Case Number0Revision 12/06/2017 Sixth Circuit Guardianships SIMPLIFIED ANNUAL ACCOUNTING The 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. American LegalNet, Inc. www.FormsWorkFlow.com Name 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] Amended Form? [Place 'Yes' in this box.] FromToLine 1Line 2Line 3Line 4Line 5Line 6Line 7Line 8Enter 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).Case Number0Income Starting Balance [Net Assets per the Prior Report]Attorney for GuardianType of GuardianshipGuardian(Only the following receipts qualify)Less DisbursementsDeposits pursuant to Settlement $0.00 INSTRUCTIONS Remaining Assets On Hand should agree with the fiscal yearend statements.(continued) Financial Institution Service ChargesFederal Income TaxRemaining Assets On Hand $0.00 Assets On Hand $0.00 Total DisbursementsThis Simplified Annual Accounting report with ORIGINAL Signatures is DUE on the FIRST Day of the FOURTH Month after the Ward's Fiscal YearendTHIS SIMPLIFIED ANNUAL ACCOUNTI NG, as provided for within Florida Statute 744.3679, is appropriately used when, and only when, all assets of the guardianship are in designated depositories under F.S. 69.031 and the only transactions that occur in that account are interest income, deposits pursuant to settlement, financial institution service charges and payment of federal income tax.Copies of the FISCAL year-end statement{s) of all the Ward's cash accounts from each of the designated depositories where cash is deposited must be attached.(Only the following receipts qualify)Total IncomeInterest IncomeIN THE CIRCUIT COURT, SIXTH JUDICIAL CIRCUIT, FLORIDAACCOUNTING SUMMARY and REMAINING ASSETS ON HAND For Official Use Only: SIMPLIFIED ANNUAL ACCOUNTING0IN RE: GUARDIANSHIP OFSocial Security NumberFor the Period Part II REQUIRED INFORMATION The Guardianship Inception Date ("GID ") is the date the Letters of Guardianship were signed. Part I American LegalNet, Inc. www.FormsWorkFlow.com Name of Ward:0Case Number:(insert date)01/00/00 Guardian #1's Street Address Guardian #1's Name 0 Guardian #1's Signature (continued) Co-Guardian #2's Signature Date Co-Guardian #2's Name Co-Guardian #2's SSN / EIN Co-Guardian #2's Street Address Co-Guardian #2's City / State / Zip Code Co-Guardian #2's Phone Number from205205205205205.205.. through205205205205205205205205205205205... *** All guardians of the property must sign and provide the most current address, telephone number, and social security number.***Part IV (insert date) 01/00/00 Guardian #1's Phone Number *** Only reports with Original Signatures will be audited by the Clerk of the Court.*** Guardian #1's City / State / Zip Code Date Guardian #1's SSN / EIN Part IIIUnder penalties of perjury, I declare that I 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 disbursements by me from ........................................................Page 2IN THE CIRCUIT COURT, SIXTH JUDICIAL CIRCUIT, FLORIDA0SIMPLIFIED ANNUAL ACCOUNTING0 Co-Guardian #3's Signature Date Co-Guardian #3's Name Co-Guardian #3's SSN / EIN Co-Guardian #3's Street Address Co-Guardian #3's Phone Number Co-Guardian #3's City / State / Zip Code American LegalNet, Inc. www.FormsWorkFlow.com Name of Ward:Page 3Case Number:00Summary0IN THE CIRCUIT COURT, SIXTH JUDICIAL CIRCUIT, FLORIDASIMPLIFIED ANNUAL ACCOUNTINGPart V SIGNATURE of GUARDIAN ATTORNEYThe attorney may use an electronic signature "/s/"The undersigned Attorney hereby notifies the Court of the filing of the simplified annual accounting of the Guardian 205205205205205205205205205205205205205205205205205205205205205205205205205. Ward's name for the period205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205205.0 Attorney Signature Date Attorney's Name [linked to Part I] from205205205205205.205205205205205. (insert date) through205205205205205205205205205205205205205205205.. (insert date) 01/00/0001/00/00This simplified 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 .......................................................................................................................................... County, Florida. 0/s/0 Attorney's Bar Number Attorney's Street Address Attorney's Phone Number Attorney's City / State / Zip Code Part X GUARDIAN ATTORNEYCertificate of Service The attorney may use an electronic signature "/s/"Pursuant to the Florida Statute 744.362(1), I hereby certify that a copy of this simplified annual accounting has been furnished to: Name and Address of RecipientName and Address of RecipientName and Address of RecipientName and Address of RecipientAttorney's Name [linked to Part I]Indicate if:DateDate on this date205205205205205205205205205205205205205205205.. Attorney Signature (End of Simplified Annual Accounting)0 Attorney's Street Address Attorney's City / State / Zip CodeAttorney's Phone Number/s/ Attorney's Bar Number American LegalNet, Inc. www.FormsWorkFlow.com