Approved, SCAO JIS CODE: ACC STATE OF MICHIGAN PROBATE COURT COUNTY FILE NO. ACCOUNT OF FIDUCIARY, SHORT FORM Number CIRCUIT COURT - FAMILY DIVISION Annual Final AMENDED Interim 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 to Month, day, year (may not exceed 12 months). Month, day, year COLUMN 1. INCOME, GAIN, AND OTHER RECEIPTS COLUMN 2. EXPENSES, LOSSES AND OTHER DISBURSEMENTS $ $ Investment gain Investment loss 0.00 Total Column 1 (Enter on line 2.b on page 2.) SEE SECOND PAGE Total Column 2 (Enter on line 2.d on page 2.) 0.00 Do not write below this line - For court use only PC 583 (9/09) ACCOUNT OF FIDUCIARY, SHORT FORM MCL 330.1631, MCL 700.3703(4), MCL 700.5418, MCR 5.308, MCR 5.310(C), MCR 5.313, MCR 5.409 American LegalNet, Inc. www.FormsWorkFlow.com 2. a. Balance on hand from last account, or value of inventory, if first account ........................................... $ b. Enter Total Column 1, Income, Gain, and Other Receipts, from the other side of this form ................ $ 0.00 $ 0.00 d. Enter Total Column 2, Expenses, Losses, and Other Disbursements, from the other side of this form $ 0.00 e. Balance of assets on hand (Subtract line 2.d from line 2.c and enter the amount here.) ............................................. $ This line must equal the last line in item 3. (Itemize assets below.) 0.00 c. Subtotal (Add line 2.a to line 2.b and enter the amount here.) ......................................................................................... 3. The balance of assets on hand are as follows: ITEMIZED ASSETS REMAINING AT END OF ACCOUNTING PERIOD $ Total balance on hand. This line must equal the last line in item 2. $ 0.00 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. 4. 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. ) 5. This account lists all income and other receipts and expenses and other disbursements that have come to my knowledge. 6. This account is not being filed with the court. 7. 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. 8. 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 Attorney signature Attorney name (type or print) Fiduciary signature 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