THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) Trust of TRUSTEE'S ACCOUNTING Original Amended 1. The and ending 2. Trustee name Mailing address Co-trustee name Mailing address 3. Attorney name Firm name Mailing address 4. Account Summary (totals taken from the following page) TOTAL PRINCIPAL RECEIVED TOTAL PRINCIPAL DISBURSED BALANCE OF PRINCIPAL ON HAND TOTAL INCOME RECEIVED TOTAL INCOME DISBURSED BALANCE OF INCOME ON HAND ORDER Account allowed. Account allowed pending filing of Account disallowed for the following reasons If this is a final account, receipts for the balance must be filed within 30 days. Date NHJB-2118-P (03/25/2013) Page 1 of 4 account for the period beginning Check if final account Telephone Telephone Telephone Bar ID # $ $ $ $ $ $ Judge American LegalNet, Inc. www.FormsWorkFlow.com Case Name: Trust of Case Number: TRUSTEE'S ACCOUNTING PRINCIPAL 5. PRINCIPAL RECEIVED Schedule A ­ Inventory Total of Personal and Real Estate or Balance held at Prior Accounting * .............................. $ On a separate sheet of paper, list all trust assets, including real estate, that were listed on the Inventory form. For accounts other than the first account, list each item included in Schedule G of the prior accounting. Schedule B ­ Net Gains (or losses) on Sales, Other Dispositions $ On a separate sheet of paper, list the Inventory value and sale price for any asset sold, and show the difference between the two amounts. Also list the date of the sale. Schedule C ­ Other Receipts ...................................................... $ On a separate sheet of paper, list any additional contributions received by the trust, including the source of the money, the amount and date given. Schedule D ­ Net gains (or losses) from sale of real estate ....... $ If real estate was listed on the Inventory, and has been sold during this accounting period, on a separate sheet of paper, list the address of the real estate, sale price, amounts deducted from sale price, amount received by the trust and the date of sale. Note: may attach a copy of the HUD settlement statement. TOTAL PRINCIPAL RECEIVED (Schedules A + B + C + D) Add the amounts in Schedules A through C. Also enter this amount on Page 1, #4. $ 6. PRINCIPAL DISBURSED Schedule E ­ Distribution to Beneficiaries ................................... $ On a separate sheet of paper, list each person who received specific distributions from the principal of the trust. List name, amount received or item received and its value, and the date it was received by the beneficiary. Schedule F ­ Other payments from principal ............................... $ On a separate sheet of paper, list any other payments made from the principal that are not listed in Schedules D or F, including any attorney fees. List the payment amount, date it was paid, and the name of the person receiving the payment. Schedule G ­ Trustee Compensation .......................................... $ On a separate sheet of paper, list any trustee's fees paid from the principal. TOTAL PRINCIPAL DISBURSED (Schedules E + F + G) ........... Add the amounts in Schedules D through F. Also enter this amount on Page 1, #4. $ 7. Schedule H ­ BALANCE OF PRINCIPAL ON HAND * ............. (Total Principal Received minus Total Principal Disbursed) Page 2 of 4 $ American LegalNet, Inc. www.FormsWorkFlow.com NHJB-2118-P (03/25/2013) Case Name: Trust of Case Number: TRUSTEE'S ACCOUNTING On a separate sheet of paper, list all the assets, including real estate, remaining in the trust and the values of each. Also enter this amount on Page 1, #4. INCOME 8. INCOME RECEIVED Schedule 1 ­ Balance held at Prior Accounting * ....................... $ List each item included in Schedule 8 of prior accounting. Schedule 2 ­ Dividends and Interest ........................................... $ On a separate sheet of paper, list all dividend and interest income received during this accounting period. List the source, the individual amounts and date each was received. Schedule 3 ­ Other Income ......................................................... $ On a separate sheet of paper, list any additional income of the trust, including the source of the income (name), the amount and date received. TOTAL INCOME RECEIVED (Schedules 1 + 2 + 3) .................... Add the amounts in Schedules 1 through 3. Also enter this amount on Page 1, #4. $ 9. INCOME DISBURSED Schedule 4 ­ Distributions to Beneficiaries ................................. $ On a separate sheet of paper, list each person who received specific distributions from the income of the trust. List name, amount received or item received and its value, and the date it was received. Schedule 5 ­ Administrative Expenses ....................................... $ Administrative expenses are all expenses incurred in administering the trust, such as filing fees, publication fees, bond premiums, attorney's fees, etc. On a separate sheet of paper, list each expense, the amount and the date paid. Schedule 6 ­ Other payments from income ................................ $ On a separate sheet of paper, list any other payments made from the income that are not listed in Schedules 4, 5 or 7. List the payment amount, date it was paid, and the name of the person receiving the payment. Schedule 7 ­ Trustee Compensation .......................................... $ On a separate sheet of paper, list any trustee's fees paid from the income. TOTAL INCOME DISBURSED (Schedules 4 + 5 + 6 + 7) ........... Add the amounts in Schedules 4 through 7. Also enter this amount on Page 1, #4. $ 10. Schedule 8 ­ BALANCE OF INCOME ON HAND* .................... (Total Income Received minus Total Income Disbursed) $ On a separate sheet of paper, list all the income and assets, including real estate, remaining in the trust and the value of each. Also enter this amount on Page 1, #4. *These schedules must list each asset at both book value/cost and current market value at the beginning (Schedules A and 1) and end (Schedules H and 8) of the accounting period. NHJB-2118-P (03/25/2013) Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case Name: Trust of Case Number: TRUSTEE'S ACCOUNTING 11. Is an Information Schedule pursuant to Probate Rule 108(E) attached to this Accounting? Yes No 12. Have all Federal and State Income Tax Returns of the trust, which are due at the time of filing this accounting been filed