In The Circuit Court For The Seventh Judicial Circuit of Illinois Sangamon County, Springfield, Illinois ESTATE OF Case No. _ M lIlor ~ Incompetent - Deceased ACCOUNT ~, I, state that I am~ of being first duly sworn, on oath _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _~, and submit to the Court of following report of my acts as such from the date of my appointment to _ I charge myself with the foIl owing, to-wit: RECEIPTS Total Receipts Form PR9009-20A American LegalNet, Inc. www.FormsWorkflow.com I ask to be credited with the following disbursements: DISBURSEMENTS Total Disbursements American LegalNet, Inc. www.FormsWorkflow.com In The Circuit Court For The Seventh Judicial Circuit of Illinois Sangarnon County, Springfield, Illinois ESTATE OF Case No. _ Mmor - Incompetent - Deceased RECAPITULAnON Total Receipts: _ Total Disbursements:. _ Balance:. _ I report that: I. All assets have been collected. 2. *All claims have been paid or dismissed. 3. *No claims have been presented. 4. __ (TI_,_el_("_·o_l .Illinois Inheritance Tax~ (Has been paid in the amount of $ 5. _ _ CT_he_)(_N_o_l -!)(has been provided for as follows:)(is due) .Federal Estate Tax~ (Has been paid in the amount of $ _ _ )(has been provided for as fallows:)(is due) 6. All court costs have been paid. 7. **An Estate Tax Closing Letter is filed with this Report. 8. **A countersigned receipt for the payment of the Illinois Inheritance Tax is filed with this Report. 9. Income tax returns for the estate through the fiscal year ending have been filed and the income tax, both Federal and Illinois, have been paid. Final income tax returns to the Internal Revenue Service and the Illinois Department of Revenue for the estate will be filed through the _ closing of the estate showing full distribution of income to The foregoing is a full account of all my dealings and transactions and of all monies and effects received by me and paid out by me on account of said administration from the date of my appointment to: American LegalNet, Inc. www.FormsWorkflow.com CHOOSE THE APPLICABLE RELIEF ** I submit receipts of all beneficiaries of the estate waiving notice of hearing on this report and consenting to the approval ofthis report. ** I request that this Report be approved and that this estate be closed and that I be discharged as representative. ** I state that the following real and personal estate is on hand. I request that this Report be set for hearing and that I be directed to make distribution of the remaining assets as follows: Upon report of distribution as above provided I request that this estate be closed without further notice and that I be discharged as representative. Dated this,_ _-----'day of. ~, 20,_ _ STATE OF ILLINOIS COUNTYOF Subscribed and sworn to before me this _ _ _ day of __ ,20_ _ Notary Public Name: Attorney for: _ _ Address: City, State, Zip: Telephone: _ _ (** Strike is not applicable) American LegalNet, Inc. www.FormsWorkflow.com