) IN CIRCUIT COURT ) COUNTY OF ________________ ) ____________ JUDICIAL CIRCUIT ****************************************************************************** In the Matter of the Conservatorship of ) ) __GDN______________ _______________________________ , ) ) INITIAL ANNUAL FINAL OTHER a Minor Protected Person. ) CONSERVATOR ACCOUNTING ) ****************************************************************************** I/We, ______________________________________ , the Conservators(s) of the above-named Individual, being duly sworn upon oath, state and affirm the following: The Court appointed Conservator(s) in the above-entitled case on _______________ (month) _____ (day), ________ (year). Unless this is an initial accounting, Conservators(s) last accounting period ended on ______________ (month) ______ (day), _________ (year). This accounting describes the status of the Individual and the efforts of his/her Conservators(s) from: _____________ (month), ___ (day), _____ (year) to ____________ (month), ___ (day), _____ (year). [Note that SDCL 29A-5-408 provides that an accounting can only cover a maximum of one year.] STATE OF SOUTH DAKOTA I/We further affirm the following as true and complete to the best of my/our knowledge: 1. The services provided by the Conservator(s) to the above-named Individual include (describe the financial services, who provided them, when they were provided, and the outcomes for the Individual): ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ UJS-141 Conservator Accounting Rev. 06/2016 American LegalNet, Inc. www.FormsWorkFlow.com 2. Besides the above-mentioned services, the Conservator(s) took the following significant actions on behalf of the Individual and his or her estate: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. Does the conservatorship need to continue in its current form, or should it be modified or terminated? (Check one): Current Form Explain why: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 4. Any other information requested by the Court or useful in the opinion of the Conservator(s)? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ UJS-141 Conservator Accounting Rev. 06/2016 American LegalNet, Inc. www.FormsWorkFlow.com Modified Terminated 5. All receipts and disbursements/distributions from the above-named Individual's estate over the aforementioned accounting period are provided below: RECEIPTS DISBURSEMENTS/DISTRIBUTIONS (Do not include financial account #s.) Type: Amount ($): Gross pay: Type: Amount ($): Gua