Wisconsin > Statewide > Circuit Court > Guardianship
Account Of Guardian Or Conservator GN-3500 - Wisconsin
| Account Of Guardian Or Conservator Form. This is a Wisconsin form and can be used in Guardianship Circuit Court Statewide . |
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FORM SUMMARY Name of Form: Form Number: Statutory Reference: Benchbook Reference: Purpose of Form: Account of Guardian or Conservator GN-3500 §§54.19(5), 54.62, 54.66 and 54.76, Wisconsin Statutes GA-1, GA-2 and GA-6 To provide an accounting of the financial activity of the estate by the guardian /conservator. This may be an annual, interim or final account. Guardian of the estate or conservator. Original to court. Who Completes It: Distribution of Form: Accompanying Forms: New Form/Modification: Modifications: Comments: Modification, last update 01/06. Modified form to comply with 2005 Wis. Acts 264, 387 and 388. Use this form for both guardianship and conservatorship. About this form: PLEASE BE INFORMED: This form is based on unofficial text from Revisor of Statutes. This form is the product of the Wisconsin Records Management Committee, a committee of the Director of State Court's Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. Date: 10/05/2006 Page 1 American LegalNet, Inc. www.FormsWorkflow.com For Official Use STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Amended IN THE MATTER OF Account of Guardian or Conservator Annual Interim Final Case No. Date of Birth I am the Guardian or Conservator of the above named ward or conservatee. I certify that this is an accurate account of the administration of the guardianship or conservatorship for the period from to Line 1. Summary Explanation Beginning Balance. Do not change this amount. (Inventory net value or ending balance from prior account.) Total $ 2. Total of newly discovered assets and income received during this period. (Add) (Attach Schedule A- Assets and Income Received.) $ 3. Subtotal $ 4. Total disbursements, distributions and losses incurred. (Subtract) $ (List details in Schedule B Disbursements, Distributions and Realized Capital Losses.) 5. Ending Balance (Total Assets on Hand) at end of accounting period. (List details in Schedule C Assets on Hand.) Beginning Balance for next Account $ Status of Surety on Bond The status of the surety upon the guardian or conservator's bond: has changed. Explain: has not changed. Signature of Guardian/Conservator Signature of Co-Guardian/Conservator Name Printed or Typed Telephone Number Name Printed or Typed Telephone Number Address Address Subscribed and sworn to before me on Subscribed and sworn to before me on Notary Public/Court Official Notary Public/Court Official My commission expires: My commission expires: Name of Attorney Telephone Number Bar Number Address GN-3500, 10/06 Account of Guardian/Conservator Page 1 of 3 §§54.19(5), 54.62, 54.66 and 54.76, Wisconsin Statutes American LegalNet, Inc. www.FormsWorkflow.com This form shall not be modified. It may be supplemented with additional material. GN-3500 Account of Guardian/Conservator Page 2 of 3 Case No. (If the space given is insufficient for any item, attach additional sheets.) Schedule A Assets and Income Received Description (Example: Social security, pensions, interest, dividends, rental or other income, realized capital gains from assets sold for more than inventory value or purchase price if acquired after the initial inventory, assets discovered after filing initial inventory.) See attached. Amount Total: (Enter in Summary on Line 2 on page 1.) $ Schedule B Disbursements, Distributions and Realized Capital Losses Itemize Disbursements, Distributions and Realized Capital Losses (Example: Costs of care of the individual; payments made for the benefit of the individual; assets sold for less than inventory value or purchase price if acquired after the initial inventory.) See attached. Amount Total: (Enter in Summary on Line 4 on page 1.) $ GN-3500, 10/06 Account of Guardian/Conservator Page 2 of 3 §§54.19(5), 54.62, 54.66 and 54.76, Wisconsin Statutes American LegalNet, Inc. www.FormsWorkflow.com This form shall not be modified. It may be supplemented with additional material. GN-3500 Account of Guardian/Conservator Page 3 of 3 Schedule C Assets on Hand (at end of accounting period) Case No. See attached. Amount Cash, Checking Accounts, Savings Accounts, Certificates of Deposit (Including Names and Account Numbers) (List balance at end of accounting period.) Investments (List inventory value, or purchase price if acquired after the initial inventory.) Amount Real Estate (Including Encumbrances) (List inventory value, or purchase price if acquired after the initial inventory.) Amount Other Assets (Including Burial Trusts) (List inventory value, or purchase price if acquired after the initial inventory.) Amount Grand Total: (Enter in Summary on Line 5 on page 1.) $ For Authorized Persons Only Display of Assets and Examination of Accounts: I am not the guardian or conservator. I am authorized by the court to examine assets. I have examined all securities, depository accounts, and other investments, and such assets correspond with the account, except as indicated. Authorized Signature (Not guardian/conservator) Name Printed or Typed Title Date GN-3500, 10/06 Account of Guardian/Conservator Page 3 of 3 §§54.19(5), 54.62, 54.66 and 54.76, Wisconsin Statutes American LegalNet, Inc. www.FormsWorkflow.com This form shall not be modified. It may be supplemented with additional material.
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