IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT WILL COUNTY, ILLINOIS - IN PROBATE IN RE THE ESTATE OF __________________________________ Name of Minor Child A Minor CASE NO: ____________________________ ANNUAL REPORT AND ACCOUNTING _________________________________, by order entered ______________________, was appointed Name of guardian Date of order for guardianship plenary guardian of the estate/person/estate and person of _________________________________ and now Circle one Name of minor child respectfully submits the following annual report and accounting of the personal and real property discovered to date: A. Status of Minor 1. The address of the minor child at the time I was appointed guardian was _________________________________________________________________________________. 2. The minor child now lives at the following address _________________________________________________________________________________. (If the ward has changed addresses, an explanation must be provided.) 3. The minor's current school is _________________________________________________________. 4. The minor has health insurance through: Private insurance company _______________________________ through Name of insurance company ________________________________________________________________________ Name of person who provides minor child with insurance Illinois Medicaid Program Other: __________________________________________________________________ None 5. _______________________________________ receives food stamps on behalf of the minor child. B. Real Property (List any land, houses or real estate owned by the minor child): Address Value How Value Determined ANDREA LYNN CHASTEEN, CLERK OF THE CIRCUIT COURT OF WILL COUNTY American LegalNet, Inc. www.FormsWorkFlow.com 93 Part 1 of 2 (Revised 12/16) C. Personal Property (This may include items such as bank accounts, life insurance, savings bonds, college savings program, automobiles, and cash): ALL ACCOUNTS DO NOT ALLOW FOR ANY WITHDRAWALS WITHOUT COURT ORDER OR UNTIL MINOR REACHES 18 YEARS OLD Item No. Description Amount 1. 2. 3. Summary: The total value of the minor's estate on _________________ is $______________________. Date of signing Total of all items in B and C D. Expenditures (List in detail, including all bills paid with the minor's money including all medical bills, school supplies, activities, etc. � ATTACH SEPARATE SHEET IF NECESSARY) E. Income received by minor or for minor (List in detail, including any income for the minor child from Social Security- ATTACH SEPARATE SHEET IF NECESSARY) Respectfully submitted, ______________________________________, Signature of guardian Guardian of ____________________________ Minor child VERIFICATION UPON AFFIRMATION I, __________________________________, being first duly sworn on oath, depose and state that Name of guardian I am guardian of the estate of _________________________, that I have read the foregoing Annual Report and Name of minor child Accounting, that I know the contents thereof, and that the same are true and correct to the best of my knowledge. ______________________________________ Signature of guardian Person/Attorney Who Prepared Form: Name: __________________________________________________ Address: ________________________________________________ City and Zip: ____________________________________________ Phone: _________________________________________________ ARDC #: _______________________________________________ ANDREA LYNN CHASTEEN, CLERK OF THE CIRCUIT COURT OF WILL COUNTY American LegalNet, Inc. www.FormsWorkFlow.com 93 Part 2 of 2 (Revised 12/16)