FIRST AND [PARTIAL/INTERIM] ACCOUNT OF PERSONAL REPRESENTATIVE

COURT INFORMATION

State of: [________________________________]

County of: [________________________________]

Court: [☐ Probate Court ☐ Surrogate's Court ☐ Superior Court ☐ Circuit Court]

Case Number: [________________________________]

IN THE MATTER OF THE ESTATE OF:

Decedent's Full Legal Name: [________________________________]

Also Known As: [________________________________]

DECEASED

ACCOUNT INFORMATION

Account Type:
☐ First Account
☐ Second Account
☐ [____] Account
☐ Interim/Partial Account

Accounting Period:
From: [__/__/____] To: [__/__/____]

Personal Representative:
Name: [________________________________]
Address: [________________________________]
Telephone: [(___)___-____]

Attorney for Personal Representative:
Name: [________________________________]
Firm: [________________________________]
Address: [________________________________]
Telephone: [(___)___-____]

SUMMARY OF ACCOUNT

SCHEDULE A: ASSETS ON HAND AT BEGINNING OF PERIOD

[// GUIDANCE: For first account, this matches inventory. For subsequent accounts, matches prior ending balance.]

Real Property

Real Property Subtotal: $[____________]

Financial Accounts

Financial Accounts Subtotal: $[____________]

Securities

Securities Subtotal: $[____________]

Other Personal Property

Other Personal Property Subtotal: $[____________]

SCHEDULE A TOTAL (Beginning Balance): $[________________________________]

SCHEDULE B: RECEIPTS DURING ACCOUNTING PERIOD

B-1: Income Receipts

Income Receipts Subtotal: $[____________]

B-2: Sale of Assets

Net Sales Proceeds: $[____________]

B-3: Collections

Collections Subtotal: $[____________]

B-4: Other Receipts

Other Receipts Subtotal: $[____________]

SCHEDULE B TOTAL (All Receipts): $[________________________________]

SCHEDULE C: DISBURSEMENTS DURING ACCOUNTING PERIOD

C-1: Administration Expenses

Administration Expenses Subtotal: $[____________]

C-2: Funeral and Last Illness Expenses

Funeral/Medical Expenses Subtotal: $[____________]

C-3: Debts and Claims Paid

Debts/Claims Paid Subtotal: $[____________]

C-4: Taxes Paid

Taxes Paid Subtotal: $[____________]

C-5: Property Maintenance and Expenses

Property Expenses Subtotal: $[____________]

C-6: Personal Representative Compensation

[// GUIDANCE: Compensation must comply with state statutory rates or court approval]

PR Compensation Subtotal: $[____________]

C-7: Distributions to Beneficiaries

Distributions Subtotal: $[____________]

C-8: Other Disbursements

Other Disbursements Subtotal: $[____________]

SCHEDULE C TOTAL (All Disbursements): $[________________________________]

SCHEDULE D: ASSETS ON HAND AT END OF PERIOD

Real Property

Real Property Subtotal: $[____________]

Financial Accounts

Financial Accounts Subtotal: $[____________]

Securities

Securities Subtotal: $[____________]

Other Assets

Other Assets Subtotal: $[____________]

SCHEDULE D TOTAL (Ending Balance): $[________________________________]

RECONCILIATION

[// GUIDANCE: Any difference must be explained. Common reasons include unrealized gains/losses on securities.]

STATUS OF ADMINISTRATION

Debts and Claims

Creditor claim period expires: [__/__/____]

Tax Returns

Pending Matters

☐ No pending matters

☐ The following matters are pending:
- [________________________________]
- [________________________________]
- [________________________________]

Estimated Time to Close Estate

[________________________________]

REQUEST FOR COMPENSATION

[// GUIDANCE: May be combined with accounting or filed separately]

Personal Representative requests approval of compensation:

☐ Statutory compensation of $[____________]
Basis: [% of estate value per state statute]

☐ Extraordinary compensation of $[____________]
Basis: [________________________________]

Attorney fees requested:
☐ Statutory fees of $[____________]
☐ Hourly fees of $[____________] (attach time records)
☐ Other: $[____________]

VERIFICATION

I, [PERSONAL REPRESENTATIVE NAME], the [Executor/Administrator/Personal Representative] of this Estate, declare under penalty of perjury under the laws of the State of [STATE] that:

1. I have read this account and know its contents.

2. The statements in this account are true and correct.

3. All receipts and disbursements are accurately stated.

4. No disbursements were made for purposes other than the administration of the estate.

5. The assets on hand are as stated and are in my custody or under my control.

Executed on [DATE] at [CITY], [STATE].

_________________________________
[Personal Representative Signature]

_________________________________
[Printed Name]

NOTICE TO INTERESTED PARTIES

Notice of this accounting has been provided to all interested parties:

ATTACHMENTS

☐ Bank statements for all accounts during period
☐ Investment account statements
☐ Receipts for significant disbursements
☐ Invoices for professional fees
☐ Copies of tax returns filed
☐ Creditor claim documentation
☐ Court orders during period
☐ Attorney fee time records
☐ Other: [________________________________]

END OF FIRST/INTERIM ACCOUNT