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Applicant(s) Relationship Or Interest In Proceeding Deputy CSC Assistant CSC Clerk Of Superior Court Deputy CSC Assistant CSC Clerk Of Superior Court 4. Other: (Give any other information requested by Clerk.) The incompetent person was so adjudicated on the date and in the proceeding identified above. A statement of the assets and liabilities of the incompetent person, including any income and receivables to which the incompetent is entitled, is set forth on the reverse side of this Application. (Not necessary if applying for guardianship of the person only.) 2. I hereby acknowledge receipt of AOC-SP-850, "Responsibilities Of Guardians In North Carolina" or I acknowledge that said pamphlet is available online at www.nccourts.org/forms and I further acknowledge that I am required to comply with said responsibilities and to manage the guardianship estate in accordance with North Carolina law. STATE OF NORTH CAROLINA File No. APPLICATION FOR LETTERS OF The Undersigned, being duly sworn, applies to be appointed guardian(s) for the incompetent person named above, to serve in the capacity indicated, and to be issued letters of appointment in this estate. County Of Residence Of Applicant 1 FOR AN INCOMPETENT PERSON IN THE MATTER OF THE ESTATE OF: G.S. 35A-1210, -1212, 35A-1251 Name And Address Of Incompetent Person County Of Residence Date Of Birth Social Security No. (Last Four Digits) File Or Other ID No. Of Incompetence Proceeding Name And Street Address, PO Box, City, State And Zip Of Applicant 2 Date Of Adjudication Of Incompetence Name And Street Address, PO Box, City, State And Zip Of Applicant 1 County Of Adjudication Telephone No. County Of Residence Of Applicant 2 Name And Address Of Attorney For Applicant(s) Telephone No. Telephone No. Attorney Bar No. Date My Commission Expires County Where Notarized VERIFICATION I, the undersigned applicant, have read this Application and state that its contents are true to my own knowledge except those matters stated on information and belief, which I believe to be true. Signature Of Person Authorized To Administer Oaths Signature Of Applicant 1 SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME Signature Of Applicant 2 Signature Of Person Authorized To Administer Oaths SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME SEAL SEAL Notary Date Date Date Date Date My Commission Expires Notary Original - File Copy - Applicant (Over) In The General Court Of Justice Superior Court Division Before The Clerk County AOC-E-206, Rev. 4/11 © 2011 Administrative Office of the Courts 1. County Where Notarized (TYPE OR PRINT IN BLACK INK) 3. GUARDIANSHIP OF THE ESTATE LIMITED GUARDIANSHIP OF THE ESTATE GUARDIANSHIP OF THE PERSON LIMITED GUARDIANSHIP OF THE PERSON GENERAL GUARDIANSHIP LIMITED GENERAL GUARDIANSHIP TOTAL PART I. (Base bond on this amount) 1. Interests In Real Estate 2. Right Of Action For Injury, etc. (NOTE: Increase bond before receipt.) 3. Trust Income NOT Administered Or Received By Guardian 4. Other Resources Available For Support Of Incompetent, NOT Administered Or Received By Guardian (Attach itemized list.) $ TOTAL PART II. $ TOTAL PART III. $ $ $ 2. Accounts (list bank, etc.; each account number; balance & Interest) $ $ Major medical or similar insurance is in effect through (Name Of Insurer) (Policy No.) PART III. LIABILITIES PART II. OTHER PROPERTY $ $ $ $ Annuity, Pension Or Retirement Benefits, Social Security, Disability Or Other Compensation, Insurance Proceeds, Injury Settlement Or Other Periodic Subtotal of Line 10 PART I. PRELIMINARY INVENTORY OF THE INCOMPETENT'S ESTATE Estimated Value 11. Other 10. Estimated Annual Income 3. Stocks And Bonds 4. Notes, Judgments And Other Debts Due 5. Household Furnishings 6. Motor Vehicles 7. Interest In Partnership Or Sole Proprietor Businesses 8. Farm Products, Livestock And Equipment 9. Miscellaneous Personal Property Description Soc. Sec. Payee, VA Guardian, Attorney-in-fact, etc. (Name) Living Will, Heath Care P.O.A., etc. (Health Care Agent) Description Description AOC-E-206, Side Two, Rev. 4/11 © 2011 Administrative Office of the Courts Wages, Salaries, Etc.................................................................................. Rental Income............................................................................................ Other Investment Income........................................................................... 1. Cash And Undeposited Checks On Hand Account No. 1. Mortgage Loans 2. Other Secured Loans Or Obligations 3. Unsecured Obligations