PB 1-Conservatorship Accounting Form 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF DESCHUTES [PROBATE DEPARTMENT] In the Matter of the [ ] Conservatorship [ ] Estate of ( which applies) ) ) ) ) ) Case No. ACCOUNTING ( Accounting#) accounting. 1 Accounting Period. This accounting covers the period from , 20 , 2 Prior Balance. The total value of the estate assets, as reflected in the inventory or as of the last date of the previous accounting (whichever is most recent), was $. 3 Bonding. (Mark one): [ ] No bond has been required in this matter. The court waived the requirement of a bond by order dated . (Skip to section 5 below.) American LegalNet, Inc. www.FormsWorkFlow.com PB 1-Conservatorship Accounting Form 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 [ ] A bond has been required in this estate. The current amount of the of the total total bond, inclu ding riders is $. (Continue to subsection (a) of this section) (a) The total value of estate assets as of the last date of the accounting period is $. (b) The income in the estate estimated to be received during the next account period is $. (c) Tota l of (a) and (b) $. (d) The current value of all estate assets that have been restricted by court order ar e: $. The dat e(s) of the court order(s) restricting assets is/are: . (e) TOTAL (amount to be bonded) $. 4 Change in Amount of Bond. The fiduciary asks the court to change the amount of the surety bond or the restriction of assets as follows: (Check all that apply) [ ] No charge. [ ] Reduce the bond to $. [ ] Increase the bond to $. [ ] Restrict the following assets:. [ ] Remove the restriction from the following assets:. 5 Asset Schedule. The Asset S chedule is attached as Exhibit 1. This is a summary that lists all assets that existed during the accounting period. 6 Receipts and Disbursements. The list of receipts and disbursements for all assets are attached as Exhibit 2 to Exhibit. (Attach a separate exhibit for each asset listed in the Asset Schedule which has receipts or disbursements during the accounting period.) Also attached are depository statements for each bank or investment account, showing the beginning and ending balance of the a ccount for the accounting period. (No depository statement is needed showing the beginning balance if it was provided to show the final balance in the previous accounting.) American LegalNet, Inc. www.FormsWorkFlow.com PB 1-Conservatorship Accounting Form 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Vouchers. (Choose (a), (b), or (c). (a) [ ] Vouchers showing every payment are also attached in Exhibit 2 to Exhibit to the receipts and disbursements for any account from which payments are made. (b) [ ] The Fiduciary asks the court to waive the requirement of filing vouchers for this accounting. The vouchers for this accounting are located at the following address: . The vouchers will continue to be m aintained and be available for examination at that location for one year after the closing of this estate. (c) [ ] Vouchers are waived by court rule. 8 Ret urn of Vouchers and Depository Statements. (Choose (a) or (b).) (a) [ ] The fiduciary does not want to receive back the vouchers or depository statement, if any. (b) [ ] Upon approval of this accounting, the Fiduciary requests that the court return the vouchers and depository statements in the enclosed self - addressed, stamped envelope. 9 Changes During the Accounting Period. During the accounting period, the following changes in assets or financial circumstances occurred: 10 Disclosures of Dealing with Related Parties. During the accounting period, the following transactions occurred between s family : American LegalNet, Inc. www.FormsWorkFlow.com PB 1-Conservatorship Accounting Form 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 11 Fees. 12 Notices. WHEREFORE, the Fiduciary prays for an order of thi s court: 1. Approving the annual accounting; 2. Changing the required amount of the surety bond and asset restrictions as shown to be necessary and appropriate by this accounting. 3. Fees (if requested) Date: , 20. Signature of Fiduciary Title: (Mark one of the following) [ ] Conservator [ ] Personal Representative Printed Name of Fiduciary STATE OF OREGON ) ) ss. County of) I, , being sworn, say: I believe t he information provided in this accounting is true. Signature of Fiduciary SUBSCRIBED AND SWORN to me before this day of , 20. Notary Public for Oregon American LegalNet, Inc. www.FormsWorkFlow.com Page-ACCOUNTING ASSET SCHEDULE Exhibit 1 Exhibit No* Description of asset Beginning value Value of later - acquired asset Value at disposition Current (ending) value Restricted / order date COLUMN TOTALS * The Exhibit Number corresponds to the Receipts and Disbursements exhibit number for each asset that has receipts or disbursements during the accounting period. Attach additional pages if needed. Exhibit 1 American LegalNet, Inc. www.FormsWorkFlow.com Page -ACCOUNTING EXHIBIT 2 Page RECEIPTS AND DISBURSEMENTS Exhibit 2 ASSET (State here which asset): RECEIPTS Date Source of receipt Description Amount TOTAL DISBURSEMENTS Date Check # Name (payee) Description Amount TOTAL The Receipts and Disbursements exhibit for each separate asset includes any of the following that exists for the asset: receipts, account statements, disbursements, and vouchers (unless waived by the court). Each exhibit also includes reconciliation. Exhibits can be typed on blank paper using substantially the same format as this form. American LegalNet, Inc. www.FormsWorkFlow.com Page - ACCOUNTING Exhibit 2 Page Exhibit 2 continued RECONCILIATION Value at beginning of accounting period (Attach copy of opening depository statement for this asset) $ Total Receipts (The total of all pages for this asset) $ Total Disbursements (The total of all pages for this asset) (Attach vouchers proving disbursements) $ Current Value (The value at the end of the accounting period) (Attach a copy of the closing depository statement for this asset) $ If the Current Value does not equal the depository statement balance, please explain: American LegalNet, Inc. www.FormsWorkFlow.com