IN THE CIRCUIT COURT FOR HILLSBOROUGH COUNTY, STATE OF FLORIDA, GUARDIANSHIP, PROBATE AND MENTAL HEALTH DIVISION IN RE: THE GUARDIANSHIP OF ___________________________________ (Name) Please circle/specify guardianship type: Plenary Minor Limited CASE NO.: ____-CP-__________ DIVISION: __________________ Voluntary (attach physician's statement if voluntary) ACCOUNTING (GUARDIANSHIP REPORT) OF GUARDIAN OF PROPERTY FROM: __________________ THROUGH: ________________ __________________________________________________________________________________________ SUMMARY Income Starting Balance Assets per Inventory or on Hand at Close of Last Accounting Period Totals $ $ Receipts Schedule A: $ $ Disbursements Schedule B: $ $ Capital Transactions and Adjustments Schedule C: Net Gain or (Loss) $ $ Assets on Hand at Close of Accounting Period Schedule D: Cash and Other Assets $ $ __________________________________________________________________________________________ 1 American LegalNet, Inc. www.FormsWorkFlow.com IN THE CIRCUIT COURT FOR HILLSBOROUGH COUNTY, STATE OF FLORIDA, GUARDIANSHIP, PROBATE AND MENTAL HEALTH DIVISION IN RE: THE GUARDIANSHIP OF ____________________________ CASE NO.: ___________________ FROM: __________________ THROUGH: ________________ __________________________________________________________________________________________ SCHEDULE ­A RECEIPTS Date Amount Bank Account Number Type of Income Ex: Social Security, Payor Income __________________________________________________________________________________________ TOTAL RECEIPTS . $ 2 American LegalNet, Inc. www.FormsWorkFlow.com IN THE CIRCUIT COURT FOR HILLSBOROUGH COUNTY, STATE OF FLORIDA, GUARDIANSHIP, PROBATE AND MENTAL HEALTH DIVISION IN RE: THE GUARDIANSHIP OF ____________________________ CASE NO.: ___________________ FROM: __________________ THROUGH: _________________ __________________________________________________________________________________________ SCHEDULE ­B DISBURSEMENTS Check Date of Court Payee Brief Description Amount Number Order (if required) of items __________________________________________________________________________________________ Date TOTAL DISBURSEMENTS . 3 $ American LegalNet, Inc. www.FormsWorkFlow.com IN THE CIRCUIT COURT FOR HILLSBOROUGH COUNTY, STATE OF FLORIDA, GUARDIANSHIP, PROBATE AND MENTAL HEALTH DIVISION IN RE: THE GUARDIANSHIP OF _____________________________ CASE NO.: __________________ FROM: __________________ THROUGH: ________________ _________________________________________________________________________________________ SCHEDULE ­C CAPITAL TRANSACTIONS AND ADJUSTMENTS Date Brief Description of Transactions Net Gain Net Loss __________________________________________________________________________________________ TOTAL NET GAINS AND LOSSES TOTAL NET GAIN OR (LOSS) 4 ________________________________ $ $ $ $ American LegalNet, Inc. www.FormsWorkFlow.com IN THE CIRCUIT COURT FOR HILLSBOROUGH COUNTY, STATE OF FLORIDA, GUARDIANSHIP, PROBATE AND MENTAL HEALTH DIVISION IN RE: THE GUARDIANSHIP OF _____________________________ CASE NO.: __________________ FROM: __________________ THROUGH: ________________ __________________________________________________________________________________________ SCHEDULE ­D ASSETS ON HAND AT CLOSE OF ACCOUNTING PERIOD (Indicate where held and legal description, certificate numbers or other identification) Current Value __________________________________________________________________________________________ ASSETS OTHER THAN CASH OTHER ASSETS TOTAL ____________________________________ $ CASH ACCOUNTS (with, at least, last four digits of account number: *Important Note: Please attach a copy of the bank statement that shows the account balance as of the last day of the reporting period, for each account. In the alternative, a letter from the bank with a bank official's signature and business card attached, which states the asset amount as of the date Letters of Guardianship were signed, may be provided for each account. CASH TOTAL _____________________________________ $ TOTAL ASSETS (must agree with the Total from the Summary Page) $________________ 5 American LegalNet, Inc. www.FormsWorkFlow.com IN THE CIRCUIT COURT FOR HILLSBOROUGH COUNTY, STATE OF FLORIDA, GUARDIANSHIP, PROBATE AND MENTAL HEALTH DIVISION IN RE: THE GUARDIANSHIP OF _____________________________ CASE NO.: __________________ FROM: __________________ THROUGH: ________________ The undersigned guardian (the Guardian) certifies that the Guardian has obtained a receipt or cancelled check for all expenditures and disbursements made on behalf of the ward, which the guardian will preserve along with other substantiating papers for a three (3) year period after discharge of the guardian, and will upon request be made available for inspection as the Court may order. Attached are copies of the annual or year-end statements of all the ward's cash accounts from each of the institutions where the cash is deposited. Attached is the required fee for the auditing of this accounting (unless waived by court order). AUDIT FEE MUST BE ATTACHED TO THIS REPORT: If the remaining Estate value is: $25,000 or less Fee $20.00 More than $25,000 to and including Fee $85.00 More than $100,000 to and including $500,000 Fee $170.00 More than $500,000 Fee $250.00 PURSUANT TO F.S. §744.3678 Under penalties of perjury, I declare that I have read and examined the foregoing accounting and that, to the best of my knowledge and belief, it constitutes a full and correct account of the receipts and disbursements of all of the ward's property over which the Guardian has control, including a complete report of all cash and property transactions and of all receipts and disbursements by the Guardian from _________________ through ________________ and a statement of the ward's assets at the end of the accounting period. This accounting has _____ been reviewed with the ward to the extent possible. Signed on________________________, 20____. __________________________ Guardian Print Name: _______________ Address: __________________ __________________________ Phone Number: (___) ___-____ Email Address: ___________________________ __________________________ Attorney for Guardian Print Name: _______________ Florida Bar No. ____________ Address: __________________ Phone Number: (___) ___-____ Email Address: _____________ 6 American LegalNet, Inc. www.FormsWorkFlow.com REMEMBER CERTIFICATE OF SERVICE: *Ward, if a Limited G