Trust Account {MPC 859}

Docket No. TRUST ACCOUNT Commonwealth of Massachusetts The Trial Court Probate and Family Court Division case name Under the Will dated: (date) Under Declaration of Trust dated: (date) Trustee Information: Name: First Name MI Last Name Address (Address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) under trust section This is the (1st, 2nd, etc.) for the benefit of ANNUAL FINAL ACCOUNT AMENDED FOR THE REPORTING PERIOD FROM (MM/DD/YYYY) TO (MM/DD/YYYY) If Final Account, indicate why: Appointment terminated Trust terminated Judicial Order Summarize the financial activity below after completing the detailed accounting information in Schedules A, B, C, D, E and F. Attach additional sheets for each applicable schedule. Notice to Interested Persons. Interested persons have the responsibility to protect their own rights and interests within the time and in the manner provided by the Massachusetts Uniform Probate Code, including the appropriateness of disbursements, the compensation of fiduciaries, attorneys, and others, and the distribution of estate assets. The Court will not review or adjudicate these or other matters unless specifically requested to do so by an interested person or the Fiduciary. SUMMARY OF SCHEDULES TOTAL SCHEDULE A - Principal amounts received: SCHEDULE B - Principal payments and charges: SCHEDULE C - Principal balance invested: SCHEDULE D - Income received: SCHEDULE E - Payments from income: SCHEDULE F - Income balance: $ $ $ $ $ $ MPC 859 (3/19/12) page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com I state under penalty of perjury that this is a true and complete report of the administration of this trust, during the period shown, both dates inclusive, to the best of my knowledge, information and belief. I understand that this Account is subject to audit and verification. I understand that I am required to maintain supporting documentation for all receipts and disbursements including detailed billing statements from any professional. The Court or any Interested Persons may request copies at any time. Date Signature of Trustee Date Signature of Co-Trustee (if applicable) Attorney for Trustee: Signature of Attorney Print Name (Address) (City/Town) (State) (Apt, Unit, No. etc.) (Zip) Primary Phone #: BBO No.: Email: MPC 859 (3/19/12) page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com