AOC-850 Rev. 2-17 Page 1 of 2 Doc. Code: AFF & SETI COM M O NW E A LT H O F K E lex et justitia Case No. ____________________ Court County Division ____________________ ____________________ ____________________ NT U C KY CO Commonwealth of Kentucky Court of Justice www.courts.ky.gov U RT OF JUS TI KRS 395.605 INFORMAL FINAL SETTLEMENT: AFFIDAVIT, MOTION, AND ORDER IN RE: Estate of __________________________________________________________________________________ Date of Death: ___________________________________ (month, day, year) C AFFIDAVIT/MOTION Comestheaffiant,beingfirstdulysworn,andstatesasfollows: 1. 2. Sixmonthshavepassedsincemyappointmentasfiduciarytotheaboveestate. q q Iamsolebeneficiary. Iamnotsolebeneficiary,butIhaveattachedaverifiedwaiverfromeachbeneficiary(AOC-851). (No verifiedwaiverisrequiredofthe"nonresiduarylegatee,"abeneficiarywhohasreceivedandreceipted forhis/hersharepursuanttoaspecificwillprovision.Thecancelledcheckorsignedreceiptisattachedas evidence of satisfaction.) 3. 4. The estate is solvent. q q 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. All court costs have been paid. q My attorney's fee is _________________________. His/her name and address: Name: _______________________________________________________________________ Address: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ q I do not have an attorney. 6. 7. 8. Eachbeneficiaryhasreceived his/her share. E Social Security Number: _________________________ American LegalNet, Inc. www.FormsWorkFlow.com AOC-850 Rev. 2-17 Page 2 of 2 IaskthisCourttodispensewiththerequirementsofKRSChapter395regardingsettlementoffiduciaries'accounts anddispensewiththerequirementsofasuretyforthefiduciaryandacceptthisinformalsettlementasfinalsettlement. ___________________________________________________ Affiant ___________________________________________________ Address ___________________________________________________ ___________________________________________________ ___________________________________________________ Phone Number Subscribed and sworn to before me this ______________________________________________, 2________. (month) (day) (year) ____________________________________________ Name/Title ORDER Upontheaffidavit/motionoftheaboveaffiant/fiduciary, ITISHEREBYORDEREDthattherequirementsofKRSChapter395regardingsettlementoffiduciaries' accounts and therequirementsofasuretyforthefiduciaryarewaived,theinformalsettlementisfiled,andthefiduciary(andsurety,ifany) is discharged. ________________________________, 2_______ Date ____________________________________________ Judge NOTICE TO CLERK AND JUDGE: When a settlement is effected in the informal manner, no notice to any person shall berequired(forexample,NOADVERTISEMENTISREQUIRED)norshallthecourtbecompelledtoinquireintodetailed items of income or disbursements. KRS 395.605(1). Original - Court File Copy-Affiant/Attorney American LegalNet, Inc. www.FormsWorkFlow.com