STATE OF INDIANA, CIRCUIT COURT
[COUNTY] COUNTY
In Re: The Sample Family Revocable Trust dated March 15, 2011
VERIFIED WRITTEN STATEMENT OF ACCOUNTS
Accounting Period: January 1, 2025 through December 31, 2025
Format: Ind. Code §30-4-5-12 (annual written statement of accounts to income beneficiaries: receipts, disbursements, and trust property at inventory value) and §30-4-5-13 (contents of verified accounting: period, receipts and disbursements, property on hand at inventory value, trustee compensation, other information the court requires). Amounts are illustrative sample data.
1. Period Covered
January 1, 2025 through December 31, 2025
2. Property at Beginning of Period: at Inventory Value
| Description | Inventory Value |
|---|---|
| Checking – First Sample Bank (…4417) | $48,250.00 |
| Brokerage – Sample Securities (…8821) | $312,400.00 |
| Residence – 123 Sample Lane, Anytown | $650,000.00 |
| Total | $1,010,650.00 |
3. Receipts
| Date | Source | Nature / Purpose | Amount |
|---|---|---|---|
| 01/01/2025 | Tenant – 123 Sample Ln | Rent – January | $2,000.00 |
| 01/15/2025 | Sample Securities | Dividends – Q4 2024 (various) | $2,460.00 |
| 02/01/2025 | Tenant – 123 Sample Ln | Rent – February | $2,000.00 |
| 03/01/2025 | Tenant – 123 Sample Ln | Rent – March | $2,000.00 |
| 04/01/2025 | Tenant – 123 Sample Ln | Rent – April | $2,000.00 |
| 04/15/2025 | Sample Securities | Dividends – Q1 2025 (various) | $2,460.00 |
| 05/01/2025 | Tenant – 123 Sample Ln | Rent – May | $2,000.00 |
| 06/01/2025 | Tenant – 123 Sample Ln | Rent – June | $2,000.00 |
| 06/30/2025 | First Sample Bank | Interest – Jan–Jun | $607.75 |
| 07/01/2025 | Tenant – 123 Sample Ln | Rent – July | $2,000.00 |
| 07/15/2025 | Sample Securities | Dividends – Q2 2025 (various) | $2,460.00 |
| 08/01/2025 | Tenant – 123 Sample Ln | Rent – August | $2,000.00 |
| 09/01/2025 | Tenant – 123 Sample Ln | Rent – September | $2,000.00 |
| 10/01/2025 | Tenant – 123 Sample Ln | Rent – October | $2,000.00 |
| 10/15/2025 | Sample Securities | Dividends – Q3 2025 (various) | $2,460.00 |
| 11/01/2025 | Tenant – 123 Sample Ln | Rent – November | $2,000.00 |
| 12/01/2025 | Tenant – 123 Sample Ln | Rent – December | $2,000.00 |
| 12/31/2025 | First Sample Bank | Interest – Jul–Dec | $607.75 |
| Total Receipts | $35,055.50 |
3-A. Sales of Trust Property
| Date | Asset Sold | Carry Value | Proceeds | Gain / (Loss) |
|---|---|---|---|---|
| 09/12/2025 | 200 sh XYZ Corp | $8,400.00 | $9,650.00 | $1,250.00 |
| Net Gain on Sale | $1,250.00 |
4. Disbursements
| Date | Payee | Nature / Purpose | Amount |
|---|---|---|---|
| INCOME DISBURSEMENTS | |||
| 03/10/2025 | Anytown Property Mgmt | Repairs – roof leak, 123 Sample Ln | $3,675.00 |
| 04/15/2025 | Franchise Tax / IRS | Fiduciary income tax – 2024 | $1,950.00 |
| 06/30/2025 | Jane Q. Sample | Trustee compensation – 1st half (per trust §7.2) | $3,000.00 |
| 12/31/2025 | Jane Q. Sample | Trustee compensation – 2nd half (per trust §7.2) | $3,000.00 |
| Subtotal – Income | $11,625.00 | ||
| PRINCIPAL DISBURSEMENTS | |||
| 04/10/2025 | Anytown County Tax Collector | Property tax – 1st installment | $3,910.00 |
| 05/20/2025 | Sample Mutual Insurance | Homeowner's insurance – annual | $2,140.00 |
| 08/05/2025 | Doe & Roe LLP | Attorney fees – trust administration | $4,500.00 |
| 11/15/2025 | Autonomi Books | Accounting & bookkeeping services | $2,800.00 |
| 12/10/2025 | Anytown County Tax Collector | Property tax – 2nd installment | $3,910.00 |
| Subtotal – Principal | $17,260.00 | ||
| Total Disbursements | $28,885.00 | ||
5. Trustee Compensation
| Date | Paid To | Basis / Source | Amount |
|---|---|---|---|
| 06/30/2025 | Jane Q. Sample | Trustee compensation – 1st half (per trust §7.2): charged to income | $3,000.00 |
| 12/31/2025 | Jane Q. Sample | Trustee compensation – 2nd half (per trust §7.2): charged to income | $3,000.00 |
| Total Trustee Compensation | $6,000.00 |
6. Distributions to Beneficiaries
| Date | Beneficiary | Description | Amount (at carry value) |
|---|---|---|---|
| 06/30/2025 | Beneficiary A (Sample, Robert) | Discretionary distribution – cash | $15,000.00 |
| 06/30/2025 | Beneficiary B (Sample, Maria) | Discretionary distribution – cash | $15,000.00 |
| Total Distributions | $30,000.00 |
7. Property on Hand at End of Period: at Inventory Value (with current value for reference)
| Description | Inventory Value | Est. Current Value |
|---|---|---|
| Checking – First Sample Bank (…4417) | $34,070.50 | $34,070.50 |
| Brokerage – Sample Securities (…8821) | $304,000.00 | $338,750.00 |
| Residence – 123 Sample Lane, Anytown | $650,000.00 | $728,000.00 |
| Total | $988,070.50 | $1,100,820.50 |
Liabilities at Close of Period
| Creditor | Description | Amount |
|---|---|---|
| Anytown County Tax Collector | Property tax accrued (due 04/2026) | $3,910.00 |
8. Verification
I affirm under the penalties for perjury that the foregoing representations are true.
Dated: ____________________ ______________________________________
Jane Q. Sample, Successor Trustee