1 Check 221Final222 if the guardianship has been terminated or this is the last accounting of this guardian. 2 Beginning Date: If this is your first report, the beginning date is the date you were appointed the guardian. If this is a later report, the beginning date is the ending date of your last accounting. 3 Ending Date: Anniversary date. 251 2018 Nevada Supreme Court Page 1 226 Accounting COURT CODE: 1010 Your Name: Address: City, State, Zip: Phone: Email: Self-Represented IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE In the Matter of the Guardianship of the: Estate Person and Estate of: ( name of person who has a guardian) A Protected Person. CASE NO.: DEPT: ACCOUNTING ( check one) [ First, Second, Third, ] or Final1 through BEGINNING DATE2 ENDING DATE3 I/we certify that this is a true and accurate accounting of the assets, income, and expenses of this estate for the period described. American LegalNet, Inc. www.FormsWorkFlow.com Page Account Summary (totals from the following worksheets) Have you discovered any assets belonging to the Protected Person that were not listed on the previous inventory or accounting? No Yes: (describe the newly discovered assets) Have any claims been filed on behalf of the Protected Person (this would include a demand for payment or return of property)? No Yes: (describe the claim and any action taken regarding the account) 1. Starting Balance: (this is the same number as the Beginning Net Asset Value from Worksheet A. This is also the same as the ending balance from the last accounting or inventory ) $ 2. Gross Income / Interest / Money Received (from Worksheet B) Add + $ 3. Expenses (from Worksheet C, you must attach receipts for expenses over $250. Keep all other receipts in case the judge requests them.) Subtract - $ 4. Adjustments to the Value of the Assets (this is for any increase or decrease in the value of an asset, such as a house, vehicle, etc. Attach an itemized list for any item that increased or decreased in value since your last accounting or inventory) + / - $ 5. Adjustments as a result of any Asset Sales ( this is for any asset that was sold since your last accounting or inventory. Attach an itemized list showing the adjustments up or down from the sale ) + / - $ 6. Total Ending Balance (this number must match the Ending Net Asset Value from Worksheet A) $ American LegalNet, Inc. www.FormsWorkFlow.com Page Worksheet A: ASSETS & DEBTS Assets at Start of Accounting Period Based on: ( check one) Inventory; or Last Accounting Ending Balance As filed on ( date of last report ) Assets at End of Accounting Period Asset Value Assets Value Home Home Vehicles Vehicles Jewelry Jewelry Artwork Artwork Furniture Furniture Electronics Electronics Antiques Antiques Other Other Checking account Checking account Savings account Savings account Certificates of deposit Certificates of deposit Money market account Money market account Life insurance (cash value) Life insurance (cash value) Trust (Protected person222s interest only) Trust (Protected person222s interest only) Other Other Retirement account Retirement account Bonds Bonds Mutual funds Mutual funds Individual stock shares Individual stock shares Real estate other than home Real estate other than home Other Other Liabilities Amount Owed Liabilities Amount Owed Mortgage loan - Mortgage loan - Home equity loan - Home equity loan - Car loans - Car loans - Real estate loans - Real estate loans - Student loans - Student loans - Other loans - Other loans - - - Credit card debt - Credit card debt - Other debt - Other debt - Beginning Net Asset Value: $ Ending Net Asset Value: $ *The numbers in this column should be identical to the 223ending balance224 numbers from your last accounting or inventory (whichever was filed last) American LegalNet, Inc. www.FormsWorkFlow.com Page Worksheet B: GROSS INCOME of Gross income, interest, receipts, refunds received Date Description of Income Amount Received (+) i.e., 5/31/2018 i.e., Social Security Income i.e., $882 .00 TOTAL THIS PAGE TOTAL FROM PREVIOUS INCOME PAGES + RUNNING INCOME TOTAL = COPY AND ATTACH MORE PAGES IF NEEDED TO SHOW ALL INCOME American LegalNet, Inc. www.FormsWorkFlow.com Page Worksheet C: EXPENSES of *Attach Receipts for Any Expense Over $250 Keep other receipts in case the judge requests them. Date De tailed De scription of Transaction (include details such as expense type, paid to, check #, last 4 digits of account paid from ) Expense (-) i.e., 5/31/2018 i.e., Rent paid to Senior Living, check #540 from account 0005 i.e., $780.00 TOTAL THIS PAGE TOTAL FROM PREVIOUS EXPENSE PAGES + RUNNING EXPENSE TOTAL = COPY AND ATTACH MORE PAGES IF NEEDED TO SHOW ALL EXPENSES American LegalNet, Inc. www.FormsWorkFlow.com Page DECLARATION OF GUARDIAN(S) 1. Type of Guardianship. ( check one) I am the guardian over an adult. I am the guardian over a child (skip the next sections, and sign and date the bottom). 2. Monthly Budget. ( check one) I have not provided the Court with a monthly budget. I filed a monthly budget which was approved by the Court on (date you filed the budget) . Over the past year: ( check one) I was able to provide for the protected person222s needs within the authorized budget. I was not able to provide for the protected person222s needs within the authorized budget because (explain why you were not able to follow the budget, for instance, were there one-time extraordinary expenses, or more ongoing expenses than you originally thought) 3. Monthly Budget; Next Accounting Period. ( check one) No changes are needed to the monthly budget for the next accounting period. Changes are needed to the monthly budget (or none was originally filed); a new budget will be filed. 4. I/We declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. This document does not contain the personal information of any person as defined by NRS 603A.040. Date: Date: (First Guardian222s signature) (Second Guardian222s signature) (First Guardian222s printed name) (Second Guardian222s printed name) American LegalNet, Inc. www.FormsWorkFlow.com Page VERIFICATION OF FIRST GUARDIAN Under penalty of perjury, I declare that I am the Guardian in the above-entitled action; that I have read the foregoing Accounting and know the contents thereof; that the pleading is true of my own knowledge, except for those matters therein contained stated upon information and belief, and that as to those matters, I believe them to be true. I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. DATED this (day) day of (month) , 20. (First Guardian222s signature) (print your name) VERIFICATION OF SECOND GUARDIAN Under penalty of perjury, I declare that I am the Guardian in the above-entitled action; that I have read the foregoing Accounting and know the contents thereof; that the pleading is true of my own knowledge, except for those matters therein contained stated upon information and belief, and that as to those matters, I believe them to be true. I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. DATED this (day) day of (month) , 20. (Second Guardian222s signature) (print your name) American LegalNet, Inc. www.FormsWorkFlow.com