1 2 3 4 5 Code: (Your name) __________________________ (Address) __________________________ __________________________ (Telephone) __________________________ In Proper Person 6 IN THE _______ JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA 7 IN AND FOR THE COUNTY OF ______________________ 8 10 In the Matter of the Guardianship of the  Estate  Person and Estate 11 of: 9 12 13 14 ) ) ) ) ) ) ) ) ) ) _______________________________, A(n)  Minor  Adult 15 CASE NO. ______________ DEPT. NO. ______________ ACCOUNTING 16 [First, Second, Third, _______] or Final1 Circle of fill-in appropriate number 17 _________________________ through _______________________ BEGINNING DATE ENDING DATE 18 19 DO NOT FILL IN GRAY AREAS 20 21 RECAPITULATION (RECAP) Subtotal 22 Beginning balance (balance brought forward from inventory or previous accounting) 23 + Total from Schedule A $ 24 - Total from Schedule B $ 25 Ending Balance for this accounting period Total $ $ 26 27 28 1 Final is circled if the guardianship has been terminated or this is the last accounting of this guardian. For all guardianship packets Accounting 1 of 8 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com 1 Schedule A 2 Subtotal Total Income/ Receipts/Increases in Value 3 Total Income (from Worksheet 1): 4 $ Receipts or Refunds Received (from Worksheet 2): $ 5 Increases in Value of Assets (from Worksheet 3): $ 6 Gains of Sales of Assets (from Worksheet 4): $ Total Increase to Estate: 7 $ 8 9 10 11 Worksheet 1, Income/Interest2 12 Description Amount 13 $ 14 $ 15 $ $ 16 $ 17 TOTAL 18 $ Worksheet 2, Receipts/Refunds Received3 19 Description Amount 20 $ 21 $ 22 $ 23 $ TOTAL 24 $ 25 26 27 28 2 Income/Interest may come from, but is not limited to: social security; wages from employment; and interest income. Receipts/Refunds may include, but are not limited to: retirement payments, annuity payments, rental receipts, loan payment receipts, collected receivables, refunds on utility deposits, refunds on home/apartment rental deposits. 3 For all guardianship packets Accounting 2 of 8 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com Worksheet 3, Increases in Value of Assets4 1 Description 2 Amount $ 3 $ 4 $ 5 $ 6 TOTAL 7 $ Worksheet 4, Gains on Sales of Assets5 8 Description a) Sales Price 9 b) Recorded Value c) Amount of Gain [a – b = c] 10 $ 11 $ 12 $ 13 $ TOTAL 14 $ 15 16 17 18 19 20 21 22 23 24 25 26 4 Increases in values of assets may include, but are not limited to: real property, antiques, collectibles; gains in value of investment accounts, stocks, or other securities. 5 If an asset was sold for more than its recorded value in the inventory or the last accounting, the amount received above that value is a gain on the sale of an asset. 27 28 For all guardianship packets Accounting 3 of 8 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com 1 Schedule B 2 Expenses/Disbursements/Decreases in Value 3 4 5 Subtotal Disbursements (from Worksheet 5): $ Decreases in Value of Assets (from Worksheet 6): $ Losses on Sales of Assets (from Worksheet 7): Total $ Total Decreases to Estate: $ 6 7 8 Worksheet 5, Expenses/Disbursements 9 Description Amount 10 Room & board $ 11 Medical $ 12 Clothing $ Daycare / care assistance $ Personal hygiene products and services $ Spending money $ Transportation expenses Miscellaneous (list): $ 13 14 15 16 $ 17 $ 18 $ $ 19 $ 20 $ 21 $ 22 $ 23 $ $ TOTAL 24 25 26 27 28 For all guardianship packets Accounting 4 of 8 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com Worksheet 6, Decreases in Value of Assets6 1 Description 2 Amount $ 3 $ 4 $ 5 $ 6 $ $ 7 TOTAL 8 9 $ Worksheet 7, Losses on Sale of Assets7 Description 10 a) Recorded Value b) Sales Price c) Amount of Loss 11 [a-b=c] 12 $ 13 $ 14 $ $ 15 $ 16 $ 17 TOTAL $ 18 19 20 21 22 23 24 25 26 27 28 6 Decreases in value of assets may include, but is not limited to: real property, antiques, collectibles, investment accounts, stocks, securities, motor vehicles. 7 If an asset is sold for less than its recorded value in the inventory or last annual accounting, the amount which is less than the recorded value is the loss on the sale of the asset. For all guardianship packets Accounting 5 of 8 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com 1 Assets of the Estate at the Ending Date of the Accounting 2 Value of Ward’s Interest 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 A. REAL PROPERTY Description 1.__________________________________________________________________ 2.__________________________________________________________________ 3.__________________________________________________________________ $___________ $___________ $___________ B. PERSONAL PROPERTY Cash, Checking and Savings Accounts, other Accounts (List) 4.__________________________________________________________________ 5.__________________________________________________________________ 6.__________________________________________________________________ $___________ $___________ $___________ Other Interest, Etc. (Describe) 7.__________________________________________________________________ 8.__________________________________________________________________ $___________ $___________ Notes, Bonds, Securities, Debts, Etc., (List Name & Address of Debtor) 9._________________________________________________________________ 10._________________________________________________________________ 11._________________________________________________________________ 12._________________________________________________________________ $___________ $___________ $___________ $___________ Vehicles (List) 13._________________________________________________________________ 14._________________________________________________________________ 15._________________________________________________________________ $___________ $___________ $___________ Miscellaneous Personal Property (Describe) 16._________________________________________________________________ 17._________________________________________________________________ 18._________________________________________________________________ 19._________________________________________________________________ $___________ $___________ $___________ $___________ Other (Describe) 20._________________________________________________________________ 21._________________________________________________________________ 22._________________________________________________________________ 23._________________________________________________________________ $___________ $___________ $___________ $___________ 26 TOTAL 27 $ 28 For all guardianship packets Accounting 6 of 8 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com VERIFICATION OF PETITIONER 1 2 3 4 5 6 7 8 9 10 STATE OF NEVADA COUNTY OF ______________ ) ) ) I, (your name)____________________________, being first duly sworn under penalty of perjury, hereby depose and say: That I am the Petitioner in the within action; that I have read the foregoing Petition For Appointment of Guardian(s) and know the contents thereof; that the same is true of my knowledge except as to those matters therein stated upon information and belief and as to those matters, I believe them to be true. _____________________________________ Petitioner 11 12 SIGNED and SWORN to before me by (Petitioner’s name) ___________________________ 13 on the _____ day of ____________________, _____. 14 _________________________________ NOTARY PUBLIC 15 16 ACKNOWLEDGMENT OF PETITIONER 17 STATE OF NEVADA 18 COUNTY OF ______________ ) ) ) 19 On this _____ day of ____________________, _______, before me, the undersigned Notary 20 Public in and for the said County and State, personally appeared (your name) ________________ 21 ____________________________ known to me to be the person described in and who executed 22 23 24 the foregoing instrument, and who acknowledged to me that (check one)  he/  she did so freely and voluntarily and for the uses and purposes therein mentioned. 25 WITNESS my hand and official seal. 26 __________________________ NOTARY PUBLIC 27 28 For all guardianship packets Accounting 7 of 8 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com VERIFICATION OF CO-PETITIONER 1 2 STATE OF NEVADA 3 COUNTY OF ______________ 4 5 6 ) ) ) I, (co-petitioner’s name)____________________________, being first duly sworn under penalty of perjury, hereby depose and say: That I am the Co-Petitioner in the within action; that I have read the foregoing Petition For 7 Appointment of Guardian(s) and know the contents thereof; that the same is true of my knowledge 8 except as to those matters therein stated upon information and belief and as to those matters, I 9 believe them to be true. _____________________________________ Co-Petitioner 10 11 12 SIGNED and SWORN to before me by (Co-Petitioner’s name) ___________________________ 13 on the _____ day of ____________________, _____. 14 _________________________________ NOTARY PUBLIC 15 16 17 18 19 ACKNOWLEDGMENT OF CO-PETITIONER STATE OF NEVADA COUNTY OF ______________ ) ) ) On this _____ day of ____________________, _______, before me, the undersigned Notary 20 Public in and for the said County and State, personally appeared (co-petitioner’s name) 21 ______________________________________ known to me to be the person described in 22 and who executed the foregoing instrument, and who acknowledged to me that (check one) 23 24 25 26 27  he/  she did so freely and voluntarily and for the uses and purposes therein mentioned. WITNESS my hand and official seal. ______________________________ NOTARY PUBLIC 28 For all guardianship packets Accounting 8 of 8 ©2006 Nevada Supreme Court Revised December 14, 2006 American LegalNet, Inc. www.FormsWorkflow.com