Fillable SUMMARY OF ACCOUNT for ADULT GUARDIANSHIP (Vermont Judiciary)

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SUMMARY OF ACCOUNT for ADULT GUARDIANSHIP (Vermont Judiciary)

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PAG89 – Summary of Account for Adult Guardianship (09/2014) Page 1 of 4
STATE OF VERMONT
SUPERIOR COURT
PROBATE DIVISION
Unit
Docket No.
In re Guardianship of :
SUMMARY OF ACCOUNT
for ADULT GUARDIANSHIP
As the guardian(s) of the above named adult, I/we hereby account to the Court for the period
beginning ____________________________ and ending ________________________________
Date of Your Appointment as End Date for This Accounting Period
Guardian o Date of Last Accounting
☐ This is an interim account.
☐ This is a final account.
ACCOUNTING WORKSHEET
Complete the Schedules in Sections A, B and C first. For each schedule (A1-A7, B1-B7 and C1-C2) that
you enter an amount greater than 0, you MUST include an itemized accounting on a separate sheet of
paper. Once you total the amount for each section, you must then record those totals on the
Summary of Account on page 3. You must complete all sections top and bottom. If there is no value,
please indicate with a zero.
SECTION A – ASSETS and RECEIPTS
Schedule
A-1
Personal estate: (per inventory value or last account)
A-2
Real estate: (per inventory value or last account)
A-3
Gain on personal estate sold (attach itemized list)
A-4
Gain on real estate sold (attach itemized list)
A-5
Income to estate since inventory last account (attach itemized list)
A-6
Personal and/or real estate not listed on inventory (attach itemized list)
A-7
Monies advanced to estate (attach itemized list)
TOTAL ASSETS AND RECEIPTS
Add all lines in Section A
r
PAG89 – Summary of Account for Adult Guardianship (09/2014) Page 2 of 4
SECTION B – DISBURSEMENTS
You must complete all sections top and bottom. If there is no value, please indicate with a zero. List only
disbursements since estate opened or last account
Schedule
B-1
Loss on personal estate sold (attach itemized list)
B-2
Loss on real estate sold (attach itemized list)
B-3
Paid debts (attach itemized list)
B-4
Administrative expenses (attach itemized list)
B-5
Attorney fees (attach itemized statement)
B-6
Guardian fees if approved by the Court (attach itemized statement)
B-7
Other disbursements (attach itemized list)
TOTAL DISBURSEMENTS
Add all lines in Section B
SECTION C –BALANCE HELD BY GUARDIAN
C-1
Personal Estate: Include values for cash in bank accounts, stocks, bonds, cars,
etc. If real estate has been sold, include the net proceeds from the sale. (attach
itemized list)
C-2
Real Estate: Include the value of any real property. If there is no real estate or if
all real estate has been sold, enter zero. The proceeds from any real estate that
has been sold should be entered on line C-1. (attach itemized list)
TOTAL BALANCE HELD BY GUARDIAN
Add line C-1 and C-2
PAG89 – Summary of Account for Adult Guardianship (09/2014) Page 3 of 4
STATE OF VERMONT
SUPERIOR COURT
PROBATE DIVISION
Unit
Docket No.
In re Guardianship of :
SUMMARY OF ACCOUNT
☐ This is an interim account.
☐ This is a final account.
ACCOUNT SUMMARY (totals taken from accounting worksheet(s))
1.
TOTAL ASSETS and RECEIPTS from Section A
$
2.
TOTAL DISBURSEMENTS from Section B
$
3.
BALANCE HELD BY GUARDIAN Subtract Line (2) from Line (1)
$
REAL ESTATE (Value of real estate not sold)
$
PERSONAL ESTATE (Include value of all personal property
including cash, stocks, bonds, cars, etc.
$
Signature of Guardian
Date
Guardian’s Name Printed
Signature of Co-Guardian if applicable
Date
Co-Guardian’s Name Printed
Subscribed and sworn before me on:
date
My commission expires on:
Date of Expiration
Signature of Notary
STOP: Did you include an itemized list for each schedule where the value you recorded was greater than
zero? The itemized lists must be attached to this form when you file it. At the top of each list,
please indicate clearly the Section of the Form, the Schedule letter and number (e.g. A-1) and the
type of asset, receipt or disbursement (e.g. Section B, Schedule B-3, Paid Debts).
PAG89 – Summary of Account for Adult Guardianship (09/2014) Page 4 of 4
STATE OF VERMONT
SUPERIOR COURT
PROBATE DIVISION
Unit
Docket No.
In re Guardianship of :
MOTION TO ALLOW ACCOUNT
I/We, request that the Court
allow the account as set forth in the attached Summary of Account for Adult Guardianship. I have attached an
itemized list for each schedule that has a value greater than zero.
Signature of Guardian
Date
Guardian’s Name Printed
Signature of Co-Guardian if applicable
Date
Co-Guardian’s Name Printed
Note: If there are co-guardians, both guardians must sign.
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Completed 30 July 2020

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