File No.
STATE OF NORTH CAROLINA

                                                                                                            In The General Court Of Justice
                                             County                                                     Superior Court Division Before The Clerk
            IN THE MATTER OF THE ESTATE OF
Name                                                                                                            ACCOUNT
                                                                                                            ANNUAL            FINAL
     Deceased            Minor               Adult Ward                    Trust                           G.S. 28A-21-1, -21-2, -21-3, -23-1; 35A-1264, -1266
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.
Accounting Period From              Extending To                                 Date Of Death                        NOTE:  If Date Of Death is prior to January 1, 2013, 
                                                                                                                           do not use this version of the form. Instead, 
                                                                                                                           use the Rev. 12/17 version of the form.
                                                             PART  I.SUMMARY
1.  Subtotal Personal Property on Inventory or Subtotal Personal Property Held/Invested as Shown on Last Account $
2.  Minus Loss from Sale of Personal Property when Compared to Value Listed on Inventory or Prior Account
   (Include or attach explanation.)                                                                                          –      $

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.)                                         $
                                                  PART II. BALANCE HELD OR INVESTED
(Complete ONLY when filing an Annual Account with assets remaining in the Estate. Do not list account nos.)
1.  On Deposit in Banks, etc.                                                                                                           Balance
                                                                                                                                    $
                                                                                                                                    $
                                                                                                                                    $
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                                                                                                                          $
                                  TOTAL BALANCE HELD OR INVESTED(Must equal Balance shown in Part   above)I.                        $
Name And Address Of Fiduciary      Change Of Address                             Name And Address Of Co-Fiduciary      Change Of Address

Signature Of Fiduciary                      Title                                Signature Of Co-Fiduciary                   Title

SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME                                       SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME
Date                    Signature Of Person Authorized To Administer Oaths       Date                      Signature Of Person Authorized To Administer Oaths

       Deputy CSC          Assistant CSC           Clerk Of Superior Court             Deputy CSC            Assistant CSC         Clerk Of Superior Court
Date Commission Expires                                                          Date Commission Expires
                                                                 Notary                                                                           Notary
County Where Notarized                                                           County Where Notarized
                                                             SEAL                                                                                SEAL
                                             OUTCOME OF AUDIT BY CLERK AND ORDER
Bond?        Yes, reviewed.          Not applicable.
      The above account has been audited by me and the vouchers or verified proofs submitted in support were examined. The account 
     is      approved       disapproved                                                                                                                           .
      As this is the final account, the fiduciary is discharged.
Date                              Signature                                                                                         Assistant CSC
                                                                                                                                    Clerk Of Superior Court
AOC-E-506, Rev. 6/21                                                       (Over)
© 2021 Administrative Office of the Courts

                                                           PART III. RECEIPTS
NOTES: 1.   Rent from real property not willed to the estate goes to the heirs and is not a receipt of the estate.
      2.   List loans to the estate for the purpose of paying claims.
      3.   If a sale of personal property results in a gain over the value listed on the Inventory (AOC-E-505), list the gain as a receipt. If a sale results 
          in a loss as compared to the value listed on the Inventory, report the loss on Side One, Part  I  of this form.
      4.   Do not report, as a receipt, changes in value (when compared to the value listed in the Inventory) of items which have not been sold.
      5.   If any real property willed to the estate has been sold, report the entire proceeds as a receipt.
      6.   If any real property not willed to the estate has been sold in a special proceeding to create assets with which to pay claims of the estate, 
          report as a receipt only that portion of the proceeds received from the Commissioners (the balance not needed to pay claims of the estate is 
          distributed in the special proceeding).
 Date                          Received From                                             Description                                  Amount Or Value
                                                                                                                                     $

NOTE: The AOC-E-506 Part III Continuation may be used as an attachment.      Sum Total From Attachment(s), If Any                    $
                                                                                                            TOTAL PART III.          $
                               PART IV. DISBURSEMENTS (Debts or Administrative Expenses)
NOTES: 1.   Disbursements are expenditures of and for the estate and do not include expenses regarding real property not willed to the estate.
      2.   List payments to creditors out of loans to the estate, or reimbursements by the estate to persons who had directly paid creditors of the estate.
      3.  Provide copies of receipts, cancelled or imaged checks, or other satisfactory detailed proof of payments.
 Date                    Paid Or Disbursed To                                            Description                                  Amount Or Value
                                                                                                                                     $

NOTE: The AOC-E-506 Part IV Continuation may be used as an attachment.       Sum Total From Attachment(s), If Any                    $
                                                                                                            TOTAL PART IV.           $
                                           PART  V.DISTRIBUTIONS             (Inheritance to Heirs)
NOTES: 1.   Provide copies of receipts, cancelled or imaged checks, or other satisfactory detailed proof of delivery or distribution.
      2.   Attach itemized description of unrealized gains or losses or assets not sold but distributed. Do not include unrealized gain or loss amounts in 
          Total Part V.
 Date                                                      Distributed To                                                             Amount
                                                                                                                                     $

NOTE: The AOC-E-506 Part  VContinuation may be used as an attachment.        Sum Total From Attachment(s), If Any                    $
                                                                                                            TOTAL PART V.            $

 AOC-E-506, Side Two, Rev. 6/21
 © 2021 Administrative Office of the Courts