Fill and Sign the Adult Ward Form

ACCOUNT ANNUAL FINAL G.S. 28A-21-1, -21-2, -21-3, -23-1; 35A-1264, -1266 Name Accounting Period From Extending To File No. In The General Court Of Justice Superior Court Division Before The Clerk IN THE MATTER OF THE ESTATE OF STATE OF NORTH CAROLINA County I, the undersigned representative, being first duly sworn, say that the following is a complete and accurate account of my receipts, disbursements and other transactions as representative of this estate or trust. Deceased Minor Adult Ward Trust PART I. SUMMARY 2. Minus Loss from Sale of Personal Property when Compared to Value Listed on Inventory or Prior Account (Include or attach explanation.) – 1. Subtotal Personal Property on Inventory or Subtotal Personal Property Held/Invested as Shown on Last 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 Expenses) as Shown on Reverse [Part IV. ] – 7. SUBTOTAL 8. Minus Distributions (Inheritance to Heirs) as Shown on Reverse [Part V.] – 9. BALANCE AT END OF ACCOUNTING PERIOD (When filing Final Account, this should equal zero.) $ $ $ $ $ $ $ $ $ (Over) PART II. BALANCE HELD OR INVESTED Name And Address Of Fiduciary Change Of Address Signature Of Fiduciary Signature Of Co-Fiduciary Title Title Name And Address Of Co-Fiduciary Change Of Address (Complete ONLY when filing an Annual Account with assets remaining in the Estate.) 1. On Deposit in Banks, etc. 2. Invested in Securities, etc. 3. Tangible Personal Property 4. SUBTOTAL - PERSONAL PROPERTY 5. Real Estate Willed to the Estate and Not Sold (fair market value at date of death) 6. Real Estate Acquired by the Estate Under G.S. 28A-15-1 7. Other Balance Account No. $ $ $ $ $ $ $ $ $ $ TOTAL BALANCE HELD OR INVESTED (Must equal Balance shown in Part I. above) Date Date Signature Of Person Authorized To Administer Oaths Signature Of Person Authorized To Administer Oaths Deputy CSC Deputy CSC Assistant CSC Assistant CSC Clerk Of Superior Court Clerk Of Superior Court SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME Date Commission Expires County Where Notarized Notary SEAL Date Commission Expires County Where Notarized Notary SEAL (ONLY complete this section IF this is a final account for a decedent’s estate AND ONLY IF the decedent died prior to January 1, 2013. If this is a final account for a decedent’s estate of a decedent who died before January 1, 2013, one of the options below MUST be selected. ) I determined that this estate was subject to North Carolina’s estate tax and I have filed with the clerk of superior court a certificate issued by the Secretary of Revenue that states that the estate tax liability has been satisfied. I determined that this estate was not subject to North Carolina’s estate tax, the decedent died on or after January 1, 1999, but prior to January 1, 2013, and I have filed with the clerk of superior court a completed form AOC-E-212 or other sufficient certification, which is incorporated by reference in this Final Account. I determined that this estate was not subject to North Carolina’s estate tax, the decedent died prior to January 1, 1999, and I have filed with the clerk of superior court a completed form AOC-E-207 or other sufficient certification, which is incorporated by reference in this Final Account. AOC-E-506, Rev. 12/17