Trustee Accounting And Proposed Budget {02.0102}

(Copy Receipt) (Clerk's Date Stamp) SUPERIOR COURT OF WASHINGTON COUNTY OF SPOKANE In the Trust of: _______________________________________ CASE NO. ______________________ TRUSTEE'S ACCOUNTING AND PROPOSED BUDGET If you need more room to answer any item, please attach an additional page. 1. Date of Appointment and Reporting Period: The Trustee was appointed on ___________. This report covers the period from ____________ through ____________. The closing date for all reports is _______________, and the Trustee is required to file reports within 90 days of that date. The Trustee is to file a report annually. 2. Contact Information: Beneficiary Full Name Mailing Address City, State & Zip Telephone Number Fax Number Email Address TRUSTEE'S ACCOUNTING AND PROPOSED BUDGET - PAGE 1 OF 8 SPO TRU 02.0102 (04/2007) Guardian (if applicable) Trustee American LegalNet, Inc. www.FormsWorkFlow.com 3. Contact Information for Trust Advisory Committee (if applicable): Committee Member Full Name Mailing Address City, State & Zip Telephone Number Fax Number Email Address Committee Member Committee Member 4. Are Trust Advisory Committee members related to the beneficiary? Yes No Specify: ___________________________________________________________________ 5. Relationship, if any, of trustee to beneficiary: ________________________________ 6. Is trustee a residual beneficiary of trust? 7. Is there a bond? Yes No Yes No Amount $___________________ 8. Which trust fund accounts, if any, are blocked? _________________________________ a. Trustee's Bond: The Court now requires a bond in the amount of: $ $ $ $ No b. Total balance in blocked accounts at end of review period: c. Total balance unblocked at end of review period: d. The bond should: remain the same; OR be changed to 9. Have trust reports been prepared annually? Yes 10. Benefits Received. The Beneficiary receives the following: SSDI/SSA; Stamps; GAU; SSI; Medicaid; Medicare; VA; Copes; CSA; TANF; HUD; Food Public Assistance; Other--Specify: __________________________________________________________ 11. Inventory: An inventory of all trust property updated inventory is contained in this Report. is, or is not on file herein. An TRUSTEE'S ACCOUNTING AND PROPOSED BUDGET - PAGE 2 OF 8 SPO TRU 02.0102 (04/2007) American LegalNet, Inc. www.FormsWorkFlow.com 12. Proposed Budget: The Trustee seeks authority to make expenditures for the Incapacitated Person or beneficiary according to the proposed attached budget. 13. Fees: If Trustee and/or attorney fees are requested, attach or submit a separate, itemized fee declaration which describes the specific services rendered, the time required, the rate of compensation, and the out-of-pocket costs incurred. Trustee $_____________ Attorney $_______________ Accountant $______________ 14. Court Approval: The trustee petitions the Court for approval of this Accounting and Proposed Budget. TRUSTEE'S ACCOUNTING AND PROPOSED BUDGET - PAGE 3 OF 8 SPO TRU 02.0102 (04/2007) American LegalNet, Inc. www.FormsWorkFlow.com ACCOUNTING SUMMARY FORM FOR TRUSTEES 15. Estate Information For Accounting Period starting ____________ and ending _____________. A. Total Assets at Market Value as of the beginning of review period $______________. SET FORTH TOTAL FIGURES FOR ENTIRE ACCOUNTING PERIOD. DO NOT USE MONTHLY FIGURES. Income Received from All Sources (do not include new assets purchased) Wages & Benefits Wages Social Security Retirement Benefit Disability Health Insurance Benefits Other (Specify): CURRENT MONTHLY BENEFIT $ $ $ $ $ $ TOTAL RECEIVED $ Interest & Dividends List account and amount received: $ $ $ $ Other Receipts List source and amount received: $ $ $ $ B. Total Income: Disbursements and Outgoing Payments Personal Living Expenses Housing/Facility/Rent Companion/Attendant Care Food and Groceries Incidentals/Clothing Utilities Phone/Cable Insurance $__________________ TOTAL $ $ $ $ $ $ $ $ TRUSTEE'S ACCOUNTING AND PROPOSED BUDGET - PAGE 4 OF 8 SPO TRU 02.0102 (04/2007) American LegalNet, Inc. www.FormsWorkFlow.com Personal Allowance Auto and Transportation Other (Specify): $ $ $ Healthcare Expenses Medical/Dental Pharmaceutical Medical Transportation Health Insurance Outside Case Management Fees Other (Specify): Trustee Fees Trustee Fees Professional Fees Paid to Others Guardian ad Litem Fees Attorney Fees: for Trustee Attorney Fees: for Asset Management Fees Bond Premium Medical Claims Assistance Accountant/Tax Preparation Fees Other (Specify): $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Real Property Expenses: Residence Maintenance & Repair Homeowners/Co-op Dues Property Taxes Mortgage Insurance Other (Specify): $ $ $ $ $ $ $ Investment Property Expenses Other Expenses Employment Tax Income Tax Payments Costs Advanced Bank/Service Fees Other (Specify): $ $ $ $ $ C. Total Disbursements TRUSTEE'S ACCOUNTING AND PROPOSED BUDGET - PAGE 5 OF 8 SPO TRU 02.0102 (04/2007) $__________________ American LegalNet, Inc. www.FormsWorkFlow.com Adjustments to Market Value of Estate Addition of Assets/(Liabilities) Not Previously Reported (Do not use this section for assets purchased) $ $ Deletion or Reduction in Value (Assets)/Liabilities Listed on previous accounting $ $ Gifts Received/(Made) Date of Court Order Authorizing $ $ Net Gains/(Losses) from Sales of Assets $ $ Unrealized Gains/(Losses) Increase/(decrease) in unrealized gain on securities Increase/(decrease) in market value of real property Increase/(decrease) in market value of personal property Other Adjustments (Specify) $ $ $ $ D. Total Adjustments to Market Value of Estate: $_________________ E. Ending Balance at Market Value, as of _______________ $____________________ (A + B ­C +/- D = E) 16. Balance Sheet for the Trust Estate ASSETS Description Accounting: Cost Basis at End of Accounting Date: Market Value on Start of Accounting Date: Market Value at End of Accounting Date: Real Property $ $ $ $ $ $ TRUSTEE'S ACCOUNTING AND PROPOSED BUDGET - PAGE 6 OF 8 SPO TRU 02.0102 (04/2007) American LegalNet, Inc. www.FormsWorkFlow.com Receivables (Mortgages, Liens, Notes payable to the Incapacitated Person, the Estate, or Trust) $ $ $ $ $ $ Blocked Liquid Assets (Investment Accounts, Stocks, Bonds, Securities, IRA, Cash in Court Blocked Accounts) $ $ $ $ $ $ $ $ $ Unblocked Liquid Assets (Investment Accounts, Stocks, Bonds, Securities, IRA, Cash) $ $ $ $ $ $ $ $ $ Personal and Other Property (Household Goods, Vehicles, Burial Plots, Funeral Plans, Life Insurance) $ $ $ $ $ $ $ $ $