IN THE DISTRICT COURT OF ____________________ COUNTY, KANSAS
Filed Pursuant to K.S.A. Chapter 59
IN THE MATTER OF THE (GUARDIANSHIP) (CONSERVATORSHIP) OF _______________________________________
CASE NO. ____________
(ANNUAL)(FINAL) ACCOUNTING PLEASE PRINT AND USE BLACK INK TO COMPLETE THIS FORM. In the Conservatorship of _______________________________, For period beginning _________________, 20____ and ending ________________, 20____. Comes now, _______________________________ ________________________________
Conservator City, State and Zip Code Address Telephone Number
_______________________________ ________________________________ conservator in the above entitled estate and submits the following (annual)(final) accounting in the conservatorship of: ______________________________ _________________
Name of Ward Date of Birth
_________________________
Social Security Number
______________________________
Address, City, State & Zip Code
SUMMARY FOR ACCOUNTING PERIOD TOTAL RECEIPTS TOTAL DISBURSEMENTS CASH BALANCE ON HAND $_______________ $_______________ $______________
ACCOUNTING - CASE NO. _____________ ATTACH DETAILED ACCOUNTING OF RECEIPTS, DISBURSEMENTS AND INVENTORY OF PROPERTY ON THE FOLLOWING PAGES: RECEIPTS EXPLANATION
DATE
RECEIVED FROM
AMOUNT
BALANCE FORWARD
TOTAL RECEIPTS ATTACH ADDITIONAL PAGES IF NECESSARY. ACCOUNTING - CASE NO. ___________ SHEETS CAN BE ATTACHED FOR FURTHER DETAILS. DISBURSEMENTS
$
DATE
PAID TO
PURPOSE
AMOUNT
TOTAL DISBURSEMENTS
$
ACCOUNTING - CASE NO. __________ SHEETS CAN BE ATTACHED FOR FURTHER DETAILS (ANNUAL)(FINAL) INVENTORY (For Period Ending _______________, _____) Including the above cash balance, your accounts for the following assets: REAL ESTATE 1. _______________________________________________ $______________ 2. _______________________________________________ $______________ 3. _______________________________________________ $______________ TOTAL REAL ESTATE $______________
PERSONAL PROPERTY 1. Financial Institution Accounts (Location) (a) Checking ____________________________________ $______________ (b) Savings _____________________________________ $______________ (c) Certificates of Deposit __________________________ $______________ (d) Other _______________________________________ $______________ 2. Stocks & Bonds (Description) _______________________________________________ $______________ _______________________________________________ $______________ _______________________________________________ $______________ 3. Other Personal Property (Description) _______________________________________________ $______________ _______________________________________________ $______________ _______________________________________________ $______________ TOTAL PERSONAL PROPERTY $______________ TOTAL REAL ESTATE AND PERSONAL PROPERTY $______________ ____________________________ CONSERVATOR'S SIGNATURE
STATE OF KANSAS, COUNTY OF _________________ SS: ____________________________, of lawful age, being first duly sworn on oath states: That __________ is the conservator above named; that _________ has read the above (annual)(final) accounting in the conservatorship of _______________________ that _______ knows the content thereof, and that all the statements made therein are true. __________________________________
CONSERVATOR'S SIGNATURE
Subscribed and sworn to before me this ______ day of __________________________, ________.
____________________________ NOTARY PUBLIC