American LegalNet, Inc. www.FormsWorkFlow.com ACCOUNT FOR MINOR Court File No. ................................................. COMMONWEALTH OF VIRGINIA VA. CODE 247247 64.2-1206, 64.2-1308 Circuit Court of ............................................................................................................................................... Estate of ............................................................................................................................................, a minor Minor222s date of birth: .................................................................................... Is either parent alive? [ ] Yes [ ] No Type of Fiduciary: [ ] Guardian [ ] Temporary Guardian Name of Fiduciary ..................................................................... Day telephone ................................................ Mailing address ............................................................................................................................................... Name of Co-fiduciary ................................................................. Day telephone ................................................ Mailing address ............................................................................................................................................... ...................................................................................................................................................................... This is account number [ ] one [ ] two [ ] three or [ ] ....................................Is this a final account? [ ] yes [ ] no From ................................. (date of qualification or end of last account) to .............................. (end of this account) ACCOUNT SUMMARY 1. BEGINNING ASSETS (from Parts 1 and 2 of the inventory or from the prior account): $ ............................... 2. RECEIPTS* $ ................................. .......................................................................................... $ ................................. .......................................................................................... ................................... .......................................................................................... ................................... .......................................................................................... ................................... .......................................................................................... ................................... .......................................................................................... ................................... .......................................................................................... ................................... Total Receipts $ ............................... 3. GAINS ON ASSET SALES: .......................................................................................... $ ................................. .......................................................................................... ................................... Total Gains $ ............................... 4. ADJUSTMENTS: .......................................................................................... $ ................................. .......................................................................................... ................................... Total Adjustments $ ............................... GRAND TOTAL OF 1, 2, 3 and 4 (must equal GRAND TOTAL of 5-9) $ ................................. * Any amounts received as Designated Representative but not included in 2 above (see Va. Code Section 64.2-1312). $ ................................. FORM CC-1683 (MASTER, PAGE ONE OF TWO) 10/12 American LegalNet, Inc. www.FormsWorkFlow.com 5. DISBURSEMENTS FOR ADMINISTRATIVE EXPENSES: .......................................................................................... $ ................................. .......................................................................................... ................................... .......................................................................................... ................................... Total Administrative Expenses $ ............................... 6. DISBURSEMENTS FOR CARE OF THE MINOR: .......................................................................................... $ ................................. .......................................................................................... ................................... .......................................................................................... ................................... Total Care Disbursements $ ............................... 7. LOSSES ON ASSET SALES: .......................................................................................... $ ................................. .......................................................................................... ................................... Total Losses $ ............................... 8. DISTRIBUTIONS .......................................................................................... $ ................................. .......................................................................................... ................................... Total Distributions $ ............................... 9. ASSETS ON HAND: .......................................................................................... $ ................................. .......................................................................................... ................................... .......................................................................................... ................................... Total Assets on Hand $ ............................... GRAND TOTAL (must equal GRAND TOTAL of 1-4) $ ..................................... I (We) hereby certify that this is a true and accurate accounting of the assets of this guardianship for the period described and that to the best of my (our) knowledge all taxes have been paid or provided for. Date................................ Guardian Date ............................... Guardian Date ............................... Guardian FORM CC-1683 (MASTER, PAGE TWO OF TWO) 11/06