Statement Of Account

Superior Court of the District of Columbia PROBATE DIVISION Estate of _______________________________ __________ Case Year (First, Second, etc.) __________ Case Type __________ Case No. _______________________ Accounting of ______________________________________________________ (Name of Fiduciary) (Fiduciary Capacity) For period beginning ______________________ 20______, and ending ______________________ 20______ Debit(s) (Receipts) Credit(s) (Disbursements) SUMMARY OF TRANSACTIONS Receipts: Total from Schedule "A" Beginning Balance....................................................... Total from Schedule "B" Dividend Balance.......................................................... Total from Schedule "C" Interest Income........................................................... Total from Schedule "D" Annuity Income............................................................ Total from Schedule "E" Rental Income............................................................. Total from Schedule "F" Other Collections......................................................... Total from Schedule "G" Gain................................................................................ Disbursements: Total from Schedule "G" Losses.............................................................................. Total from Schedule "H" Administrative Expenses............................................ Total from Schedule "I" Rental Property Expenses.......................................... Total from Schedule "J" Other Disbursements................................................... Total from Schedule "K" Maintenance and Care Expenses ­ Distributions Total from Schedule "L" Ending Balance............................................................. Totals (Columns must agree) .................................................... $ $ $ $ Jan. 2010 Sheet 1 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE "A" BEGINNING BALANCE List below the assets held at the beginning of the accounting. In the First Accounting, these would be the assets held or in existence on the date of Appointment or Qualification. Each asset must be listed separately and described fully. In Guardianship, Conservatorship and Trust cases, include all personal property. Example: 600 shares XYZ Co., common stock Carrying value $8,000.00 Carrying Value $ If continuation sheet(s) are used, enter total here............................... $ Total (carry forward to summary) ................................................................. $ Jan. 2010 Sheet 2 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE "B" DIVIDEND INCOME List below the source of each dividend received, the amount, and the date of payment. Example: 100 shares common stock of XYZ Co. March 30, 19____ $30.00 June 30, 19____ 30.00 Sept. 30, 19____ 35.00 Dec. 31, 19____ 35.00 130.00 Receipts $ If continuation sheet(s) are used, enter total here............................ Total (carry forward to summary) ....................................................... $ $ SCHEDULE "C" INTEREST INCOME List below the source of each interest payment received, the amount, and the date of payment. Example: ABC Bank: March 30, 19____ $30.00 June 30, 19____ 30.00 Sept. 30, 19____ 30.00 Dec. 31, 19____ 40.00 130.00 Receipts $ If continuation sheet(s) are used, enter total here............................ Total (carry forward to summary) ....................................................... Jan. 2010 $ $ Sheet 3 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE "D" ANNUITY INCOME List below each annuity, pension, etc., identifying each as to source, period or months covered and the rate. Example: Social Security benefits for the calendar months of June 19____ through May 19____ 12 months as follows: 5 at $130.00 (136.70 Less 6.70 Insurance Premium) $650.00 7 at 140.00 (146.70 Less 6.70 Insurance Premium) 980.00 $1630.00 Receipts $ If continuation sheet(s) are used, enter total here............................ Total (carry forward to summary) ....................................................... $ $ SCHEDULE "E" RENTAL INCOME List below each parcel of real estate or rental unit, the period covered, the gross rent collection and the amount. If the property is not rented or was only partially rented, please indicate and explain the reason(s) therefore: Example: ABC Bank: 1111 ­ 99th Street, for the months of June 19____ through May 19____, at $300.00 $3,600.00 Receipts $ If continuation sheet(s) are used, enter total here............................ Total (carry forward to summary) ....................................................... Jan. 2010 $ $ Sheet 4 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE "F" OTHER COLLECTIONS List in detail below, the source(s) and amount(s) of all other collections not appropriate for inclusion in Schedules "B", "C", "D", "E", or "G". This would include insurance, reimbursements, refunds, additional assets, proceeds from sale of real estate, etc. Receipts $ If continuation sheet(s) are used, enter total here............................... $ Total (carry forward to summary) ................................................................. $ Jan. 2010 Sheet 5 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE "G" GAINS AND LOSSES List in detail below, all security or other transaction(s). If the transaction resulted in a gain or loss, the amount of such gain or loss should be extended to the appropriate column. Example: 19____ 9/30 100 shares XYZ Co., common sold for $3,000.00 100 shares XYZ Co., common carried at $2,500.00 Net Gain $500.00 Gains $ $ Losses If continuation sheet(s) are used, enter total here............... Total (carry forward to summary) ................................................ $ $ $ $ Jan. 2010 Sheet 6 American LegalNet, Inc. www.FormsWorkFlow.com SCHEDULE "H" ADMINISTRATIVE EXPENSES List in detail below each expenditure of an administrative nature. This would include attorney's fees, audit fees, bond premiums, bank charges, court costs, etc. Disbursements $ If continuation sheet(s) are used, enter total here.......................... Total (carry forward to summary) ....................................................... $ $ SCHEDULE "I" RENTAL PROPERTY EXPENSES List in detail below, all expenditures related to rental property(ies). If the expenses relate to more than one property, the expenses should be grouped as to each property. Disbursements $ If continuation sheet(s) are used,