Conservator Annual Accounting (Short Form) {562PC}

STATE OF SOUTH CAROLINA COUNTY OF: IN THE MATTER OF: ) ) ) ) ) ) IN THE PROBATE COURT CONSERVATOR ANNUAL ACCOUNTING CASE NUMBER: through . The undersigned Conservator submits this accounting, which covers the period from The documentation on page 2 of this form sets forth a complete accounting for the period specified, which is summarized as follows: Beginning Balance Plus: Receipts Subtotal Less: Disbursements Ending Balance The Conservator declares that this account has been examined and that its contents represent a correct statement of all receipts and disbursements and is true to the best knowledge and belief of the Conservator. Executed this day of , 20 . SWORN to before me this , 20 day of Signature: Name: Address: Telephone (O): (H): Notary Public for South Carolina My Commission Expires: FORM #562PC (2/2004) 62-5-419 Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com RECEIPTS (assets received into estate) DISBURSEMENTS (assets disbursed/paid out from estate) TOTAL FORM #562PC (2/2004) Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com