Fill and Sign the Account Annual Final North Carolina Form

$(TYPE OR PRINT IN BLACK INK) STATE OF NORTH CAROLINA C oun ty IN THE M A TTER OF THE EST A TE OF: N ame D e c e a s ed M in o r In c omp e te n t Tru s t File N o. In T h e G ene r a l Cou rt Of J u stice Supe ri o r Cou rt D i v isi o n Befo re T h e Cle rk ACCOUNT AN N UAL FINAL G.S. 28A-21- 1 , - 21-2, - 21-3; 35A-1264, 35A-1266, 28A-23-1 I, the undersigned repre s entative, being first duly sworn, say that the following is a complete and accurate account of my receipts, disbursements and other transactions as representati v e of this estate or trust. A c c o un ting Period From E xt e nd ing To PART I . SUMMARY 1. Subtotal Personal Property on Inventory or Subtotal Personal Property Held/In v ested as Shown on Last Account............................................................................. ..... ..................................................................... $ 2. Minus Loss from Sale of Personal Property when Compared to Value Listed on In v entory or Prior _ $ Account............................................................................. ..... ...................................................................... 3. SUBTOTAL ..................................................................... .. . .. ...................................................................... $ 4. Plus Total Receipts as shown on Reverse [Part III .] (costs apply to this amount)................................. . + $ 5. TOTAL ASSETS .............................................................. ... .. ..................................................................... $ 6. Minus Disbursements (Debts or E x penses) as Shown on Re v erse [Part I V .]........................................... _ $ 7. SUBTOTAL....................................................................... .... . ...................................................................... $ _ 8. Minus Distributions (Inheritance to Heirs) as Shown on Re v erse [Part V .]............................................... 9. BALANCE AT END OF ACCOUNTING PERIOD (When f iling Final Ac c ount, t his s hould e qual zero.) $ PART I I . BALAN C E H ELD OR INVESTED (Complete ONLY w hen f iling an Annual Ac c ount w ith assets r emaining in the Estate.) 1. On Deposit in Banks, etc. Account No. $ $ $ 2. Invested in Securities, etc................................................... .... ...................................................................... $ 3. Tangible Personal Property.............................................. ..... ....................................................................... $ 4. SUBTOTAL - PERSONAL PROPERTY........................... . . . ........................................................................ $ Balance 5. Real Estate Willed to the Estate And Not Sold (fair m arket value at date of death)... $ 6. Real Estate Acquired by the Estate Under G.S. 28A-15-1........................................................................... $ 7. Other................................................................................. ..... ....................................................................... $ TOTAL BALANCE HELD OR INVESTED ( M ust equal Balance shown in P a rt I. a bove) $ N ame And Ad d r es s O f Fid u c iary C ha ng e O f Ad d re s s N ame And Ad d r es s O f C o-fid u c iary C ha ng e O f Ad d re s s Sig na ture O f Fid u c iary Title Sig na ture O f C o-fid u c iary Title SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME D ate Sig na ture O f Per s on Auth o ri z ed To Admini s ter O aths D ate Sig na ture O f Per s on Auth o ri z ed To Admini s ter O aths D e pu ty C SC A ss i s ta n t C SC C lerk O f Su pe rior C o u rt D e pu ty C SC A ss i s ta n t C SC C lerk O f Su pe rior C o u rt N otary D ate M y Co mmi ss ion Expires D ate M y Co mmi ss ion E x pires N otary C o un ty W h e re N otari z ed C o un ty W h e re N otari z ed SEAL SE A L The abo v e account has been audited by me and the v ouchers or v erified proofs submitted in s upport were exa m ined. The account is appro v ed. disapproved. As this is the final account, the personal representative is disch a rged in accordance with G.S. 28A-23-1. D ate Sig na ture (O v er) A ss i s ta n t C SC C lerk O f Su pe rior C o u rt AOC-E-506, Re v . 1/12, © 2012 Administ r ative Office of t he Courts PART I I I . RECEIPTS NOTES: 1. Rent f r om real property not w illed to the estate goes to the heirs, and is not a receipt o f the estate. 2. List loans to the estate for the purpose o f paying clai m s. 3. If a sale of personal property results in a gain ov e r the value listed on the Inventory (AOC-E-505), li s t the gain as a receipt. If a sale results in a loss as co m pared to the value listed on the Inventor y , r eport the loss on Side 1, Part I of this for m . 4. Do not r eport, as a receipt, changes in value (when co m pared to the value listed in the Inventory) of ite m s which have not been sold. 5. If any real property w illed to the estate has been sol d , r eport the entire proceeds as a receipt. 6. If any real property not w illed to the estate has been sold in a special proceeding to create assets with which to pay clai m s o f the estate, report as a receipt only that portion o f t he proceeds received f r om the C omm issioners (the balance not needed to pay clai m s o f the estate is dist r ibuted in the special proceeding.) Date Recei v ed From Description Amount Or Value $ Total From A ttachment, If Any $ TOTAL PA R T I I I . $ PART I V . DISBURSEME N TS (Debts or Administrative Expenses) NOTES: 1. Disburse m ents are expenditures o f and for the estate, and do not include expenses regarding real property not w illed to the estate. 2. List pay m ents to creditors out of loans to the estate, or rei m burse m ents by the estate to heirs who had directly paid creditors o f the estate. 3. Provide copies of r eceipts, canceled or i m aged checks or other satisfactory det a iled proof of pay m ents. Date Paid Or Distributed To Description Amount Or Value $ Total From A ttachment, If Any $ TOTAL PA R T I V . $ PART V . DISTRIBUTIONS (Inheritance to Heirs) NOTES: 1. Provide copies of r eceipts, cancelled or i m aged checks, or other satisfactory det a iled proof of d elivery or distribution. 2. Attach ite m ized description of unrealized gains or losses or assets n o t sold but dist r ibuted. Do not include unrealized gain or loss a m ounts in Total Part V. Date Distributed To Amount $ Total From A ttachment, If Any $ TOTAL PA R T V . $ AOC-E-506, Side T w o, Re v . 1/12 © 2012 Administ r ati v e Office of t he Courts