Approved, SCAO JIS CODE: ACC FILE NO. STATE OF MICHIGAN PROBATE COURT COUNTY ACCOUNT OF FIDUCIARY, LONG FORM Annual Final Interim Number AMENDED CIRCUIT COURT - FAMILY DIVISION In the matter of 1. I, , am the Name Title of the estate and submit the following as my account, which covers the period from Month, day, year to (may not exceed 12 months). Month, day, year 2. SUMMARY Balance on hand from last account, or value of inventory if first account ......................................... Add income in this accounting period (Total from Schedule A.) ............................................................ Total assets accounted for ......................................................................................................... Subtract disbursements in this accounting period (Total from Schedule B.)........................................... Total balance of assets remaining (Itemize and describe in Schedule D.) ........................................ $ $ $ $ $ 0.00 0.00 0.00 0.00 If additional sheets are required for Schedules A or B, place all itemization on those sheets and include only category totals on the schedules below. SCHEDULE A: Income and gain in this accounting period SCHEDULE B: Expenses, losses, and other disbursements, including distributions to devisees and beneficiaries Investment gain Investment loss Disposition gain, if any, from Schedule C Disposition loss, if any, from Schedule C Total Income and Gain Total Expense, Loss, and Disbursement 0.00 0.00 SEE SECOND PAGE Do not write below this line - For court use only PC 584 (9/09) ACCOUNT OF FIDUCIARY, LONG FORM MCL 330.1631, MCL 700.3703(4), MCL 700.5418, MCR 5.308(A), MCR 5.310(C), MCR 5.313, MCR 5.409 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE C: Gain and loss on disposition of assets DESCRIPTION DATE ACQUIRED DATE SOLD/DISPOSED VALUE AT TIME ACQUIRED BY FIDUCIARY (Use only if needed.) NET SALES PRICE GAIN (LOSS) 0.00 0.00 0.00 0.00 0.00 TOTAL GAIN (LOSS) .................................................... 0.00 0.00 If gain, transfer to Schedule A. If loss, transfer to Schedule B. SCHEDULE D: Itemized assets remaining at end of accounting period If additional sheets are required, indicate on Schedule "See attached sheets." BALANCE OF ASSETS REMAINING (Show this amount on summary.) ............................ NOTE: In guardianships and conservatorships, except as provided by MCR 5.409(C)(4), you must present to the court copies of corresponding financial institution statements or you must file with the court a verification of funds on deposit, either of which must reflect the value of all liquid assets held by a financial institution dated within 30 days after the end of the accounting period. 3. The interested persons, addresses, and their representatives are identical to those appearing on the initial application/petition, except as follows: (For each person whose address changed, list the name and new address; attach separate sheet if necessary. ) 4. This account lists all income and other receipts and expenses and other disbursements that have come to my knowledge. 5. This account is not being filed with the court. 6. My fiduciary fees incurred during this accounting period (including fees that have already been approved and/or paid for this accounting period) are $ . Attached is a written description of the services performed. 7. Attorney fees incurred during this accounting period (including fees that have already been approved and/or paid for this accounting period) are $ . Attached is a written description of the services performed. I declare under the penalties of perjury that this account has been examined by me and that its contents are true to the best of my information, knowledge, and belief. Date Fiduciary signature Attorney signature Attorney name (type or print) Bar no. Address City, state, zip Fiduciary name (type or print) Address Telephone no. City, state, zip Telephone no. NOTE: If the decedent died before October 1, 1993, you must attach proof of inheritance tax paid. If the decedent died between October 1, 1993 and December 31, 2004, you must attach proof of estate tax paid. If the decedent died on or after January 1, 2005, there is no Michigan estate tax or inheritance tax. (For accounts that must be filed with the court.) NOTICE TO INTERESTED PERSONS 1. You must bring to the court's attention any objection you have to this account. The court will not review the account otherwise. 2. You have the right to review proofs of income and disbursements at a time reasonably convenient to the fiduciary and yourself. 3. You may object to all or part of an accounting by filing a written objection with the court before the court allows the account. You must pay a $20.00 filing fee to the court when you file the objection. (See MCR 5.310[C].) 4. If an objection is filed and is not otherwise resolved, the court will conduct a hearing on the objection. 5. You must serve the objection on the fiduciary or his/her attorney. American LegalNet, Inc. www.FormsWorkFlow.com