COURT CODE: Your Name: Address: City, State, Zip: Phone: Email: Self-Represented DISTRICT COURT COUNTY, NEVADA ACCOUNTING ( check one) First, Second, Third, or Final1 through BEGINNING DATE2ENDING 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. 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 In the Matter of the Guardianship of the: EstatePerson and Estate of: CASE NO.: DEPT: ( name of person who has a guardian ) A Protected Person. American LegalNet, Inc. www.FormsWorkFlow.com Page 1.Starting Balance: Account Summary (totals from the following worksheets) (this is the same number as the Beginning NetAsset Value from Worksheet A. This is also thesame as the ending balance from the lastaccounting or inventory) 2.Gross Income / Interest / Money Received(from Worksheet B)3.Expenses(from Worksheet C, you must attach receipts forexpenses over $250. Keep all other receipts incase the judge requests them.) 4.Adjustments to the Value of the Assets(this is for any increase or decrease in the value ofan asset, such as a house, vehicle, etc. Attach anitemized list for any item that increased ordecreased in value since your last accounting orinventory) 5.Adjustments as a result of any Asset Sales (this isfor any asset that was sold since your lastaccounting or inventory. Attach an itemized listshowing the adjustments up or down from the sale) Add + Subtract - +/ - +/ - 6.Total Ending Balance(this number must match the Ending Net AssetValue from Worksheet A)Have you discovered any assets belonging to the Protected Person that were not listed on the previous inventory or accounting? NoYes: (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)? NoYes: (describe the claim and any action taken regarding the account) American LegalNet, Inc. www.FormsWorkFlow.com Page Worksheet A: ASSETS & DEBTS *The numbers in this column should be identical to the 223ending balance224 numbers from your last accounting or inventory (whichever was filed last) Assets at End of Accounting Period Assets Value Home Vehicles Jewelry Artwork Furniture Electronics Antiques Other Checking account Savings account Certificates of deposit Money market account Life insurance (cash value) Trust (Protected person222s interest only) Other Retirement account Bonds Mutual funds Individual stock shares Real estate other than home Other Liabilities Amoun t Owed Mortgage loan - Home equity loan - Car loans - Real estate loans - Student loans - Other loans - - Credit card debt - Other debt - Ending Net Asset Value: $ Assets at Start of Accounting Period Based on: ( check one) Inventory; or Last Accounting Ending Balance As filed on ( date of last report ) Asset Value Home Vehicles Jewelry Artwork Furniture Electronics Antiques Other Checking account Savings account Certificates of deposit Money market account Life insurance (cash value) Trust (Protected person222s interest only) Other Retirement account Bonds Mutual funds Individual stock shares Real estate other than home Other Liabilities Amount Owed Mortgage loan - Home equity loan - Car loans - Real estate loans - Student loans - Other loans - - Credit card debt - Other debt - Beginning Net Asset Value: $ 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 Detailed Description 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. 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