ACCOUNT FOR TRUST COMMONWEALTH OF VIRGINIA VA. CODE §§ 64.2-1206, 64.2-1308, 64.2-1306 Court File No. .................................................................... Circuit Court of ............................................................................................................................................................................................................................ Name of trust beneficiary(ies) ............................................................................................................................................................................................... .............................................................................................................................................................................. Name of decedent, if trust under a will Mailing address Name of trustee ............................................................................................................... Day telephone ........................................................................... ........................................................................................................................................................................................................................... ................................................................................................... Name of other trustee Name of other trustee Mailing address Day telephone ........................................................................... Day telephone ........................................................................... Is this a final account? [ ] yes [ ] no. (end of this account) Mailing address............................................................................................................................................................................................................................. ................................................................................................... ........................................................................................................................................................................................................................... ...................................................... This is account number [ ] one [ ] two [ ] three or [ ] From ................................................... (date of qualification or end of last account) to ACCOUNT SUMMARY .................................................. 1. 2. 3. 4. 5. Beginning Assets (from Parts 1, 2, 3 & 4 of the inventory or from the prior account) Principal receipts (attach itemized list) Income receipts (attach itemized list) Gains on Asset Sales (attach itemized list) Adjustments (attach itemized list) 6. Total of 1, 2, 3, 4, & 5 (must equal Total on Line 13) $ .................................................. ...................................................... ...................................................... ...................................................... ...................................................... $ $ .................................................. .......................................................... 7. 8. 9. Principal Disbursements (attach itemized list) Income Disbursements (attach itemized list) Losses on Asset Sales (attach itemized list) ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... 10. Principal Distributions (attach itemized list) 11. Income Distributions (attach itemized list) 12. Assets on Hand (attach itemized list) 13. Total of 7, 8, 9, 10, 11 & 12 (must equal Total on Line 6) Market Value of Assets on Hand $ $ .......................................................... ...................................................... I (We) certify that this is a true and accurate accounting of the assets of this trust for the period described and that to the best of my (our) knowledge all taxes have been paid or provided for. Date Date: Date: ............................................................ Trustee's Signature Trustee's Signature Trustee's Signature ____________________________________________________________ ............................................................ ____________________________________________________________ ............................................................ ____________________________________________________________ NOTE: Virginia law requires that every account be signed by all trustees. FORM CC-1684 MASTER 10/12 American LegalNet, Inc. www.FormsWorkFlow.com