Free Accounting of Conservator - West Virginia


File Size: 29.7 kB
Pages: 7
Date: March 15, 2006
File Format: PDF
State: West Virginia
Category: Court Forms - State
Author: Supreme Court of Appeals of West Virginia
Word Count: 950 Words, 10,427 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.state.wv.us/wvsca/rules/Conservator/915C.pdf

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Preview Accounting of Conservator
IN THE CIRCUIT COURT OF _______________ COUNTY, WEST VIRGINIA
For Clerk's Use Only IN RE: ___________________________________________, DATE FILED: ____________________________________ A PROTECTED PERSON CASE NUMBER ___________ - G - __________

ACCOUNTING OF CONSERVATOR
[West Virginia Code: §§ 44A-3-9 and 11]

INSTRUCTIONS FOR COMPLETION OF REPORT
A. This form is a required submission under West Virginia Code: § 44A-3-9. Pursuant to the provisions of West Virginia Code: § 44A-3-11, the first accounting form must be completed and filed not later than sixty (60) days following the first anniversary of your appointment as a conservator. You have the option and may elect to file your accountings on a calendar year basis and the due date for calendar year accountings is April 15 of the succeeding year. Please note: If you elect to file on a calendar year basis, the accounting cannot cover a period of more than one (1) year. You are also required to file an accounting at least annually after the first accounting, unless the Court requires you to file additional accountings, and you are also required to file an accounting if your appointment as conservator is terminated. This report, and any subsequent reports, must be filed with the Circuit Court Clerk on or before the due dates above. All information provided in this accounting must be printed or typed and be clearly readable. All information requested MUST be provided, if known. If unknown, you must state it is unknown. Please be sure you read and answer all questions carefully and in as much detail as possible. Answers to some questions may require more space than provided. If so, attach additional pages as needed and label each response on such page(s) with the number of the applicable question.

B. C. D. E.

PLEASE TURN TO THE NEXT PAGE TO BEGIN ACCOUNTING
SCA-CG 915C-1 / 6-94

Accounting of Conservator Page 1 of 7 Pages

Name of Protected Person: ___________________________________________

Court Case Number __________-G-___________

Name of Conservator: _________________________________________ Date of Appointment: ______________________________ This accounting is your [check any applicable category]: __________ __________ first accounting final accounting __________ __________ periodic annual accounting other accounting ordered by Court

Date of this accounting: __________________ covering a time period from ___________________ to _________________________ Date of your last accounting [if applicable]: _________________ covering ___________________ to _________________________

PART 1: RECEIPTS. List any and all receipts of income, cash, checks, interest, dividends or other money received during the reporting period. Include any property received and the fair market value thereof unless you have filed an amended inventory with the Court which describes the property and value of such property.

DESCRIPTION AND SOURCE OF RECEIPT

AMOUNT OR VALUE

TOTAL RECEIPTS. Total of all receipts in this part including any amounts or values on attached pages.

SCA-CG 915C-2 / 6-94

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PART 2: DISBURSEMENTS or DISTRIBUTIONS. List any and all disbursements or distributions of cash, checks or other money or property during the reporting period. If property was given, disbursed, or distributed in addition to indicating the payee and purpose, also indicate the specific item of property given in column 1 and the fair market value of the property in column 2

PAYEE AND PURPOSE OF DISBURSEMENT OR DISTRIBUTION

AMOUNT OR VALUE

TOTAL OF ALL DISBURSEMENTS AND/OR DISTRIBUTIONS in this part, including any amounts or values on attached pages.

SCA-CG 915C-3 / 6-94

Accounting of Conservator Page 3 of 7 Pages

PART 3: ASSETS OF THE ESTATE. List all known assets of the Estate of the Protected Person and the approximate amount or fair market value of each item as of the closing date of this accounting.

DESCRIPTION OF ASSET

AMOUNT OR VALUE

TOTAL ASSETS. Total of all assets in this part, including any amounts or values on attached pages.

SCA-CG 915C-4 / 6-94

Accounting of Conservator Page 4 of 7 Pages

PART 4: LIABILITIES OF THE ESTATE. List all known liabilities of the Estate of the Protected Person as of the closing date of this accounting.

DESCRIPTION OF LIABILITY

AMOUNT OR VALUE

TOTAL LIABILITIES. Total of all liabilities in this part, including any amounts or values on attached pages.
SCA-CG 915C-5 / 6-94

Accounting of Conservator Page 5 of 7 Pages

PART 5: OTHER INFORMATION. Answer each of the following questions in as much detail as possible.

1.

Describe the services being provided to the Protected Person during the time period covered by this accounting: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

2.

Describe the significant actions taken by the conservator during the time period covered by this accounting: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

3.

What is your recommendation as to the need for continued conservatorship? Explain your response. ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

4.

Do you recommend any changes in the scope of the conservatorship? If so, detail the changes recommended and explain the reasons for recommending such changes. ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

SCA-CG 915C-6 / 6-94

Accounting of Conservator Page 6 of 7 Pages

5.

In the space below, provide any information requested by the Court but not otherwise requested in this form: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

6.

In the space below, provide any further information which, in your opinion, the Court may find useful in reviewing the case of the Protected Person: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

7.

Are you requesting compensation for your services as conservator ? If you responded with "YES," what is the amount of your request:

__________ YES

__________ NO

$ _____________________________ $ _____________________________

8.

What are the reasonable and necessary expenses you have incurred as conservator

[If you listed an amount in this question, attach an itemized listing of your reasonable and necessary expenses.]

STATE OF ___________________________________ COUNTY OF ________________________________, to-wit:

I, ________________________________________________, the conservator named in this accounting, do hereby certify that the information provided in this ACCOUNTING OF CONSERVATOR is true, correct and complete to the best of my knowledge, information and belief. Given under my hand this ________ day of _______________________________, 20 ___________.

_________________________________________________________ CONSERVATOR'S SIGNATURE The foregoing was taken, subscribed and sworn to before me by the said _________________________________________, in my said county and state on this, the __________ day of __________________________________, 20_____________. Given under my hand and NOTARIAL SEAL. [AFFIX NOTARIAL SEAL]

_________________________________________________________ NOTARY PUBLIC

My Commission Expires:__________________________________.

SCA-CG 915C-7 / 6-94

Accounting of Conservator Page 7 of 7 Pages