STATE OF MICHIGAN

CASE NO. and JUDGE

PROBATE COURT
COUNTY

ACCOUNT OF FIDUCIARY, SHORT FORM
 Interim

 Annual 

 Final 

 
Number

 AMENDED

Court address              

 

 

 

Court telephone no.

$

$

  of the estate and submit the following as my account, which covers the period from 

Month, day, year

 

to 

Month, day, year

 (may not exceed 12 months).

Note:  Do not put financial account numbers on this form.  If an account number is necessary to distinguish between accounts, put it on form MC 97.

COLUMN 1. INCOME, GAIN, AND OTHER RECEIPTS

COLUMN 2. EXPENSES, LOSSES, AND OTHER DISBURSEMENTS

 , am the 

Title

Name

. I, 

  1

In a guardianship or conservatorship, the ward’s or protected individual’s current address and telephone number are:

In the matter of 

First, middle, and last name

Investment gain

                                    Total Column 1      

Investment loss

Total Column 2

                                          (Enter on line 2.b on page 2.)

                                         (Enter on line 2.d on page 2.)

Approved, SCAO
Form PC 583, Rev. 1/21
MCL 330.1631, MCL 700.3703(4), MCL 700.5418, MCR 5.308, 
MCR 5.310(C), MCR 5.313, MCR 5.409
Page 1 of 2

JIS Code: ACCAccount of Fiduciary, Short Form 
Page 2 of 2

(1/21) 

Case No. 
 

2. a. Balance on hand from last account, or value of inventory, if first account............................................ $ 
 
  b. Enter Total Column 1, Income, Gain, and Other Receipts, from page 1 of this form............................ $ 
 
  c.  Subtotal (Add line 2.a to line 2.b and enter the amount here)............................................................................. $ 
 
  d. Enter Total Column 2, Expenses, Losses, and Other Disbursements, from page 1 of this form.......... $ 
 
  e. Balance of assets on hand (Subtract line 2.d from line 2.c and enter the amount here.)........................................ $ 
 
3. The balance of assets on hand are as follows:

    This line must equal the last line in item 3. (Itemize assets below.)

 

ITEMIZED ASSETS REMAINING AT END OF ACCOUNTING PERIOD

$

Total balance on hand. This line must equal the last line in item 2. $

NOTE: In guardianships and conservatorships, except as provided by MCR 5.409(C)(4), you must present to the court copies of corresponding 
financial institution statements or you must file with the court a verification of funds on deposit, either of which must reflect the value of all liquid assets 
held by a financial institution dated within 30 days after the end of the accounting period.
4. The interested persons, addresses, and their representatives are identical to those appearing on the initial application/
  petition, except as follows: (For each person whose address changed, list the name and new address; attach separate sheet if necessary.)

 This account is not being filed with the court.
 My fiduciary fees incurred during this accounting period (including fees that have already been approved and/or paid 

 
 5. This account lists all income and other receipts and expenses and other disbursements that have come to my knowledge.
6. 
7. 
 
8. 
 

 Attorney fees incurred during this accounting period (including fees that have already been approved and/or paid for 

 . Attached is a written description of the services performed.

 . Attached is a written description of the services performed.

    for this accounting period) are $ 

    this accounting period) are $ 

 

 

I declare under the penalties of perjury that this account has been examined by me and that its contents are true to the best 
of my information, knowledge, and belief.
 

                     

 Date

Fiduciary signature

 

 

 

Address

 
Attorney name (type or print)                                                            Bar no.

Fiduciary name (type or print)                                                    

 

ity, state, zip                                                                        Telephone no.

City, state, zip                                                                            Telephone no.

NOTICE TO INTERESTED PERSONS

conservatorships, the court does not normally review the account without an objection.

(For accounts that must be filed with the court.)
1.   You must bring to the court’s attention any objection you have to this account. Except in guardianships and 
 
2.  You have the right to review proofs of income and disbursements at a time reasonably convenient to the fiduciary and
 
3.   You may object to all or part of an accounting by filing a written objection with the court before the court allows the 
 
4.  If an objection is filed and is not otherwise resolved, the court will conduct a hearing on the objection.
5.  You must serve the objection on the fiduciary or his/her attorney.

account.  You must pay a $20.00 filing fee to the court when you file the objection. (See MCR 5.310[C].)

yourself.

Attorney signature

Address

  C