Free Periodic/Final Settlement of Guardian/Conservator for Minor/Disabled Person (Not electronic) - Kentucky

AOC-856 Doc. Code: SET Rev. 4-02 Page 1 of 2 Commonwealth of Kentucky Court of Justice www.kycourts.net KRS 387.175, 387.670, 387.710 395.610-.657; 395.990

Case No. PERIODIC/FINAL SETTLEMENT OF GUARDIAN/CONSERVATOR FOR [ ] MINOR [ ] DISABLED PERSON Court County District Probate

Notice to Guardian/Conservator: File this Settlement one (1) year after appointment and annually thereafter. If the net estate is $5,000 or less, file this Settlement every two (2) years after the original report. IN RE: Estate of ___________________________________________, a [ ] Minor under 18 [ ] Disabled Person. Comes ______________________________________________, appointed as [ ] Guardian [ ] Conservator of the above estate on ____________________, 2____. This [ ] Periodic [ ] Final Settlement indicates, by itemized statement and supported by receipts and vouchers, the assets received and disbursements made since the Inventory or last Settlement was filed. It is submitted pursuant to: [ ] KRS 387.710 OR [ ] KRS 387.175 and 395.610 - 395.657

ASSETS & INVESTMENTS (Include anything of value to the estate including government benefits, Social Security and SSI pension plan benefits, savings and checking accounts, certificates of deposit, all personal property, rents from real estate, and proceeds from the sale of real estate and personal property. Attach additional sheets of paper if necessary). ITEM _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ TOTAL ASSETS RECEIVED: DISBURSEMENTS _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ TOTAL DISBURSEMENTS MADE: BALANCE ASSETS LESS DISBURSEMENTS: AMOUNT $ ________________ ________________ ________________ ________________ ________________ ________________ $ ________________ AMOUNT $ ________________ ________________ ________________ ________________ ________________ ________________ ________________ $ ________________ $ _________________

For Periodic Settlements - carry balance forward to next report. For Final Settlements - indicate to whom balance was paid and attach receipt.

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AOC-856 Rev. 4-02 Page 2 of 2 IN PERIODIC SETTLEMENTS: PLAN FOR PRESERVING AND MAINTAINING ESTATE (not to be filled out if estate has net value of $5,000 or less) _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ IN FINAL SETTLEMENTS: UNPAID CREDITORS - ALLOWED CLAIMS ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ TOTAL CREDITORS - DISALLOWED CLAIMS ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ TOTAL $ _____________ _____________ _____________ _____________ _____________ _____________ $ _____________ $ _____________ _____________ _____________ _____________ _____________ _____________ $ _____________

Above-named Guardian/Conservator submits this Settlement to the Court, and if a Final Settlement, asks that the Surety be discharged. ____________________________________________ Guardian's/Conservator's Signature

Subscribed and sworn before me on __________________, 2____. My commission expires: _________________, 2____. ______________________________________________________ Name/Title

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