Final Report Of Emergency Temporary Guardian

1 ETG Final Report SJCCOC 2018 IN THE CIRCUIT COURT, SEVENTH JUDICIAL CIRCUIT, IN AND FOR ST. JOHNS COUNTY, FLORIDA IN RE: THE GUARDIANSHIP OF Case No.: Division: FINAL REPORT OF EMERGENCY TEMPORARY GUARDIAN SUMMARY EMERGENCY TEMPORARY GUARDIAN START AND END DATES Date of Letters of Emergency Temporary Guardian: (Start Date) Expiration Date of Letters of Emergency Temporary Guardian: (End Date) SCHEDULE A - ASSETS Line 1: Cash on Hand $ Line 2: Investments $ Line 3: Stocks/Bonds/Securities $ Line 4: Real Property $ Line 5: Personal Property $ TOTAL ASSET VALUE $ SCHEDULE B - LIABILITIES Line 6: Current Expenses $ Line 7: Credit Cards $ American LegalNet, Inc. www.FormsWorkFlow.com 2 ETG Final Report SJCCOC 2018 Line 8: Loans/Notes $ TOTAL LIABILITIES $ SCHEDULE C - INCOME Line 9: Periodic Income $ Line 10: Other Income $ TOTAL INCOME $ SCHEDULE D - EXPENSES Line 11: Periodic Expenses $ (Circle one) SCHEDULE E - PENDING CAUSES OF ACTION Yes No SCHEDULE F - WITNESS TO INVENTORY Yes No SCHEDULE G - CLAIMS AGAINST THE ESTATE Yes No SCHEDULE H - SAFE DEPOSIT BOX Yes No SCHEDULE I - LAST WILL AND TESTIMENT Yes No SUMMARY OF EMERGENCY TEMPORARY GUARDIANSHIP Starting Asset Balance $ Total Receipts $ Total Disbursements $ Total Capital Transactions/Adjustments $ Balance at Close of Emergency Temporary Guardianship $ American LegalNet, Inc. www.FormsWorkFlow.com 3 ETG Final Report SJCCOC 2018 FINAL REPORT OF EMERGENCY TEMPORARY GUARDIAN WORKSHEET SCHEDULE A - ASSETS Line 1: Cash on Hand (Include all cash on deposit, name/address of institution and account number(s). Attach a separate sheet if necessary.) Institution Name/Address: Account Number: $ Institution Name/Address: Account Number: $ Institution Name/Address: Account Number: $ Institution Name/Address: Account Number: $ Institution Name/Address: Account Number: $ TOTAL OF ALL CASH ON HAND (Transfer total to Schedule A , Line 1 of Summary Page) $ American LegalNet, Inc. www.FormsWorkFlow.com 4 ETG Final Report SJCCOC 2018 Line 2: Investments (Include complete description of all investments, including the name and address of the institution, account or identifying number, and current market value. Attach a separate sheet if necessary.) Description/Account Number # of Shares Current Market Value $ $ $ $ $ $ $ TOT AL MARKET VALUE OF INVESTMENTS (Transfer total to Schedule A , Line 2 of Summary Page) $ Line 3: Stocks/Bonds/Securities (Include complete description of all stocks/bonds/securities, number of shares, identifying number and current market value. Attach separate sheet if necessary.) Description/Identifying Number # of Shares Current Market Value $ $ $ $ $ $ $ TOTAL MARKET VALUE OF STOCKS/BONDS/SECURITIES (Transfer total to Schedule A , Line 3 of Summary Page) $ American LegalNet, Inc. www.FormsWorkFlow.com 5 ETG Final Report SJCCOC 2018 Line 4: Real Property (Include complete description of all real property, attach current Description Income Producing Estimated FMV Yes No $ Yes No $ Yes No $ Yes No $ Estimated FMV for Income Producing Property Estimated FMV for Non - Income Producing Property $ $ TOTAL FMV FOR ALL REAL PROPERTY (Transfer total to Schedule A , Line 4 of Summary Page) $ Line 5: Personal Property (Other than Cash. Include complete description. General household furnishings of nominal value may be shown together. Attach separate sheet if necessary.) Item Location Estimated FMV Encumbrances $ Yes No $ Yes No $ Yes No $ Yes No General Household Furnishings: $ Yes No TOTAL FMV FOR ALL PERSONAL PROPERTY (Transfer total to Schedule A , Line 5 of Summary Page) $ American LegalNet, Inc. www.FormsWorkFlow.com 6 ETG Final Report SJCCOC 2018 SCHEDULE B - LIABILITIES Line 6: Curr ent Expenses (Include a complete description of all outstanding obligations. Attach separate sheet if necessary.) Institution Authorized Names & Relationship Account No. Account Type Credit Line Balance Owed $ $ $ $ $ $ $ $ TOTAL OF ALL EXPENSES (Transfer total to Schedule B , Line 6 of Summary Page) $ Line 7: Credit Cards (Attach separate sheet if necessary.) Institution Authorized Names & Relationship Account No. Account Type Credit Line Balance Owed $ $ $ $ $ $ $ $ TOTAL BALANCE OWING ON ALL CREDIT CARDS (Transfer total to Schedule B , Line 7 of Summary Page) $ American LegalNet, Inc. www.FormsWorkFlow.com 7 ETG Final Report SJCCOC 2018 Line 8: Loans/Notes (Include all outstanding loans/notes, name and address of payee, account number and dollar amount owing. Attach separate sheet if necessary.) Loan/Note Name & Address of Payee Account No. Dollar Amount Owed $ $ $ $ TOTAL OF ALL OUTSTANDING LOANS/NOTES (Transfer total to Schedule B , Line 8 of Summary Page) $ SCHEDULE C - INCOME Line 9: Periodic Income (Include complete description of all sources, name of payer, frequency and amount of payments. Attach separate sheet if necessary.) Source Name of Payer Frequency of Payments Amount of Payments $ $ $ $ TOTAL OF ALL PERIODIC INCOME (Transfer total to Schedule C , Line 9 of Summary Page) $ American LegalNet, Inc. www.FormsWorkFlow.com 8 ETG Final Report SJCCOC 2018 Line 10: Other Income (Include complete description of all sources, name of payer, frequency and amount of payments. Attach separate sheet if necessary.) Source Name of Payer Frequency of Payme nts Amount of Payments $ $ $ $ TOTAL OF ALL OTHER INCOME (Transfer total to Schedule C , Line 10 of Summary Page) $ SCHEDULE D - EXPENSES Line 11: Periodic Expenses (Include complete description of expenses, frequency and amount of payment. Attach separate sheet if necessary.) Name & Address of Payee Type of Payment Frequency of Payments Amount of Payments $ $ $ $ TOTAL OF ALL PERIODIC EXPENSES (Transfer total to Schedule D , Line 11 of Summary Page) $ American LegalNet, Inc. www.FormsWorkFlow.com 9 ETG Final Report SJCCOC 2018 SCHEDULE E - PENDING CAUSES OF ACTION (See schedule E on Summary Page) Type of Action/State/County/Case No. Status SCHEDULE F - WITNESSES (See schedule F on Summary Page) Name Address Occupation SCHEDULE G - CLAIMS AGAINST ESTATE A. Secured: Creditor Description of Debt Description of Security When Occurred Amount $ $ $ TOTAL OF SECURED CLAIMS (Refer to Schedule G of Summary Page) $ American LegalNet, Inc. www.FormsWorkFlow.com 10 ETG Final Report SJCCOC 2018 B. Unsecured Creditor Description of Debt Description of Security When Occurred Amount $ $ $ TOTAL OF UNSECURED CLAIMS (Refer to Schedule G of Summary Page) $ SCHEDULE H - SAFE DEPOSIT BOX Contents of Safe Deposit Box, as listed on Safe Deposit Box Inventory, are shown in applicable categories under Assets, Schedule A. Yes No (circle one) (Refer to Schedule H . of Summary Page.) SCHEDULE I - LAST WILL AND TESTAMENT Yes No (circle one) If yes, the location of the Last Will and Testament is: (Refer to Schedule I. of Summary Page.) American LegalNet, Inc. www.FormsWorkFlow.com 11 ETG Final Report SJCCOC 2018 RECEIPTS DURING EMERGENCY TEMPORARY GUARDIANSHIP ACCOUNT NUMBER: DATE MONEY IN - DESCRIPTION AMOUNT $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TOTAL RECEIPTS (For this bank account) $ American LegalNet, Inc. www.FormsWorkFlow.com 12 ETG Final Report SJCCOC 2018 RECEIPTS DURING EMERGENCY TEMPORARY GUARDIANSHIP ACCOUNT NUMBER: DATE MONEY IN - DESCRIPTION AMOUNT $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TOTAL RECEIPTS (For this bank account) $ American LegalNet, Inc. www.FormsWorkFlow.com 13 ETG Final Report SJCCOC 2018 RECEIPTS DURING EMERGENCY TEMPORARY GUARDIANSHIP ACCOUNT NUMBER: DATE MONEY IN - DESCRIPTION AMOUNT $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TOTAL RECEIPTS (For this bank account) $ American LegalNet, Inc. www.FormsWorkFlow.com 14 ETG Final Report SJCCOC 2018 FEES & COSTS, AND/OR OTHER COURT ORDERED DISBURSEMENTS) DATE DESCRIPTION & ACCOUNT NUMBER AMOUNT $ $ $ $ $ $ $ $ $ $ $ $ TOTAL COURT ORDERED MONEY OUT $ COMPANION/GUARDIAN ASSISTANT FEES (MONEY OUT) DATE DESCRIPTION & ACCOUNT NUMBER AMOUNT $ $ $ $ $ $ TOTAL COMPANION/GUARDIAN ASSISTANT FEES MONEY OUT $ American LegalNet, Inc. www.FormsWorkFlow.com 15 ETG Final Report SJCCOC 2018 DISBURSEMENTS DURING EMERGENCY TEMPORARY GUARDIANSHIP ACCOUNT NUMBER: DATE MONEY OUT - DESCRIPTION AMOUNT $