Document Sample
					                          PROBATE COURT OF BALDWIN COUNTY


Instructions: Conservators are required to file with the Court a report each year with such
information as set forth on this form. Pleae fill out this form and file it with the Court at least 10
days prior to the anniversary date of appointment. Mail to: Probate court of Baldwin County,
P.O. Box 459, Bay Minette, Al 36507.

1.     Case No. ________________

2.     Information on Ward/Minor
           Name of Ward/Minor: _____________________________________________
           Address of Ward/Minor: ___________________________________________
           Social Security No. for Ward/Minor: __________________________________

3.     Information on Conservator
           Name of Conservator: _____________________________________________
           Address of Conservator: ____________________________________________
           Phone Numbers for Conservator: Home _____________ Office:___________
           Social Sevurity No. for Conservator: ___________________________________


       State the balance on hand from the last report (n/a for first report)     $ _____________
       State the total income received furing the reporting period               $ _____________
       State the total disbursements made during the reporting period            $ _____________
       State the balance on hand as of the close of the reporting period         $ _____________
Annual Report of Conservator: Page 2.                             Baldwin County Probate Court

5.      Bank Information:

     List below the name(s) of the bank(s) where estate assets are on deposit, account numbers
     and current balances. Include checking, savings and certificates of deposit (CDs).
            Name of bank                Account No.                Balance           As of Date

6.      Other Assets Held:
     List below all other assets of the estate under the control and supervision of the Conservator:

           (Note: You may attach additional sheets if the room provided is insufficient)
Annual Report of Conservator: Page 3                              Baldwin County Probate Court

7.      Sources of Income: (i.e.; interest, social security, retirement, rents, dividends, etc.)
     List below all sources of income due the Conservatorship Estate:

                  Source of Income                      Amount          Monthly/Yearly/Other

8.      Certification:

     I the undersigned, being the Conservator over the assets of said estate, do hereby state that
     the above report is for the period _______________ to ________________ and that the
     information provided therein is true and correct to the best of my knowledge and belief.

                                                  Signature of Conservator

Subscribed and sworn to before me
this _____ day of ______________
19 _____.

Notary Public in and for Said State
Accounting sheet       Probate Court of Baldwin County          Case No.                  Page      of

    DATE           CK NO          SOURCE(RECEIPT OR DISBURSEMENT)                INCOME   EXPENSE        BALANCE

  ******       *******                                   Page Totals -------->
Accounting Sheet        Probate Court of Baldwin County     Case No. ___________   Page        of


Total of all receipts                  $

Total of all disbursements

Balance on hand                        $                                     Balance on hand must
                                                                             reconcile with bank statement

Comments on accounting and requests for reimbursements, if any:
Accounting Sheet     Probate Court of Baldwin County           Case No.                       Page           of

                                             OTHER ASSETS HELD
                   (list below all other non-cash assets held, description, location and estimated values)

            DESCRIPTION OF ASSET                                       LOCATION                              VALUE