AOC-856
Doc. Code: SET
Rev. 10-12
Case No. ____________________
Page 1 of 2
l e x
e t
j u s t i t i a
District
Court _______________________
Commonwealth of Kentucky
Court of Justice
Periodic/Final Settlement of
Guardian/Conservator For
County ______________________
KRS 387.175, 387.670, 387.710
[
] Minor
[
] Disabled Person
395.610-.657; 395.990
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, 395.610 - 395.657 and 395.990
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
AMOUNT
_______________________________________________________________________
$
____________
_______________________________________________________________________
____________
_______________________________________________________________________
____________
_______________________________________________________________________
____________
_______________________________________________________________________
____________
_______________________________________________________________________
____________
TOTAL ASSETS RECEIVED:
$
____________
DISBURSEMENTS
AMOUNT
_______________________________________________________________________
$
____________
_______________________________________________________________________
____________
_______________________________________________________________________
____________
_______________________________________________________________________
____________
_______________________________________________________________________
____________
_______________________________________________________________________
____________
_______________________________________________________________________
____________
TOTAL DISBURSEMENTS MADE:
$
____________
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.