GN-3510, 05/18 Modified Annual Account of Married Ward 24724754.19(5), 54.62(4) and 54.66, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF Name Date of Birth Amended Modified Annual Account of Married Ward Case No. UNDER OATH, I STATE: I am the Guardian and I certify that this is an accurate account of the administration of the Guardianship with marital property for the period from January 1, to December 31, . I am filing this Modified Annual Account of the Married Ward as permitted by the court. Line Summary Explanation Total 1. Total assets of ward as determined under ch . 766 , on January 1 of the reporting year. (Attach Schedule A ) $ 2. I ncome in the name of the ward without regard to ch. 766 , and the joint income. (Attach Schedule B ) $ 3 . Expenses incurred on behalf of the ward share of household expenses if the ward and the spouse resi des in the same household, without regard to ch. 766. (Attach Schedule C) $ 4 . Total m arital property of the ward , as determined under ch . 766 , on December 31 of the reporting year . ( Attach Schedule D ) $ Status of Surety on Bond bond has not changed. has changed. Explain: Guardian Spouse Name Printed or Typed Telephone Number Name Printed or Typed Telephone Number Address Address State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: American LegalNet, Inc. www.FormsWorkFlow.com GN-3510, 05/18 Modified Annual Account of Married Ward 24724754.19(5), 54.62(4) and 54.66, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 Schedule A - Total assets of ward as determined under ch. 766 , on January 1 of the reporting year. See attached Amount $ Total: (Enter in Summary on Line 1 on page 1.) $ Schedule B - I ncome in the name of the ward without regard to ch. 766 , and the joint income. See attached Amount $ Total: (Enter in Summary on Line 2 on page 1.) $ Schedule C - share of household expenses if the ward and the spouse resides in the same household, without regard to ch. 766. See attached Amount $ Total: (Enter in Summary on Line 3 on page 1.) $ American LegalNet, Inc. www.FormsWorkFlow.com GN-3510, 05/18 Modified Annual Account of Married Ward 24724754.19(5), 54.62(4) and 54.66, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 Schedule D - Total m arital property of the ward as determined under ch. 766 , on December 31 of the reporting year. See attached Amount $ $ Total: (Enter in Summary on Line 4 on page 1.) $ For Authorized Persons Only Display of Assets and Examination of Accounts: I am not the guardian or spouse . I am authorized by the court to examine assets. I have examined all securities, depository accounts, and other investments, and such assets correspond with the account, except as indicated. Aut horized Signature (Not guardian or spouse ) Name Printed or Typed Title Date American LegalNet, Inc. www.FormsWorkFlow.com