ACCOUNTING SUMMARY FORM #2 – SHORT FORM (Estates less than $80,000.00 in liquid assets) 9. Estate Information For Accounting Period starting ___________________ and ending ____________________. 10. Total Assets at Market Value as of the beginning of review period $_________________. Income: Social Security (SSA) SSI VA/Railroad/CSA Pension Retirement Pension Wages Interest and Dividends Other $ $ $ $ $ $ $ 11. Total Income: $ ____________________ Disbursements: Room and Board (Rent, Nursing Home, Family Home) Personal Funds Entertainment & Travel Transportation (mileage, bus pass, taxi scrip, etc.) Medical and Dental Guardian Fees (if allowed) Attorney Fees Other: $ $ $ $ $ $ $ $ 12. Total Disbursements: $ ____________________ 13. Adjustments (Net gain/loss in value of assets over accounting period) $ ____________________ 14. Total Assets (as of closing date of accounting period) $ ____________________ (Line 10, plus Line 11, minus Line 12 plus or minus Line 13 should equal Line 14. If it does not, your account does not balance. The account must balance to be approved by the Court.) Guardian’s Report, Accounting, and Proposed Budget-Page 5 2001 Guardianship Forms American LegalNet, Inc. www.USCourtForms.com 15. Explanation (for any large or unusual expenditures, adjustments, or purchases) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. 16. Asset List (as of Accounting Period Ending Date stated on Line 9 above) [For all financial accounts, include the type of account, account number, bank or company name, and branch location. You may use the figures from the last statement received from a bank or company prior to the ending date of the accounting period.] Account # ____________________ ____________________ Account # ____________________ ____________________ Account # ____________________ ____________________ Other: ____________________ ____________________ Type ________________ ________________ Type ________________ ________________ Type ________________ ________________ with _______________ _______________ with _______________ _______________ with _______________ _______________ Balance/Market Value $ $ $ $ TOTAL: (This total should equal line 14.) $ ____________________ Guardian’s Report, Accounting, and Proposed Budget-Page 6 2001 Guardianship Forms American LegalNet, Inc. www.USCourtForms.com I certify (or declare) under penalty of perjury under the laws of the State of Washington that to the best of my knowledge the statements in this Guardian’s Report, Accounting, and Proposed Budget and attached Accounting Summary are true and correct and hereby petition the Court for approval. SIGNED AT ____________________, WASHINGTON THIS _______ DAY OF ___________________, 200___. Signature of Guardian Printed Name of Guardian, WSBA/CPG# Address Telephone/Fax Number City, State, Zip Code Email Address Guardian’s Report, Accounting, and Proposed Budget-Page 7 2001 Guardianship Forms American LegalNet, Inc. www.USCourtForms.com