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AOC-856 |
Doc. Code: SET or |
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EALT H OF |
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Case No. ____________________ |
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Rev. 7-18 |
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Page 1 of 2 |
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j u s t i t i a |
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Commonwealth of Kentucky |
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Court of Justice |
www.courts.ky.gov |
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County ______________________ |
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KRS 387.175; 387.710; 395.610-.657; |
PERIODIC/FINAL SETTLEMENT |
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q GUARDIAN OR CONSERVATOR FOR MINOR |
Division ______________________ |
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395.990 |
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q CONSERVATOR FOR DISABLED PERSON |
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NOTICE TO GUARDIAN OR CONSERVATOR FOR MINOR AND TO CONSERVATOR FOR DISABLED PERSON:
File this Settlement one (1) year after appointment and annually thereafter. If the net estate is $5,000 or less, ile this
Settlement every two (2) years after the original report. (NOTE: YOU ARE NOT REQUIRED TO FILE THIS INVENTORY IF YOU ARE THE GUARDIAN FOR A DISABLED PERSON.)
IN RE: Estate of ______________________________________________, a q Minor under 18 q Disabled Person.
Comes ____________________________________________, appointed as q Guardian q Conservator of the
above estate on ________________________, 2_____. This q Periodic q
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 iled. It is submitted pursuant to:
q KRS 387.710 OR q KRS 387.175, 395.610 - 395.657 and 395.990
ASSETS & INVESTMENTS
(Include anything of value to the estate including government beneits, Social Security and SSI pension plan beneits, savings and checking accounts, certiicates 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 |
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AMOUNT |
_______________________________________________________________________ |
$ |
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_______________________________________________________________________ |
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_______________________________________________________________________ |
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_______________________________________________________________________ |
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_______________________________________________________________________ |
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_______________________________________________________________________ |
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TOTAL ASSETS RECEIVED: |
$ |
____________ |
DISBURSEMENTS |
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AMOUNT |
_______________________________________________________________________ |
$ |
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_______________________________________________________________________ |
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_______________________________________________________________________ |
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_______________________________________________________________________ |
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_______________________________________________________________________ |
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_______________________________________________________________________ |
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_______________________________________________________________________ |
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TOTAL DISBURSEMENTS MADE: |
$ |
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BALANCE |
ASSETS LESS DISBURSEMENTS: |
$ |
_________________ |
For Periodic Settlements - carry balance forward to next report.
For Final Settlements - indicate to whom balance was paid and attach receipt.
AOC 856 |
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Rev. 7-18 |
Case No. ____________________________ |
Page 2 of 2 |
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IN PERIODIC SETTLEMENTS:
PLAN FOR PRESERVING AND MAINTAINING ESTATE (not to be illed out if estate has net value of $5,000 or less)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
IN FINAL SETTLEMENTS: |
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UNPAID CREDITORS - ALLOWED CLAIMS |
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AMOUNT |
___________________________________________________________________________ |
$ |
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___________________________________________________________________________ |
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___________________________________________________________________________ |
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___________________________________________________________________________ |
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___________________________________________________________________________ |
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___________________________________________________________________________ |
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TOTAL |
$ |
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CREDITORS - DISALLOWED CLAIMS |
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AMOUNT |
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$ |
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___________________________________________________________________________ |
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___________________________________________________________________________ |
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___________________________________________________________________________ |
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___________________________________________________________________________ |
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TOTAL |
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Above-named Guardian/Conservator submits this Settlement to the Court, and if a Final Settlement, asks that the Surety be discharged.
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Date |
Guardian/Conservator Signature |
__________________________________ |
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Guardian's/Conservator's Phone Number |
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Address |
Subscribed and sworn before me on ________________________, 2_____. My commission expires: ______________________,
2_____.
_____________________________________________________
Name/Title