PR-ACC1: revised 12/01/06 Page 1 of 2 IN THE CIRCUIT COURT OF THE 17TH JUDICIAL CIRCUIT BOONE COUNTY, ILLINOIS Probate Division IN THE MATTER OF THE GUARDIANSHIP OF ) ) ) ) Disabled Person ) Case Number ACCOUNTING I, , am the Guardian of the Estate of , a disabled person, and the following is a true and complete Accounting of the Estate222s Cash Receipts and Disbursements covering the period from , 20, to , 20, and an Inventory of the Ward222s Assets as of , 20. CASH RECEIPTS Date Description Amount $ $ $ $ $ TOTAL CASH RECEIPTS $ CASH DISBURSEMENTS Recapitulation Date Description Amount $ $ $ $ $ $ $ $ TOTAL CASH DISBURSEMENTS $ Cash on Hand Beginning of Accounting Period $ Total Cash Receipts (Listed above) $ Total Cash Disbursements (Listed above) $ Cash on Hand Ending of Accounting Period $ American LegalNet, Inc. www.FormsWorkFlow.com PR-ACC1: revised 12/01/06 Page 2 of 2 INVENTORY Item Number Description Value $ $ $ $ $ $ $ $ $ $ TOTAL VALUE $ I am the duly appointed and acting Guardian of the Estate of , a disabled person, and attest that the above Accounting signed by me is true and correct to the best of my knowledge and belief. Signed this day of , 20. Guardian222s Signature I, , the duly appointed and acting Guardian of the Estate of , a disabled person, provided the information for this Accounting to the person named below. PREPARED BY: Name: Address City, State Zip Telephone: Email RETURN TO: Boone County Clerk of the Circuit Court Attn: Probate Division 601 N. Main Street Belvidere, IL 61008 American LegalNet, Inc. www.FormsWorkFlow.com