IN THE DISTRICT OF                                                         
IN AND FOR                                                        COUNTY

     COMES NOW, the undersigned fiduciary/conservator, on behalf of the above-captioned ward, and for the Accounting and Final Report, states the following:

     1.  That the above-captioned cause was opened on the                day of                               ,          , as a result of                                                                      (describe reason) wherein the ward recovered funds relative to                                                                            (list details).

     2.  The total sum of $                   was initially received for the ward and the entire sum of $                  was invested. The investment was placed with the                                                     (name of investment entity) at                                                                      (address) on behalf of and in the name of the ward. A copy of the most recent report from the                                                     (name of investment entity) is attached. Prior statements of the account are also attached.

     3.  The funds are invested as indicated, subject to the court approval of some payments for the expense incurred by the ward. The payments to the ward total $                 .

     4.  $                  conservator fees and $                  attorney fees relative to the administration of this conservatorship have been charged and permitted pursuant to court order dated the            day of                                   ,            .

     5.  The ward is now            years of age and is emancipated or otherwise to be relieved of the conservatorship.

     6.  On the             day of                                   ,             , an Application for Compensation to Attorney                                    (name of attorney) was filed for attorney fees incurred on behalf of the ward in the amount of $                 . An order entered the              day of                                   ,             , by the                                    (name of court) granted the payment of said fees.

     7.  Therefore, the first page of the attached represented the amount that remained in the conservatorship and was paid to the ward. The attached pages represent an accounting of the investment and transactions (payment of interest to the account) to date and amount paid to the ward on                                   ,            .

     8.  There are no other assets in this conservatorship or in the conservatorship’s name.

     9.  The ward (does/does not) have a present source of income, either annually or monthly; therefore, the release for funds to the ward would be in order.

     WHEREFORE, the fiduciary/conservator,                                    (name of fiduciary/conservator), prays that the court accept this Accounting and Final Report as evidenced by the attached documentation and allow the fiduciary/conservator to distribute the remaining funds directly to the ward,                                    (name of ward).

     I,                                    (name of fiduciary/conservator), being first duly sworn on oath, depose and state that I, the fiduciary/conservator in the above-captioned conservatorship; have caused the above and foregoing Accounting and Final Report to be prepared, know the contents thereof, and state that the same is true and correct as I verily believe.

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