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-1- Minor Conservator Inventory and Asset Management Program GEORGIA PROBATE COURT STANDARD FORM PROBATE COURT OF ____________________ COUNTY STATE OF GEORGIA MINOR: ESTATE NO. ____________________ CONSERVATOR(S): MINOR CONSERVATORSHIP INVENTORY AND ASSET MANAGEMENT PLAN SHORT FORM A.INVENTORY Approximate Current Value1. Checking/Savings/Money Market/Certificates of Deposit/Liquid Accounts: Bank/Financial Institution/Broker Acct. No. $ _________________ $__________________ $__________________ 2. Stocks/Bonds/Investments (including retirement and profit-sharing accounts): Brokerage Firm or InstitutionAcct. No. $ __________________ $ __________________ 3. Real Estate: Brief DescriptionMinor's InterestCo-Owner(s) $__________________ $__________________ 4. Personal Property (Vehicles, furniture, etc.): Description $ __________________ $__________________ TOTAL ASSET VALUE:$__________________ B.ESTIMATED MONTHLY INCOME FROM ALL SOURCES Interest, dividend, or investment income $ __________________ Social Security $__________________ Other (describe) _______________________________ $__________________ TOTAL AVERAGE MONTHLY INCOME:$__________________ Effective 8/10GPCSF59 -2- The minor: I. is not a beneficiary of a Trust II. is a beneficiary of a Trust, and the following is the name of the Trust, the Trustee, his/her address, and telephone number; state when and how payments are required to made under the Trust and the criteria for payment (attach outline if necessary): ________________________ ______________________________________________________________________________ ______________________________________________________________________ .C.BUDGET I/We plan during the following reporting year (initial one) a. not to expend any of the minor’s funds but to allow it to accumulate; OR b.to expend the interest earned on the minor’s estate for the following purposes: _ _________________________________________________________________ _________________________________________________________________ __________; OR c. regardless of interest earned, to expend from the minor’s estate the sum of $ per month for the following purposes: _____________________ _____________________________________________________________________________________________________________________; and If b. or c. above is selected, the following is the monthly estimated expenses for the care, support, health and education of the minor:Room and board allowance: $ _____________________ Child care: $______________________ School Tuition/Supplies/Expenses/Lunches: $______________________ Clothing/Diapers/Grooming/Hygiene:$ ______________________ Medical/Dental/Prescription:$______________________ Health/Life/Disability Insurance:$______________________ Entertainment/Activities:$ ______________________ Personal Caretakers/Home Health Care:$______________________ Transportation$ ______________________ Miscellaneous: $______________________ Average Monthly Expenses $______________________ Effective 8/10GPCSF59 -3- SUMMARY1. Average Monthly Income$ ______________________ 2. Monthly support provided by parent(s) $______________________ Subtotal $ ______________________ 3. Less Average Monthly Expenses -______________________ Requested spending amount $______________________ D.ASSET MANAGEMENT PLAN I/We plan to: (initial one) a.maintain the investment plan for the minor’s assets as indicated in the above Inventory, OR b.expend the amount requested above and maintain and invest the remaining funds as authorized by law or in accordance with an investment plan approved by the court. E. AFFIDAVIT I/We, , Conservator(s) of the above minor, do swear that the foregoing Inventory and Asset Management Plan contains a just, true, and complete inventory and budget of all property belonging to said minor within my/our possession, control, or knowledge, in addition to the financial information of the parent(s), if provided. This Inventory and Asset Management Plan has been provided to the Guardian of the ward, if any, by first class mail. Sworn to and subscribed beforeme this day of , 20 . _____________________________________ Conservator _____________________________________NOTARY/CLERK OF PROBATE COURT Printed NameMy Commission Expires: ________________------------------------------------------------------------------------------------------------------------------------------Sworn to and subscribed beforeme this day of , 20 . _____________________________________ Co-Conservator, if any _____________________________________NOTARY/CLERK OF PROBATE COURT Printed NameMy Commission Expires: __________________ Effective 8/10GPCSF59 -4- IN THE PROBATE COURT OF _______________ COUNTY STATE OF GEORGIA IN RE: )ESTATE NO. _____________________ ) , )ASSET MANAGEMENT PLANMINOR ) ) ,)CONSERVATOR(S)) ORDER The Conservator(s) having filed an Inventory/Asset Management Plan for the above estate on , 20 , IT IS HEREBY ORDERED that said Inventory/Asset Management Plan is hereby APPROVED.(initial if applicable) IT IS FURTHER ORDERED that Conservator(s) is/are authorized to disburse from the minor’s estate a.the sum of $ per month for the support of the minor. b.the income for the support of the minor. c. a one time lump sum distribution of $ for the following purpose: . IT IS FURTHER ORDERED that said Conservator(s) shall show in the annual return how such funds actually were spent. SO ORDERED this day of , 20 . _____________________________________ Probate Judge FILED: ____________________________ DATE ____________________________ DEPUTY CLERK