Accounting Of Guardian

IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON IN AND FOR THE COUNTY OF CLARK In re the Guardianship of: [ [ [ [ No. ] 1 year ] 3 year ] Other _______________ ] Final Accounting of Guardian an Incapacitated Person. I, ____________________________ Guardian of the above-named incapacitated person, hereby certify that the attached hereto is a true and correct statement of the receipts , and, disbursements of the Guardian for the following time period: , _________________,________ to _________________, _______. Month and day Year Month and day Year I further certify that this report contains a true and correct statement of the assets and liabilities of this estate, and that the balances are as follows, as of ______________________ ,___________. Month and day Bank Account(s) Personal Property Investments Real Estate (Fair Market Value/Assessed Value) Less Liens or other liabilities of the estate or its property Net value of estate \\nt02\kesalav\Guardianship forms\Accounting Form.doc 1 American LegalNet, Inc. www.FormsWorkFlow.com Year $ ______________________ $ ______________________ $ ______________________ $ ______________________ $(-)______________________ $ ______________________ The amount of the court-ordered bond is $ ______________________ The court has ordered restrictions on the following assets: (Describe herein the assets and nature of the restrictions) _____________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ I have/have not used the incapacitated person's property; have/have not had financial dealings with the incapacitated person, or his/her property; or obtained any benefit from the incapacitated person during the past year. (If the answer is in the affirmative, please explain.) Dated this ___________________ day of _________________ 20_______ (I) (We) declare under penalty of perjury as defined by the laws of the State of Washington that the foregoing is true and correct. ___________________________________________ (Guardian's Signature) ____________________________________________ (Guardian's Signature) Printed name and address Guardian _________________________________________________________________ Address _________________________________________________________________ _________________________________________________________________ Phone: (______) ________ - ______________ E-mail _________________________________ \\nt02\kesalav\Guardianship forms\Accounting Form.doc 2 American LegalNet, Inc. www.FormsWorkFlow.com FINANCIAL STATEMENT RECEIPTS Veteran's Benefits Social Security Pension Benefits Interest Income Dividends Refunds Public Assistance Personal Property sold or disposed of (Attach Schedule) $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ TOTAL RECEIPTS $ Statements from bank and/or other accounts must accompany this accounting. If statements are not enclosed, the accounting is not complete. \\nt02\kesalav\Guardianship forms\Accounting Form.doc 3 American LegalNet, Inc. www.FormsWorkFlow.com DISBURSEMENTS Bond Premiums Attorney Fees (Guardianship) Attorney Fees (Other) Guardian Fees Rent/House Payment Utilities Room and Board Food Medical Life Insurance Health Insurance Auto Insurance Other Insurance (Specify) ________________ Income Taxes Property Taxes Other Taxes (Specify) __________________ Home Repair/Maintenance Auto Repair/Maintenance Other Repair/Maintenance Personal Allowance Clothing Fines/Penalties $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ $ ______________________ (continued next page) \\nt02\kesalav\Guardianship forms\Accounting Form.doc 4 American LegalNet, Inc. www.FormsWorkFlow.com Court Costs Travel $ ______________________ $ ______________________ Other (Specify) ___________________________ $ ______________________ _________________________________________ $ ______________________ _________________________________________ $ ______________________ _________________________________________ $ ______________________ _________________________________________ $ ______________________ _________________________________________ $ ______________________ _________________________________________ $ ______________________ TOTAL DISBURSEMENTS $ NOTE: Disbursements paid by check must be listed by number and payee, and must accompany this itemization. Statements from bank and/or other accounts must accompany this accounting. If statements are not enclosed, the accounting is not complete. SUMMARY Balance at Last Accounting Total Receipts (this accounting) Total Disbursements (this accounting) $ ______________________ $ _______________________ $ ________________________ Current Balance $ Statements from bank and/or other accounts must accompany this accounting. If statements are not enclosed, the accounting is not complete. \\nt02\kesalav\Guardianship forms\Accounting Form.doc 5 American LegalNet, Inc. www.FormsWorkFlow.com ASSETS PERSONAL PROPERTY Value at Prior Accounting Present Value Increase/ Decrease Cash, checking/savings accounts (List banks and account numbers) Investments (Mortgages, contracts, savings certificates, stocks, bonds, etc) Other Personal Property TOTAL REAL PROPERTY Address: ___________________________ ___________________________ ___________________________ ___________________________ $ _______________$ ___________________ $ _______________ $ _______________$ ___________________ $ _______________ $ _______________$ ___________________$ ________________ $ _______________$ ___________________ $ _________________ Assessed Value Fair Market Value $ ______________________$ ________________________ $ ______________________$ ________________________ $ ______________________ $ ______________________ $ ___________