Fill and Sign the Trustees Account Annual Interim Final Wisconsin Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE MATTER OF THE ESTATE OF       For the following trust: Amended Trustee's Account Annual Interim Final Informal Administration Formal Administration       Case No.       This is an accurate account of the administration of the trust for the period from ( D ate)       through ( D ate)       . Summary Line Description (Attach Schedules) Balance 1. Beginning Balance. Do no t change any pre-printed amount. (Inventory total value or ending balance from prior account.) $       2. Total assets and income received from Schedule A (Page 1). (Add) $       3. Subtotal $       4. Total expenses, distributions and losses incurred from Schedule B (Page 2.) (Subtract) $       5. Total assets on hand from Schedule C (Page 3.) TOTAL $       STOP! YOU MUST SIGN THIS FORM IN FRONT OF A NOTARY. State of       County of       Subscribed and sworn to before me on       Notary Public/Court Official       Name Printed or Typed My commission/term expires:       ► Trustee       Name Printed or Typed       Address             Telephone Number       Date State of       County of       Subscribed and sworn to before me on       Notary Public/Court Official       Name Printed or Typed My commission/term expires:       ► Trustee       Name Printed or Typed       Address             Telephone Number       Date Form completed by: (Name)       Address       PR-1937 , 10/10 Trustee's Account (Informal Administration and Formal Administration) §701.16(4) and (5), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 Trustee's Account (Informal Administration and Formal Administration) Page 2 of 3 Case No. Telephone Number       Bar Number (If any)       (If the space given is insufficient for any item, attach additional sheets.) See attached Schedule A – Assets and Income Received Description (Example: Interest, dividends, rental and other income, gains from assets sold for more than inventory value, or purchase price if acquired after the initial inventory.) Amount                                                                   $                                                                         TOTAL : $       (Enter in Summary on Line 2 on page 1) See attached Schedule B – Expenses, Distributions and Losses Incurred Description (Example: Distributions to or for beneficiary, expenses of the trust, assets sold for less than inventory value, or purchase price if acquired after the initial inventory.) Amount                                                                         $                                                                         TOTAL: $       (Enter in Summary on Line 4 on page 1) PR-1937 , 10/10 Trustee's Account (Informal Administration and Formal Administration) §701.16(4) and (5), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 Trustee's Account (Informal Administration and Formal Administration) Page 3 of 3 Case No. See attached Schedule C – Assets on Hand (at end of accounting period) Description ( Example: Cash, Checking Accounts, Savings Accounts, Certificates of Deposit, including Names and Account Numbers; Investments; Real Estate, Including Encumbrances) Amount (List balance at end of accounting period; inventory value, or purchase price if acquired after the initial inventory.)                                                                                     $                                                                                     TOTAL: $       (Enter in Summary on Line 5 on page 1) For Authorized Persons Only: Display and Verification of Assets I am not the trustee and I am authorized by the court to verify assets . I have examined all securities, evidences of deposit and investments; and such assets correspond with the account, except as indicated. Date of verification:       ► Signature (Not Trustee)       Name Printed or Typed and Title       Telephone Number       Date PR-1937 , 10/10 Trustee's Account (Informal Administration and Formal Administration) §701.16(4) and (5), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3