District Court Denver Probate Court ___________________ County, Colorado Court Address: In the Matter of the Estate of: COURT USE ONLY Deceased Attorney or Party Without Attorney (Name and Address): Case Number: Phone Number: FAX Number: Division E-mail: Atty. Reg.#: Courtroom INTERIM FINAL ACCOUNTING FOR PERIOD: FROM _________________ TO ___________________ PURSUANT TO COLORADO RULES OF PROBATE PROCEDURE RULE 31 This Accounting shall 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 OF ASSETS REMAINING AT END OF ACCOUNTING PERIOD Asset Category Value Cash, Bank, Checking, Savings, Certificates of Deposit and Health Accounts Stocks, Bonds, Mutual Funds, Securities and Investment Accounts Life Insurance Pension, Profit Sharing, Annuities and Retirement Funds Motor Vehicles and Recreation Vehicles Real Estate General Household and Other Personal Property Miscellaneous Assets Total Assets JDF 942 1/09 INTERIM/ FINAL ACCOUNTING Page 1 of 3 Detail Listing of Funds Received or Collected During Accounting Period List below each individual item of funds received or collected for this accounting period. Attach additional pages, if needed. Date Description of Funds Received or Collected Amount Page __ of __ $ Total $ JDF 942 1/09 INTERIM/ FINAL ACCOUNTING Page 2 of 3 Detail Listing of Payments During Accounting Period List below each item of payments during this accounting period. Attach additional pages, if needed. Date Description of Payments Amount Page __ of __ $ Total $ I state under penalty of perjury that this is a true and complete Accounting of this estate, during the period shown, both dates inclusive, to the best of my knowledge, information and belief. I understand that this Accounting is subject to audit and verification and that I am required to maintain supporting documentation for the duration of my appointment as Personal Representative. Date: _____________________________________________ Signature of Personal Representative Address City, State and Zip Code JDF 942 1/09 INTERIM/ FINAL ACCOUNTING Page 3 of 3