This is not a substitute for legal advice. An attorney must be consulted.

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IN THE DISTRICT OF
IN AND FOR COUNTY

IN THE MATTER OF THE	:	PR NO.
	:
CONSERVATORSHIP OF	:	ANNUAL REPORT
	:
	:
(Ward)

COMES NOW, the undersigned Fiduciary on behalf of the above-captioned cause and for the Annual Report and current status states the following:

1. The above-captioned cause was opened on the day of , , as a result of , which occurred on the day of , .

2. The total of Dollars ($ ) was initially recovered for the Ward in this cause. From the total recovery, Dollars ($ ) has been invested in the Fund with (containing shares) and Dollars ($ ) has been placed in a account for the Ward. Said account is held at .

3. The invested funds are now invested as indicated and are in the custody of the Conservator. See attached documentation evidencing the investment.

WHEREFORE, the Fiduciary prays that the Annual Report be approved as submitted.


	FIDUCIARY

This is not a substitute for legal advice. An attorney must be consulted.
Copyright © 2003 - 2013 by LAWCHEK, LTD.

STATE OF		)
		)ss
COUNTY OF		)

I, , being first duly sworn on oath, depose and state that I am the Fiduciary in the above-captioned conservatorship; have caused the above and foregoing Annual Report to be prepared, know the contents thereof, and state that the same is true and correct as I verily believe.


	FIDUCIARY

Subscribed and sworn to before me, a Notary Public in and for the State of , on this day of , .


	NOTARY PUBLIC