Free PR-1937 - Wisconsin

For Official Use

STATE OF WISCONSIN, CIRCUIT COURT, IN THE MATTER OF THE ESTATE OF

COUNTY

Trustee's Account
Annual Interim Final

For the following trust:

Case No.

Trustee(s) certifies this is an accurate account of the administration of the trust for the period from
Date

through
Date

.

Line 1. 2. 3. 4. 5.

Summary Description Beginning Balance. Do not change this amount.
(Inventory total value or ending balance from prior account.)

Balance $ (Add) $ $ (Subtract) $ $

Total assets and income received this period.
(Attach Schedule A listing income and assets received.)

Subtotal Total disbursements, distributions and losses incurred. Ending Balance (Total Assets on Hand)
(List details in Schedule C ­ Assets on Hand.) Beginning Balance for next Account

(List details in Schedule B ­ Disbursements, Distributions and Losses Incurred.)

Signature of Trustee

Signature of Co-Trustee

Name Printed or Typed

Telephone Number

Name Printed or Typed

Telephone Number

Address

Address

Subscribed and sworn to before me on
Notary Public/Court Official

Subscribed and sworn to before me on
Notary Public/Court Official

My commission expires:
Name of Attorney

My commission expires:

Address

Telephone Number

Bar Number

PR-1937, 10/03 Trustee's Account Page 1 of 3

§701.16(4) and (5), Wisconsin Statutes

This form shall not be modified. It may be supplemented with additional material.

Trustee's Account

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 and other income, gains from assets sold for more than inventory value, or purchase price if acquired after the initial inventory.)

See attached. Amount

Total: (Enter in Summary on Line 2 on page 1.)

$

Schedule B ­ Disbursements, Distributions and Losses Incurred Itemize Disbursements

See attached. Amount

Itemize Distribution and Losses
(Example: Assets sold for less than inventory value, or purchase price if acquired after the initial inventory.)

Amount

Total: (Enter in Summary on Line 4 on page 1.)

$

PR-1937, 10/03 Trustee's Account Page 2 of 3

§701.16(4) and (5), Wisconsin Statutes

This form shall not be modified. It may be supplemented with additional material.

Trustee's Account

Page 3 of 3

Case No.

Schedule C ­ Assets on Hand (at end of accounting period) Cash, Checking Accounts, Savings Accounts, Certificates of Deposit (Including Names and Account Numbers) (List balance at end of accounting period. )

See attached. Amount

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 (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 and Verification of Assets I am not the trustee and I am authorized by the court to verify assets. I have examined all securities, evidences of deposit and investments and such assets correspond with the account, except as indicated.

Signature (Not Trustee)

Date of verification:
Name Printed or Typed and Title

Date PR-1937, 10/03 Trustee's Account Page 3 of 3 §701.16(4) and (5), Wisconsin Statutes

This form shall not be modified. It may be supplemented with additional material.