward:Case Number:00Name of countyfor the period205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205.. from205205205205205.205205205205205205... PREPARER ATTESTATIONDateIN THE CIRCUIT COURT, SIXTH JUDICIAL CIRCUIT, FLORIDASummaryANNUAL ACCOUNTINGFiling TypeAnnualThe undersigned Attorney hereby notifies the Court of the filing of the annual guardianship accounting of the Guardian 205205205205205205205205205205205205205205205205205205205Select County Preparer's Phone Number Preparer's City / State / Zip Code 0 lhave compiled the accompanying Initial Inventory of assets and liabilities arising from cash transactions, current market valuation, and current estimatedmarket valuation of the guardianship of205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205.....................Ward's Namefor the period205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205(insert date)This compilation is limited to presenting information in the form of an Annual Accounting information and is the representation of the guardian. I have not audited or reviewed the accompanying guardianship accounting and, accordingly, do not express an opinion or any other form of assurance on it.01/00/00 through205205205205205205205205205205 *** If you240are240the240Guardian, Co-Guardian,240or240Guardian240Attorney - DO240NOT240SIGN240HERE. ***Preparer's NamePreparer's Signature Preparer's Street Address(continued) Attorney Signature /s/Attorney's Bar Number0 Attorney's Name [linked to Part I] Date Attorney's Phone Number Attorney's City / State / Zip Code Attorney's Street AddressPart IV01/00/00(insert date) County, Florida. This annual accounting is the representation of the guardian. l have not audited the accompanying guardianship accounting. The undersigned attorney represents that he/she has examined the contents of the accounting and that it conforms to the requirements of the Florida Guardianship Law and the standards for accountings in ............................................................................................................................................................Ward's name0 from205205205205205.205205205205205205205.. DateDate01/00/0001/00/00 through205205205205205205205205205205 The attorney may use an electronic signature "/s/"Part V SIGNATURE of GUARDIAN ATTORNEYPreparer's SSN / EIN American LegalNet, Inc. www.FormsWorkFlow.com Name of Ward:Case Number: Schedule ASchedule B-1$0.00 Schedule B-2$0.00 Schedule B-3$0.00 Schedule B-4$0.00Schedule CAsset Amount/ValueSchedule D-1$0.00 Schedule D-2$0.00 Schedule D-3$0.00 Schedule D-4$0.00 Schedule D-5$0.00 Other Court-Ordered DisbursementsAll Other DisbursementsStarting Balance [Net Assets at End of Accounting Period, per the Prior Period Report]Income/ReceiptsNet Assets at End of Accounting Period(continued) $0.00 Income and Disbursements During PeriodDisbursementsCapital Transactions During Period, Net $0.00 $0.00 ***THE FOLLOWING DATA WILL AUTO-COMPLETE---YOU WILL NOT NEED TO FILL IN ANY INFORMATION.***Total Disbursements*** Line 20 should equal line 30. If they do not, verify the amounts on the individual schedules.*** $0.00 Net Assets at End of Accounting Period Cash Assets $0.00 Real Estate and Real Property AssetsPersonal Property AssetsIntangible AssetsMortgages / Liabilities $0.00 $0.00 0Carrying ValuePart VI At End of Accounting Period Part VII ASSETS and LIABILITIES $0.00 Attorney Fees and Costs***THE FOLLOWING DATA WILL AUTO-COMPLETE---YOU WILL NOT NEED TO FILL IN ANY INFORMATION.***Gains/(Losses)/Adjustments on Sales or Disposals of AssetsGuardian Fees and CostsANNUAL ACCOUNTINGSUMMARY Changes in