FORM #566GC (01/2019) Page 1 of 5 62-5-414, 62-5-416, 62-5-423 STATE OF SOUTH CAROLINA ) ) COUNTY OF ) ) ) IN THE MATTER OF: ) PROBATE COURT USE ONLY ) , ) CASE NUMBER - GC - - a protected person. ) ) FINANCIAL PLAN OF CONSERVATOR INITIAL FINANCIAL PLAN AMENDED FINANCIAL PLAN # 1. What steps will business affairs? 2. This Financial Plan outlines expenditures for the health, education, maintenance, and support of the Protected Person only. OR This Financial Plan outlines expenditures for the health, education, maintenance, and support of the Protected Person and his/her dependent(s). 3. The Protected Person has (number of ) dependent(s). [ , which may include a spouse or child, is someone the Protected Person is legally obligated to support ( e.g. , child support, alimony) or who depends on the Protected Person ( e.g. , child attending college, adult disabled child) .] Relationship to Protected Person: Address: 4. How long do you expect this conservatorship will be needed? Explain: 5. Can the Protected Person effectively understand information about his/her estate to the extent that he/she can participate in decision making with your assistance? YES NO Explain: 6 . Does the Protected Person have an estate plan (will, trust, jointly owned assets)? YES NO If YES, attach a copy of the document(s). 7 . Does the Protected Person have sufficient mental capacity to understand this Financial Plan? YES NO If YES, you must provid e a copy of this Financial Plan to the Protected Person. 8 . Does the Protected Person have a Guardian? YES NO If YES, you must provid e a copy of this Financial Plan to the Guardian . American LegalNet, Inc. www.FormsWorkFlow.com FORM #566GC (01/2019) Page 2 of 5 62-5-414, 62-5-416, 62-5-423 PART I. PROJECTED RESOURCES AND EXPENSES A. MONTHLY RESOURCES TOTAL CURRENT INVESTMENTS (If this is the Initial Financial Plan, use the total from Schedule B of your Inventory and Appraisement. If this is an Amended Financial Plan, provide the current total of all stocks, bonds, notes, receivables, checking and savings accounts, certificates of deposit, mutual funds, retirement accounts, etc.) TOTAL MONTHLY INCOME a. Earnings from Employment (including overtime, tips, commission, bonuses) b. Pensions, Retirement, and Annuities Income c. Social Security Benefits, VA Benefits, d. Child Support and Alimony e. Dividends, Interest, Trust Income, and Capital Gains f. Rental Income and Business Profits g. All types of Monthly Income from Dependent claimed on this Financial Plan h. Other: SUBTOTAL $ MONTHLY INCOME DEDUCTIONS a. Payroll Taxes, Social Security , and Medicare b. Other ( e.g. , retirement contributions, deferred c ompensation ) : SUBTOTAL $ AVERAGE MONTHLY INCOME ( Subtract the Subtotal of the Monthly Income Deductions from the Subtotal for the Total Monthly Income ) $ B. MONTHLY EXPENSES C onsider only the expenses related to the Protected Person and his/her dependents claimed on this Financial Plan . a. RENT OR HOME MORTGAGE PAYMENT Are real estate taxes included? YES NO If NO, specify the monthly cost. ( Annual amount divided by 12 ) Is property insurance included? YES NO If NO, specify the monthly cost. ( A nnual premium divided by 12 ) b. UTILITIES: Electricity and heating fuel Water and sewer Telephone Internet Other: c. Home maintenance ( repairs and upkeep ): d. Food e. Clothing American LegalNet, Inc. www.FormsWorkFlow.com FORM #566GC (01/2019) Page 3 of 5 62-5-414, 62-5-416, 62-5-423 f. Laundry and dry c leaning g. Medical and dental e xpenses h. Transportation i. Recreation, entertainment, newspaper, magazines, etc. j. Charitable contributions: k. INSURANCE : nsurance Life i nsurance Health i nsurance Auto i nsurance Other: l. Personal p roperty t axes m. INSTALLMENT PAYMENTS: Automobile l oan Other: Other: Other: n. Guardian f ees o. Conservator f ees p. Legal f ees q. Other p rofessional f ees r. Regular expenses from operation of business, profession, or farm: AVERAGE MONTHLY EXPENSES $ MONTHLY NET INCOME OR DEFICIT Average Monthly Income $ Average Monthly Expenses - $ MONTHLY NET INCOME ( Subtract Average Monthly Expenses from Average Monthly Income ) $ PART II. PROJECTED SUFFICIENCY OF CONSERVATORSHIP ASSETS 9 . Average Monthly In come sufficient to meet his/her monthly expenses? ( NOTE: If the Monthly Net Income above is a positive number, check YES .) YES NO ( If YES, please skip to the PROOF OF DELIVERY . ) 1 0 . sufficient to supplement the difference between the Protected Average Monthly I A verage Monthly E xpenses on an annual basis ? ( NOTE: If the Total Current Investments is greater than the deficit in the Monthly Net Income, check YES.) YES NO ( I f NO, skip to Question 12 . ) 1 1 . How many years will the Divide the Total Current Investments by the value of the Monthly Net Income from above. ) Years 1 2 . are no longer sufficient to meet the need s of the Protected Person and his/her dependents? 1 3 . Does this Financial Plan alter the overall estate plan of the Protected Person? YES NO If YES, explain how and why the changes are necessary. American LegalNet, Inc. www.FormsWorkFlow.com FORM #566GC (01/2019) Page 4 of 5 62-5-414, 62-5-416, 62-5-423 PROOF OF DELIVERY On the day of , 20, I mailed or delivered this Conservator Report to all persons required to receive a copy pursuant to S.C. Code Ann. 247 62-5-416(C) and any Orders of this Court. Delivery was accomplished by the following method (check appropriate box(es)): personal delivery ordinary first-class mail certified mail registered mail commercial delivery NAME ADDRESS VERIFICATION The Conservator being sworn, states that the facts set forth in the foregoing Financial Plan are true and correct to the best SWORN to before me this day of , 20 . Print Name: Address: Print Name: Preferred Telephone: Notary Public for: Secondary Telephone: (State) Email: My Commission Expires: (Date) SWORN to before me this day of Co - , 20 . Print Name: Address: Print Name: Preferred Telephone: Notary Public for: Secondary Telephone: (State) Email: My Commission Expires: (Date) American LegalNet, Inc. www.FormsWorkFlow.com FORM #566GC (01/2019) Page 5 of 5 62-5-414, 62-5-416, 62-5-423 STATE OF SOUTH CAROLINA ) ) COUNTY OF ) ) ) IN THE MATTER OF: ) PROBATE COURT USE ONLY ) , ) CASE NUMBER - GC - - a protected person. ) ) ) ORDER CONCERNING THE FINANCIAL PLAN OF CONSERVATOR PURSUANT TO S.C. CODE ANN. 247 62-5-414(B), the Probate Court has reviewed and considered the Financial Plan of the Conservator, and therefore orders: The Financial Plan is APPROVED. Pursuant to S.C. Code Ann. 247 62-5-423, the Conservator may expend : (1) the expenditures are for the health, education, maintenance, or support of the Protected Person or and (2) all expenditures are consistent with this Financial Plan. The Financial Plan is NOT APPROVED because: . The Conservator shall revise and resubmit the Financial Plan within days. The Financial Plan is modified, as follows: . Other: . IT IS SO ORDERED. , Judge of Probate day of , 20 , South Carolina American LegalNet, Inc. www.FormsWorkFlow.com