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AOC-850 Rev. 8-01 Page 1 of 2

Doc. Code: AFF & SETI

Case No._____________________ District/Probate Court________________________

Commonwealth of Kentucky Court of Justice www.kycourts.net KRS 395.605

INFORMAL FINAL SETTLEMENT: AFFIDAVIT, MOTION, AND ORDER

County_______________________

IN RE: Estate of ___________________________________________________________________________________ Date of Death _________________________________________ / Social Security Number _________________________ (month, day, year) AFFIDAVIT/MOTION Comes the affiant, being first duly sworn, and states as follows: 1. Six months have passed since my appointment as fiduciary to the above estate. (choose one) 2. ( ) I am sole beneficiary.

( ) I am not sole beneficiary, but I have attached a verified waiver from each beneficiary (AOC-851). (No verified waiver is required of the "nonresiduary legatee," a beneficiary who has received and receipted for his/her share pursuant to a specific will provision. The cancelled check or signed receipt is attached as evidence of satisfaction.) 3. The estate is solvent. (choose one) 4. ( ( ) All legal claims and debts have been paid. ) All legal claims and debts have not been paid, but have been provided for in the following manner:

________________________________________________________________________________________________. 5. All inheritance, estate or similar death taxes have been paid. A duplicate or photocopy of such tax releases is attached, if available. 6. All court costs have been paid.

(choose one) 7. ( ) My attorney's fee is _________________________. His/her name and address: Name: ____________________________________________________________________________ Address: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ ( 8. ) I do not have an attorney.

Each beneficiary has received his/her share.

AOC-850 Rev. 8-01 Page 2 of 2

Doc. Code: AFF & SETI

I ask this Court to dispense with the requirements of KRS Chapter 395 regarding settlement of fiduciaries' accounts and dispense with the requirements of a surety for the fiduciary and accept this informal settlement as final settlement. ___________________________________________________ Affiant ___________________________________________________ Address ___________________________________________________ ___________________________________________________ ___________________________________________________ Phone Number Subscribed and sworn to before me this ________________________________________, 2________. (month) (day) (year)

_____________________________________________ Name/Title

ORDER Upon the affidavit/motion of the above affiant/fiduciary, IT IS HEREBY ORDERED that the requirements of KRS Chapter 395 regarding settlement of fiduciaries' accounts and the requirements of a surety for the fiduciary are waived, the informal settlement is filed, and the fiduciary (and surety, if any) is discharged.

_________________________________________ Date

_____________________________________________ Judge

NOTICE TO CLERK AND JUDGE: When a settlement is effected in the informal manner, no notice to any person shall be required (for example, NO ADVERTISEMENT IS REQUIRED) nor shall the court be compelled to inquire into detailed items of income or disbursements. KRS 395.605(1).

Copy Distribution (Motion and Order): Original - Court File Copy - Affiant / Attorney