Account of Fiduciary, Short Form (1/21)
Page 2 of 2
Case No.
2. a. Balance on hand from last account, or value of inventory, if first account............................................ $
b. Enter Total Column 1, Income, Gain, and Other Receipts, from page 1 of this form............................ $
c. Subtotal (Add line 2.a to line 2.b and enter the amount here)............................................................................. $
d. Enter Total Column 2, Expenses, Losses, and Other Disbursements, from page 1 of this form.......... $
e. Balance of assets on hand (Subtract line 2.d from line 2.c and enter the amount here.)........................................ $
This line must equal the last line in item 3. (Itemize assets below.)
3. The balance of assets on hand are as follows:
ITEMIZED ASSETS REMAINING AT END OF ACCOUNTING PERIOD
$
Total balance on hand. This line must equal the last line in item 2. $
NOTE: In guardianships and conservatorships, except as provided by MCR 5.409(C)(4), you must present to the court copies of corresponding
financial institution statements or you must file with the court a verification of funds on deposit, either of which must reflect the value of all liquid assets
held by a financial institution dated within 30 days after the end of the accounting period.
4. The interested persons, addresses, and their representatives are identical to those appearing on the initial application/
petition, except as follows: (For each person whose address changed, list the name and new address; attach separate sheet if necessary.)
5. This account lists all income and other receipts and expenses and other disbursements that have come to my knowledge.
6. This account is not being filed with the court.
7. My fiduciary fees incurred during this accounting period (including fees that have already been approved and/or paid
for this accounting period) are $
. Attached is a written description of the services performed.
8. Attorney fees incurred during this accounting period (including fees that have already been approved and/or paid for
this accounting period) are $
. Attached is a written description of the services performed.
I declare under the penalties of perjury that this account has been examined by me and that its contents are true to the best
of my information, knowledge, and belief.
Date
Attorney signature
Fiduciary signature
Attorney name (type or print) Bar no.
Fiduciary name (type or print)
Address
Address
City, state, zip Telephone no.
City, state, zip Telephone no.
(For accounts that must be filed with the court.)
1. You must bring to the court’s attention any objection you have to this account. Except in guardianships and
conservatorships, the court does not normally review the account without an objection.
2. You have the right to review proofs of income and disbursements at a time reasonably convenient to the fiduciary and
yourself.
3. You may object to all or part of an accounting by filing a written objection with the court before the court allows the
account. You must pay a $20.00 filing fee to the court when you file the objection. (See MCR 5.310[C].)
4. If an objection is filed and is not otherwise resolved, the court will conduct a hearing on the objection.
5. You must serve the objection on the fiduciary or his/her attorney.
NOTICE TO INTERESTED PERSONS
