Fill and Sign the Conservator Final Report Colorado Form

 District Court  Denver Probate Court ___________________________________ County, Colorado Court Address: IN THE MATTER OF THE ESTATE OF: Protected Person COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom CONSERVATOR’S  INTERIM  FINAL REPORT FOR THE PERIOD FROM ________________________TO ___________________________ CONSERVATOR’S INFORMATION: Conservator’s Name: ________________________________________________ Home Address: ________________________________________________ (including P.O. Box) ________________________________________________ Telephone Number: (_______)________________________________________ Work Address: ________________________________________________ (including P.O. Box) ________________________________________________ Telephone Number: (_______)________________________________________ PROTECTED PERSON’S INFORMATION: Protected Person’s Name: ________________________________________________ Current Address: ________________________________________________ (include Name of Living ________________________________________________ Center or Nursing Home) ________________________________________________ Telephone Number: (________)_______________________________________ This form is designed to make it easy to see at a glance the status of the estate at the end of the accounting period. The conservator’s report (§15-14-420, C.R.S.) should be filed annually unless otherwise ordered. A Notice of Filing, (CPC 2-F), along with a copy this conservator’s report, must be given to the protected person and any others as directed by the Court, within ten (10) days of filing. ( §15-14-404(4), C.R.S .) Attach additional sheets if necessary. PART I – CONSERVATORSHIP ISSUES: CPC 29-CR R7/03 CONSERVATOR’S INTERIM/FINAL REPORT Page 1 of 6 FOR THE PERIOD _______ TO _____ This form conforms in substance to CPC 29-CR. 1. Is there a continued need for the Conservatorship?  Yes.  No. If no, please describe why and what steps should be taken. ____________________________________________________________________________________ ____________________________________________________________________________________ 2. State any concerns that you have about the estate. ____________________________________________________________________________________ ____________________________________________________________________________________ 3. Describe any changes you recommend to the scope of the Conservatorship. ____________________________________________________________________________________ ____________________________________________________________________________________ 4. Describe any changes you recommend to the financial plan for the Conservatorship. ____________________________________________________________________________________ ____________________________________________________________________________________ 5. Bond/Security.  Bond is not required by the Court.  Bond in the amount of $ ___________________ is required by the Court and the amount of the bond is sufficient to cover all unrestricted assets. (Attach a copy of the Bond.) 6. Describe the services provided by others to the protected person during the reporting period. ____________________________________________________________________________________ ____________________________________________________________________________________ PART II – ASSETS AND LIABILITIES: 1. ASSETS: Value of the Asset Description of each Asset (include account number, if applicable.)  From Previous Report  From Beginning Inv. (at beginning of period.) Value (at end of period.) Change in Value of Asset Note No. Checking - Savings - TOTAL ASSETS 2. LIABILITIES: CPC 29-CR R7/03 CONSERVATOR’S INTERIM/FINAL REPORT Page 2 of 6 FOR THE PERIOD _______ TO _____ This form conforms in substance to CPC 29-CR. Amount of Liability Description of each Liability (include account number, if applicable.)  From Previous Report  From Beginning Inv. (at beginning of period.) Value (at end of period.) Change in Amount of Liability Note No. TOTAL LIABILITIES 3. Explain the reason for any significant change in value of individual Assets or change in amount of individual Liabilities above, between estimated amounts on Financial Plan (or last Conservator Report) and current values. Note No. Explanation of Difference PART III. COMPARISON OF RECEIPTS / INCOME AND DISBURSEMENTS / EXPENSES BY CATEGORY Note: If this report covers an accounting period that is less than one year, the Estimated Amounts form the Financial Plan may need to be adjusted to reflect a proper comparison with the Actual Amount of Receipts/ Income or Disbursements / Expenses Paid, for the total number of months in the accounting period. Receipts / Income and Disbursements / Expenses below shall include all cash received, income and cash disbursed, and expenses, by category. 1. RECEIPTS / INCOME CPC 29-CR R7/03 CONSERVATOR’S INTERIM/FINAL REPORT Page 3 of 6 FOR THE PERIOD _______ TO _____ This form conforms in substance to CPC 29-CR. Description of each Receipt/Income Category Estimated Amounts from  Financial Plan  Previous Cons. Report Actual Amount of Receipt / Income Difference Note No. Wages Social Security Interest / Dividends Retirement Tax Refunds TOTAL RECEIPTS / INCOME 2. DISBURSEMENTS / EXPENSES: Description of each Disbursement / Expense Category Estimated Amounts from  Financial Plan  Previous Cons. Report Actual Amount of Disbursement / Expense Difference Note No. Total Professional Fees Paid (from PART IV below) Distributions to Protected Person TOTAL DISBURSEMENTS / EXPENSES 3. Explain the reason for any significant difference between estimated amounts on Financial Plan (or last Conservator Report) and Actual Receipts / Income and Disbursements / Expenses, in this period. CPC 29-CR R7/03 CONSERVATOR’S INTERIM/FINAL REPORT Page 4 of 6 FOR THE PERIOD _______ TO _____ This form conforms in substance to CPC 29-CR. Note No. Explanation of Difference PART IV – PAYMENTS TO PROFESSIONALS 1. List below payments to professionals that you are employing to serve you, as conservator, the protected person or the estate; and the amounts paid to such professionals during this accounting period: Type of Professional and Name of Individual Total Amount Paid to Individuals during this accounting period Conservator - Guardian - Guardian ad litem- Attorney for Protected Person - Attorney for Conservator - Court Visitor - Accountant / CPA - Case Manager - TOTAL PROFESSIONAL FEES PAID – (Include total in Part III 2 above) PART V. RECEIPTS / INCOME AND DISBURSEMENT / EXPENSES: CPC 29-CR R7/03 CONSERVATOR’S INTERIM/FINAL REPORT Page 5 of 6 FOR THE PERIOD _______ TO _____ This form conforms in substance to CPC 29-CR. Enter each individual item of Receipts / Income or Disbursement / Expenses for the entire reporting period (add additional pages, if necessary). Each Receipt / Income should be listed in the Amount Received column and each Disbursement / Expense should be listed in the Amount Disbursed column. Note: This report should resemble a Check Register for each bank account. Name of Bank and Account Number: __________________________________________ Date Check or I.D. No. Description of each item Received or Name of Payee (if Disbursement) Brief Explanation of each item Received or Disbursed Amount Received Amount Disbursed PAGE ____________ of _______ TOTALS THIS PAGE CUMULATIVE TOTALS I state under penalty of perjury that this is a true and complete report of the administration of this estate, during the period shown, both dates inclusive, to the best of my knowledge, information and belief. I understand that this report is subject to audit and verification. Dated: ____________________________ _______________________________________ Signature of Conservator CPC 29-CR R7/03 CONSERVATOR’S INTERIM/FINAL REPORT Page 6 of 6 FOR THE PERIOD _______ TO _____ This form conforms in substance to CPC 29-CR.