Account Information Sheet

<document>COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.ACCOUNT INFORMATION SHEETJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)In the Matter of the Estate of:Superior Court Case Number:Current Bond Amount: Fair Market Value of Estate Assets: (at accounting period year end). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Estimated Annual Income:Requested Bond Amount for coming year: THE PEOPLE OF THE STATE OF NEW YORK TOAll restricted estate accounts/assets should be clearly identified (i.e. marked with an asterisk: * Restricted Account) in the accounting. Does this estate have any restricted accounts? yes noGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the HonorableIf yes, is a Proof of Restricted Account for each account, signed by the current financial institution representative, on file with the Court?,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in room yes noIf the financial institution's name has changed, or if it has been merged with or acquired by another institution since the filing of the original Proof of Restricted Account, file a new Proof of Restricted Account signed by the existing financial institution. Other than professional advisors (attorneys, accountants, financial brokers), does the estate employ any private individuals such as caretakers or aides? yes no (The amount and date of all payments and the identity of the payee should be stated in the Accounting.)Are any of these private individuals related to the minor/ward or to the conservator? yes no If yes, please state the name and relationship of each individual.Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Last Revised: January 2, 2003 1Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.Have any gifts been made from the ward/minor's estate without prior Court approval? yes noJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)If yes, please state the name and relationship of the recipient, and the amount and purpose of the gift.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOIs all real property, automobile(s), and other personal property in the estate adequately insured? no yes not applicable Does the Accounting show the company name and type of property insured for each policy? yes no If not, why not?GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofDoes the ward/minor have medical insurance? no yes If yes, please list the insurance company and policy number.o'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.Are there any life insurance policies on the ward/minor's life? no yes If yes, please list the insurance company, policy number, and date of policy(s)., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Are you aware of any changes made to the ward's estate plan during this accounting period, including any change of designated beneficiary on an asset? no yes If yes, please list the date and name of the document effecting such change and identify the person(s) who signed/prepared the document(s). Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Last Revised: January 2, 2003 2Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.Please list the location of all of the ward's wills, codicils, trusts and amendments:JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)Are income tax returns required to be filed on behalf of the ward/minor? no yes If yes, list the name and address of the accountant/tax preparer: Does the ward/minor own any real property ? no yes If yes, please list the names of the person(s) living on the property, their relation to the ward/minor, and the amount, if any, of rent that is being paid on the property. Current mailing address, residence address and phone number of Conservator(s):. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomMailing Address:Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.Residence Address:Phone Number:, one of the Justices of theCourt in Witness, Honorableday of, 20 County,Current address and phone number of Ward/Minor:Residence Address: Phone Number:(Attorney must sign above and type name below)Attorney(s) forDated Signature of ConservatorOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Addres