Annual Financial Accounting Report - Utah State Courts

Guardian or Conservator Accounting Report Page 1 of 5 Name Address Phone Fax E-mail I am the Guardian Conservator I am the attorney for Guardian Conservator My Utah State Bar number is In the Judicial District Court County, Utah Court Address: In the Matter of: (W ard). [ ] Guardian’s Financial Accounting to Conservator [Section 75-5-312] [ ] Guardian’s/Conservator’s Financial Accounting to the Court [Section 75-5-312 and Section 75-5-419] Case Number Judge 1. I am the following to the above-named Ward: [ ] Guardian [ ] Conservator [ ] Guardian and Conservator 2. (Check all of the boxes which apply. Fill in the blanks if appropriate.) [ ] This is my first report. [ ] My previous report covered the

period from ______________ to ______________. [ ] This is my final report. 3. This accounting covers the period from ______________ to ______________. Guardian or Conservator Accounting Report Page 2 of 5 4. There is an estate plan to guide investment and distribution: [ ] No [ ] Yes [ ] The plan is on file with the court. [ ] The plan is being submitted along with this accounting. 5. Balance Summary (Beginning Balance must agree with Ending Balance of the Inventory or the previous accounting, whichever is later.) Schedule Category Beginning Balance Gains and Losses Ending Balance A Real Estate B Stocks and Bonds C Money Owed to Ward D Miscellaneous Property E Debts and Encumbrances F Cash and Cash Accounts ** * Total * This amount should equal the money in all of the Ward’s bank accounts on the last day of the reporting period for this accounting. **The total Gains and Losses for Cash and Cash Accounts should equal the total for Receipts and Payments. Summary of Receipts and Payments 1 Receipts Total 2 Payments Total 3 Total ** **The total Gains and Losses for Cash and Cash Accounts should equal the total for Receipts and Payments. Receipts during the reporting period Item Description Amount 1 W ages 2 Interest 3 Dividends 4 Social Security 5 Annuities 6 Insurance 7 Real Estate Sold 8 Stocks/Bonds Sold Guardian or Conservator Accounting Report Page 3 of 5 Item Description Amount 9 Money owed to Ward that was received 10 Miscellaneous Property Sold 11 Other (Describe) 12 Total Payments during the reporting period Item Category (Amount) 1 Mortgage/Rent 2 Utilities (gas, electricity, water, sewage, phone, internet, etc.) 3 Home Maintenance (Include maintenance, cleaning, repairs, etc.) 4 Home Improvement (Include additions, remodeling, etc.) 5 Home Furnishings 6 Health Care (physicians, dentists, psychiatrists, psychologists, etc.) 7 Food 8 Education 9 Clothes 10 Personal Effects 11 Activities 12 Transportation 13 Taxes 14 Charge for Conservator’s Services 15 Charge for Guardian’s Services 16 Charge for other Professional Services 17 Court Fees 18 Other (Describe) 19 Total Schedule A – Real Estate* Item Description Value on First Day of this Reporting Period Value on Last Day of this Reporting Period Amount of Gain (Loss) 1 2 3 * Attach a copy of the most recent tax assessment for each piece of real property. Guardian or Conservator Accounting Report Page 4 of 5 Schedule B –...

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