Fill and Sign the Summary of Receipts and Expenditures Only Form

JDF 942 SC R6/19 INTERIM/ FINAL ACCOUNTING Page 1 of 3 ❑ District Court ❑ Denver Probate Court ___________________ County, Colorado Court Address: In the Matter of the Estate of : Deceased COURT USE ONLY Attorney or Party W ithout Attorney (Name and Address): Phone Number: E -mail: FAX Number: Atty. Reg.#: Case Number: Division Courtroom ❑ INTERIM ❑ FINAL ACCOUNTING FOR PERIOD: FROM _________________ TO ___________________ PURSUANT TO C .R.P.P. 31 This accounting must be typed or prepared by automated data processing. SUMMARY OF RECEIPTS AND EXPENDITURES ONLY Balance on hand at the beginning of this accounting period $__________________ Add: Total funds received or collected during this accounting period from page 2 $__________________ Less: Total payments during this accounting period from page 3 $__________________ Balance on hand at the end of this accounting period $__________________ SUMMARY Schedule Asset Category Value 1 Real Estate 2 Stocks, Bonds, Mutual Funds, Securities , and Investment Accounts 3 Mortgage, Notes, Cash, and bank checking, savings, certificates of deposit and health savings accounts 4 Life Insurance 5 Pension s, Profit Sharing Plans , Annuities , and Retirement Funds 6 Motor and Recreation Vehicles 7 Other Assets Total Gross Value 8 Liens and Encumb rances Total Net Value (Total Gross Value minus Liens and Encumbrances) JDF 942 SC R6/19 INTERIM/ FINAL ACCOUNTING Page 2 of 3 Detail Listing of Funds Received or Collected During Accounting Period List below each individual item of funds received or collected for th is accounting period. Attach add itional pages , if needed . Date Description of Funds Received or Collected Amount Page __ of __ Total $ $ JDF 942 SC R6/19 INTERIM/ FINAL ACCOUNTING Page 3 of 3 Detail Listing of Payments During Accounting Period List below each item of payments during this accounting period. Attach add itional pages , if needed . Date Description of Payments Amount Page __ of __ Total $ $ VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the ______ day of Executed on the ______ day of (date) (date) _______________________, _________, _______________________, _________, (month) (year) (month) (year) at ______________________________________ at ______________________________________ (city or other location, and state OR country) (city or other location, and state OR country) ______________________________________ ________________________ ______________ (printed name) (printed name) ______________________________________ ______________________________________ (Signature of Personal Representative) (Signature of Co -Personal Representative , if any) ______________________ __________________ __________________ Attorney Signature, (if any) Date