IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT WILL COUNTY, ILLINOIS ­ IN PROBATE IN RE THE ESTATE OF _________________________________________ Name of disabled adult CASE NO: ___________________________ A Disabled Adult GUARDIAN OF ESTATE'S ANNUAL REPORT AND ACCOUNTING ________________________________________, by order entered _______________________, 20_____, Name of guardian Date Court appointed guardian was appointed plenary guardian of the estate of ________________________________________, pursuant to Name of disabled adult 755 ILCS 5/24-11 and Local Rule 10.13, respectfully submits the following annual report, accounting of the personal and real property discovered to date: A. Real Property: LIST THE ADDRESSES, TYPE OF INTEREST OF DISABLED ADULT (sole owner, joint owner, etc.) AND VALUE OF EVERY PIECE OF REAL PROPERTY OWNED. B. Personal Property: LIST EVERY BANK ACCOUNT, VEHICLE, LIFE INSURANCE POLICY, ETC. OWNED BY THE DISABLED ADULT AND ITS VALUE. FOR EACH ITEM, LIST ANY OTHER NAMES OR JOINT OWNERS OF EACH ACCOUNT, ETC. Item No. 1. 2. 3. 4. Summary: The total amount of the ward's estate on ________________is $___________________. Date of signing Total value of A + B items Description Amount ANDREA LYNN CHASTEEN, CLERK OF THE CIRCUIT COURT OF WILL COUNTY American LegalNet, Inc. www.FormsWorkFlow.com 129 ­ Part 1(Revised 12/16) C. Expenditures (List in detail) ­ LIST THE DATE AND AMOUNT OF EVERY EXPENDITURE MADE WITH THE DISABLED ADULT'S MONEY. D. Income (List in detail) ­ LIST THE DATE AND AMOUNT OF MONEY RECEIVED ON BEHALF OF THE DISABLED ADULT. _________________________________________________ (Signature of guardian) Address of Guardian:_______________________________ _________________________________________________ Guardian of _______________________________________ Name of disabled adult VERIFICATION UPON AFFIRMATION I, ________________________________________, being first duly sworn on oath, depose and state that I Name of guardian am guardian of the estate of _____________________________________, that I have read the foregoing Name of disabled adult Annual Report and Accounting, that I know the contents thereof, and that the same are true and correct to the best of my knowledge. _________________________________________________ (Signature of guardian) Prepared By: Attorney _______________________________________ Firm __________________________________________ ARDC# _______________________________________ Address ________________________________________ City and Zip ____________________________________ Telephone ______________________________________ ANDREA LYNN CHASTEEN, CLERK OF THE CIRCUIT COURT OF WILL COUNTY American LegalNet, Inc. www.FormsWorkFlow.com 129 ­ Part 2 (Revised 12/16)