GUARDIAN/CONSERVATOR ACCOUNTING
(Annual/Periodic Financial Report)
CASE INFORMATION
COURT: _______________________________________________
COUNTY: _______________________________________________
STATE: _______________________________________________
IN THE MATTER OF THE GUARDIANSHIP/CONSERVATORSHIP OF:
[NAME OF WARD/PROTECTED PERSON]
Case No.: _______________________________________________
ACCOUNTING OF GUARDIAN/CONSERVATOR OF THE ESTATE
Account Information
Type of Accounting:
☐ First and Current Account
☐ _____ Annual Account
☐ Final Account
☐ Other: _______________________________________________
Accounting Period:
From: _______________ To: _______________
Date of Appointment: _______________________________________________
SECTION 1: GUARDIAN/CONSERVATOR INFORMATION
Guardian/Conservator Name: _______________________________________________
Address: _______________________________________________
Phone: _______________________________________________
Email: _______________________________________________
Relationship to Ward: _______________________________________________
Bond Amount: $_______________________________________________
Bonding Company: _______________________________________________
SECTION 2: WARD/PROTECTED PERSON INFORMATION
Ward's Name: _______________________________________________
Date of Birth: _______________________________________________
Current Address: _______________________________________________
Current Living Situation:
☐ Home ☐ Assisted Living ☐ Nursing Home ☐ Other: _______________
SECTION 3: SUMMARY OF ACCOUNT
3.1 Summary Statement
| Line | Description | Amount |
|---|---|---|
| 1 | Beginning Balance (Assets at Start of Period) | $ |
| 2 | Plus: Total Receipts During Period | $ |
| 3 | Subtotal (Line 1 + Line 2) | $ |
| 4 | Less: Total Disbursements During Period | $ |
| 5 | Ending Balance (Assets at End of Period) | $ |
| (Line 3 - Line 4 = Line 5) |
3.2 Verification of Balance
| Category | Amount |
|---|---|
| Cash and Bank Accounts | $ |
| Investments and Securities | $ |
| Real Property | $ |
| Personal Property | $ |
| Other Assets | $ |
| TOTAL ASSETS AT END OF PERIOD | $ |
Does Total Assets match Line 5 above? ☐ Yes ☐ No (Explain if No)
SECTION 4: BEGINNING BALANCE (ASSETS AT START OF PERIOD)
4.1 Cash and Bank Accounts
| Institution | Account Type | Account # (Last 4) | Balance |
|---|---|---|---|
| Checking | $ | ||
| Savings | $ | ||
| Money Market | $ | ||
| CD | $ | ||
| $ | |||
| SUBTOTAL - CASH/BANK ACCOUNTS | $ |
4.2 Investments and Securities
| Description | Broker/Institution | # Shares/Units | Value |
|---|---|---|---|
| $ | |||
| $ | |||
| $ | |||
| SUBTOTAL - INVESTMENTS | $ |
4.3 Real Property
| Property Address | Type | Value |
|---|---|---|
| $ | ||
| $ | ||
| SUBTOTAL - REAL PROPERTY | $ |
4.4 Personal Property
| Description | Value |
|---|---|
| Vehicle(s) | $ |
| Household Items | $ |
| Other Personal Property | $ |
| SUBTOTAL - PERSONAL PROPERTY | $ |
4.5 Other Assets
| Description | Value |
|---|---|
| Life Insurance (Cash Value) | $ |
| Retirement Accounts | $ |
| Amounts Owed to Ward | $ |
| Other | $ |
| SUBTOTAL - OTHER ASSETS | $ |
TOTAL BEGINNING BALANCE: $_______________
SECTION 5: RECEIPTS (INCOME DURING PERIOD)
5.1 Summary of Receipts
| Category | Amount |
|---|---|
| Social Security | $ |
| Pension(s) | $ |
| Investment Income (dividends, interest) | $ |
| Rental Income | $ |
| VA Benefits | $ |
| Other Government Benefits | $ |
| Sale of Assets | $ |
| Insurance Proceeds | $ |
| Gifts/Inheritances | $ |
| Other Income | $ |
| TOTAL RECEIPTS | $ |
5.2 Detailed Schedule of Receipts
| Date | Description | Source | Amount |
|---|---|---|---|
| $ | |||
| $ | |||
| $ | |||
| $ | |||
| $ | |||
| $ | |||
| $ | |||
| $ | |||
| $ | |||
| $ |
(Attach additional pages if necessary)
SECTION 6: DISBURSEMENTS (EXPENSES DURING PERIOD)
6.1 Summary of Disbursements
| Category | Amount |
|---|---|
| Housing: | |
| Rent/Mortgage | $ |
| Property Taxes | $ |
| Homeowner's/Renter's Insurance | $ |
| Utilities | $ |
| Maintenance/Repairs | $ |
| Subtotal Housing | $ |
| Healthcare: | |
| Nursing Home/Care Facility | $ |
| Home Care Services | $ |
| Medical Insurance Premiums | $ |
| Medical Expenses (co-pays, etc.) | $ |
| Medications | $ |
| Dental/Vision | $ |
| Medical Equipment | $ |
| Subtotal Healthcare | $ |
| Personal Needs: | |
| Food/Groceries | $ |
| Clothing | $ |
| Personal Care Items | $ |
| Telephone | $ |
| Transportation | $ |
| Subtotal Personal | $ |
| Administrative: | |
| Guardian/Conservator Fees | $ |
| Attorney Fees | $ |
| Accountant/Tax Prep Fees | $ |
| Court Costs | $ |
| Bond Premium | $ |
| Subtotal Administrative | $ |
| Other: | |
| Income Taxes | $ |
| Property Taxes | $ |
| Insurance (other) | $ |
| Debt Payments | $ |
| Other Expenses | $ |
| Subtotal Other | $ |
| TOTAL DISBURSEMENTS | $ |
6.2 Detailed Schedule of Disbursements
| Date | Payee | Purpose | Amount | Receipt Attached? |
|---|---|---|---|---|
| $ | ☐ | |||
| $ | ☐ | |||
| $ | ☐ | |||
| $ | ☐ | |||
| $ | ☐ | |||
| $ | ☐ | |||
| $ | ☐ | |||
| $ | ☐ | |||
| $ | ☐ | |||
| $ | ☐ |
(Attach additional pages if necessary)
SECTION 7: ENDING BALANCE (ASSETS AT END OF PERIOD)
7.1 Cash and Bank Accounts
| Institution | Account Type | Account # (Last 4) | Balance |
|---|---|---|---|
| $ | |||
| $ | |||
| $ | |||
| $ | |||
| SUBTOTAL - CASH/BANK ACCOUNTS | $ |
7.2 Investments and Securities
| Description | Broker/Institution | # Shares/Units | Value |
|---|---|---|---|
| $ | |||
| $ | |||
| $ | |||
| SUBTOTAL - INVESTMENTS | $ |
7.3 Real Property
| Property Address | Type | Value |
|---|---|---|
| $ | ||
| SUBTOTAL - REAL PROPERTY | $ |
7.4 Personal Property
| Description | Value |
|---|---|
| $ | |
| $ | |
| SUBTOTAL - PERSONAL PROPERTY | $ |
7.5 Other Assets
| Description | Value |
|---|---|
| $ | |
| $ | |
| SUBTOTAL - OTHER ASSETS | $ |
TOTAL ENDING BALANCE: $_______________
SECTION 8: CHANGES IN ASSETS
8.1 Assets Sold or Disposed
| Date | Asset Description | Proceeds | Court Approval? |
|---|---|---|---|
| $ | ☐ Yes ☐ No ☐ N/A | ||
| $ | ☐ Yes ☐ No ☐ N/A | ||
| $ | ☐ Yes ☐ No ☐ N/A |
8.2 Assets Purchased or Acquired
| Date | Asset Description | Cost | Source of Funds |
|---|---|---|---|
| $ | |||
| $ | |||
| $ |
8.3 Changes in Investments
| Date | Transaction | Amount |
|---|---|---|
| $ | ||
| $ | ||
| $ |
SECTION 9: COMPENSATION AND FEES
9.1 Guardian/Conservator Compensation
Total compensation requested for this period: $_______________
Basis for compensation:
☐ Statutory fee: _______________________________________________
☐ Reasonable hourly rate: $______/hour x ______ hours
☐ Percentage of estate: ______%
☐ Other: _______________________________________________
Has compensation been previously approved by the Court?
☐ Yes - Date of Order: _______________
☐ No - Compensation requires Court approval
9.2 Attorney Fees
| Attorney Name | Services Provided | Amount |
|---|---|---|
| $ | ||
| $ |
Total attorney fees for period: $_______________
9.3 Other Professional Fees
| Professional | Services | Amount |
|---|---|---|
| Accountant | $ | |
| Financial Advisor | $ | |
| Other | $ |
Total other professional fees: $_______________
SECTION 10: LIABILITIES
10.1 Outstanding Debts and Obligations
| Creditor | Description | Amount Owed |
|---|---|---|
| $ | ||
| $ | ||
| $ | ||
| $ | ||
| TOTAL LIABILITIES | $ |
10.2 Net Worth Summary
| Item | Amount |
|---|---|
| Total Assets | $ |
| Less: Total Liabilities | $ |
| NET WORTH | $ |
SECTION 11: SUPPLEMENTAL INFORMATION
11.1 Tax Returns
Were federal and state income tax returns filed for the Ward?
☐ Yes - For tax year(s): _______________
☐ No - Explain: _______________________________________________
Were all taxes paid?
☐ Yes
☐ No - Amount outstanding: $_______________
11.2 Insurance
Is the Ward's property adequately insured?
☐ Yes
☐ No - Explain: _______________________________________________
11.3 Bond
Is the current bond adequate?
☐ Yes - Current bond amount: $_______________
☐ No - Recommend increase to: $_______________
SECTION 12: REQUESTS TO COURT
12.1 Compensation Approval
☐ I request approval of guardian/conservator fees in the amount of: $_______________
☐ I request approval of attorney fees in the amount of: $_______________
☐ I request approval of other professional fees in the amount of: $_______________
12.2 Other Requests
☐ I request approval to sell the following property:
_______________________________________________
☐ I request modification of bond to: $_______________
☐ I request discharge as guardian/conservator (if final account)
☐ Other requests:
_______________________________________________
SECTION 13: CERTIFICATION
I, _______________________________________________,
the duly appointed Guardian/Conservator of the Estate of _______________________________________________,
hereby certify under penalty of perjury that:
-
I have faithfully discharged my duties as Guardian/Conservator during this accounting period.
-
This accounting is a full, true, and correct statement of all receipts and disbursements and of all assets in my possession or under my control as Guardian/Conservator.
-
All disbursements were made for the benefit of the Ward/Protected Person.
-
I have attached supporting documentation as required.
-
I have maintained accurate records of all transactions.
Guardian/Conservator Signature: _________________________________
Printed Name: _________________________________
Date: _________________________________
NOTARY (If Required)
STATE OF _______________
COUNTY OF _______________
Subscribed and sworn to before me this ___ day of _____________, 20___.
_________________________________
Notary Public
My Commission Expires: _________________________________
[NOTARY SEAL]
SECTION 14: REQUIRED ATTACHMENTS
☐ Bank statements for all accounts (for entire period)
☐ Investment statements (for entire period)
☐ Receipts/documentation for disbursements over $_______________
☐ Invoices for professional fees
☐ Real property appraisals (if changed)
☐ Copy of tax returns filed
☐ Court orders received during period
☐ Other: _______________________________________________
FILING INSTRUCTIONS
- Complete all sections of this accounting
- Attach all required documentation
- Sign and notarize
- File original with the Court
- Serve copies on all interested parties
- Pay any required filing fee
- Retain copy for your records
Filing Fee: $_______________
Filing Deadline: _______________________________________________
Service Required On:
☐ Ward (if capable of understanding)
☐ Ward's attorney (if any)
☐ All interested parties who received original notice
☐ Others as ordered by Court
This template is provided for informational purposes only and does not constitute legal advice. Guardians and conservators have fiduciary duties and must accurately account for all financial matters. Failure to file required accountings may result in removal and personal liability. Requirements vary by state. Consult with an attorney or accountant for assistance.
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