City, State, Zip 

 
Name 

 
Address 

 
Phone 

 
Email  

 

 
 
 
 
 
 
 
Check your email. You will receive information and 
documents at this email address.  
 

I am   [  ]  Guardian 

[  ]  Guardian's Attorney 

[  ]  Conservator 
[  ]  Conservator's Attorney  (Utah Bar #:__________) 

In the District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

[  ]  Guardian’s Financial Accounting to 
Conservator (Utah Code Section 75-5-
312) 

[  ]  Guardian’s / Conservator’s 

Financial Accounting to the Court 
(Utah Code Sections 75-5-312 and 75-5-419) 

________________________________ 
Case Number 

________________________________ 
Judge 

In the Matter of: 

__________________________________ 
(Protected Person) 
 

1. 

I am the following to the above-named Protected person: 

[  ]  Guardian 

[  ]  Conservator 

[  ]  Guardian and Conservator 

2. 

(Check all of the boxes which apply.  Fill in the blanks if appropriate.) 

[  ]  This is my first report. 

 

 

 

 

 

1801GUF January 2008 / Revised by Forms 
Committee April 11, 2022 

Guardian or Conservator Financial Accounting  
 

Page 1 of 7 

[  ]  My previous report covered the period from ______________ to 
______________. 

[  ]  This is my final report. 

This accounting covers the period from ______________ to ______________. 

There is an estate plan to guide investment and distribution: 

[  ]  The plan is on file with the court. 

[  ]  The plan is being submitted along with this accounting. 

[  ]  The value of the estate (excluding the residence) is less than $50,000. 
  
 

(If you check this box, fill out paragraph 5 and then skip to the signature. You do not need to 
complete any other sections.) 

a.  Assets. The protected person has the following assets. (Attach additional sheets 
 

if needed.) 

Description 

Beginning balance  Ending balance 

b. 
 

Income. The protected person had the following income during the reporting 
period. (Attach additional sheets if needed.) 

Source 

Amount 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. 

4. 

5. 

 

 

 

 

[  ]  No 

[  ]  Yes 

 

 

 

 

 

 

 

 

 

1801GUF January 2008 / Revised by Forms 
Committee April 11, 2022 

Guardian or Conservator Financial Accounting  
 

Page 2 of 7 

c.  Spending. Money was spent on the following during the reporting period. 
 

(Attach additional sheets if needed.) 

Amount 

Expense 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d.  Other expenses. The protected person’s estate also paid for these other 
 

expenses. (Attach additional sheets if needed.) 

Expense 

Amount 

6. 

[  ]  The value of the estate (excluding the residence) is $50,000 or more. 
Balance Summary (Beginning Balance must agree with Ending Balance of the 
 
Inventory or the previous accounting, whichever is later. 
 

Schedule  Category 
A 
B 
C 

Real Estate 
Stocks and Bonds 
Money Owed to Protected 
Person 
Investments or Trusts 
Miscellaneous Property 
Debts and Encumbrances 
Cash and Cash Accounts 

D 
E 
F 
G 
1801GUF January 2008 / Revised by Forms 
Committee April 11, 2022 

 
 
 
 

 

Beginning 
Balance 
 
 
 

Gains and 
Losses 
 
 
 

Ending 
Balance 
 
 
 

 
 
 
** 

 
 
 
* 

Guardian or Conservator Financial Accounting  
 

Page 3 of 7 

 
 
** 

Amount 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

(Amount) 
 
 

 

Total 

 

 

 

* This amount should equal the money in all of the Protected Person’s bank accounts on the last day of 
the reporting period for this accounting.  

** The total Gains and Losses for Cash and Cash Accounts should equal the total for Receipts and 
Payments. 

Summary of Receipts and Payments  

1  Receipts Total 
2  Payments Total 
3  Total 

**The total Gains and Losses for Cash and Cash Accounts should equal the total for Receipts and 
Payments. 

Receipts during the reporting period  

Item  Description 
1  Wages 
Interest 
2 
Dividends 
3 
Social Security 
4 
Annuities 
5 
Insurance 
6 
Real Estate Sold 
7 
Stocks/Bonds Sold 
8 
Money owed to Protected Person that was received 
9 
10  Miscellaneous Property Sold 
11  Other (Describe) 

   

12 

Total 

ayments during the reporting period  

Item  Category 
1 
2 

Mortgage/Rent 
Utilities (gas, electricity, water, sewage, phone, internet, 
etc.) 
Home Maintenance (Include maintenance, cleaning, 
repairs, etc.) 
Home Improvement (Include additions, remodeling, etc.) 

  P

 

3 

4 

1801GUF January 2008 / Revised by Forms 
Committee April 11, 2022 

Guardian or Conservator Financial Accounting  
 

Page 4 of 7 

 
 

 
 
 
 
 
 
 
 
 
 
 
 

 

 

Value on First 
Day of this 
Reporting 
Period 
 
 
 

Value on Last 
Day of this 
Reporting 
Period 
 
 
 

Amount of 
Gain 
(Loss) 
 
 
 

* Attach a copy of the most recent tax assessment for each piece of real property. 

chedule B – Stocks and Bonds* 

Item  Description 
1 

 

Value on First 
Day of this 
Reporting 
Period 
 

Value on Last 
Day of this 
Reporting 
Period 
 

Amount of 
Gain 
(Loss) 
 

Page 5 of 7 

1801GUF January 2008 / Revised by Forms 
Committee April 11, 2022 

Guardian or Conservator Financial Accounting  
 

estate  

estate. (Describe) 

     

20 

Total 

chedule A – Real Estate* 

Item  Description 
1 
2 
3 

 
 
 

  S

  S

 

5 
6 

Home Furnishings 
Health Care (physicians, dentists, psychiatrists, 
psychologists, etc.) 
Food 
Education 
Clothes 

7 
8 
9 
10  Personal Effects 
11  Activities 
12 
13 
14  Charge for Conservator’s Services 
15  Charge for Guardian’s Services 
16  Charge for other Professional Services 
17  Court Fees 
18  Expenditures or fees charged to the protected person’s 

Transportation 
Taxes 

19  Any other expenses incurred by the protected person’s 

Value on First 
Day of this 
Reporting 
Period 
 
 
 
 
 

Value on Last 
Day of this 
Reporting 
Period 
 
 
 
 
 

Amount of 
Gain 
(Loss) 
 
 
 
 
 

Value on First 
Day of this 
Reporting 
Period 
 
 
 
 
 

Value on Last 
Day of this 
Reporting 
Period 
 
 
 
 
 

Amount of 
Gain 
(Loss) 
 
 
 
 
 

Value on First 
Day of this 
Reporting 
Period 
 
 

Value on Last 
Day of this 
Reporting 
Period 
 
 

Amount of 
Gain 
(Loss) 
 
 

Page 6 of 7 

chedule E – Miscellaneous Property  

1801GUF January 2008 / Revised by Forms 
Committee April 11, 2022 

Guardian or Conservator Financial Accounting  
 

Item  Description 
1 
2 
3 
4 
5 

 
 
 
 
 

Item  Description 
1 
2 
3 
4 
5 

 
 
 
 
 

Item  Description 
1 
2 

 
 

  S

    S

  S

 

2 
3 
4 
5 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

* Attach a copy of the most recent account statement if one has been issued. 

chedule C – Money owed to Protected Person 

chedule D – Investments or trusts held for the protected person’s benefit 

3 
4 
5 

 
 
 

 
 
 

 
 
 

 
 
 

chedule F – Debts and Encumbrances 

chedule G – Cash Accounts (Such as checking or savings accounts)* 

Debts on First 
Day of this 
Reporting 
Period 
 
 
 
 
 

Debts on Last 
Day of this 
Reporting 
Period 
 
 
 
 
 

Amount of 
Gain 
(Loss) 
 
 
 
 
 

Amount on First 
Day of this 
Reporting 
Period 
 
 
 
 
 

Amount on Last 
Day of this 
Reporting 
Period 
 
 
 
 
 

Amount of 
Gain 
(Loss) 
 
 
 
 
 

* Attach a copy of the most recent bank statement for each account. 

I declare under criminal penalty under the law of Utah that everything stated in this document is true. 

Signed at ______________________________________________________ (city, and state or country). 

 
Date 

Signature ► 

Printed Name 

 

 

1801GUF January 2008 / Revised by Forms 
Committee April 11, 2022 

Guardian or Conservator Financial Accounting  
 

Page 7 of 7 

Item  Description 
1 
2 
3 
4 
5 

 
 
 
 
 

Item  Description 
1 
2 
3 
4 
5 

 
 
 
 
 

  S

  S