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Page 1 of 2 Accounting www.mcleancountyil.gov 02/06/2013 Rev. 07/02/213 ELEVENTH JUDICIAL CIRCUIT COURT McLEAN COUNTY, IL In the Matter of the Estate of: Case Number: , a disabled adult. ACCOUNTING I, am the Guardian of the estate of a disabled person, and the following is a true and complete accounting of the estate’s cash receipts and disbursements covering the period from to and an inventory of the ward’s assets as of CASH RECEIPTS Date Description Amount $ $ $ $ $ $ $ Total cash receipts: CASH DISBURSEMENTS Date Description Amount $ $ $ $ $ $ $ Total cash disbursements: Cash on hand at beginning of accounting period: Total cash receipts (listed above): Total cash disbursements (listed above): Cash on hand at end of accounting period: ---PAGE BREAK--- Page 2 of 2 Accounting www.mcleancountyil.gov 02/06/2013 Rev. 07/02/213 INVENTORY Item Number Description Value $ $ $ $ $ $ $ $ $ $ Total value: CERTIFICATION Under penalties of perjury as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements and information set forth in this instrument are true and correct. Date Signature Phone Print Name Email Address Any person who makes a false statement, material to the issue or point in questions, which he does not believe to be true, in any document certified by such person in accordance with 735 ILCS 5/1-109 shall be guilty of a Class 3 felony punishable by two to five years imprisonment and/or a $25,000 fine.