Fill and Sign the Guardianshipnorth Carolina Judicial Branch Form

STATE OF NORTH CAROLINA File No. NAME OF PARTY/INTERESTED PERSON/FIDUCIARY ADDRESS OF PARTY/INTERESTED PERSON/FIDUCIARY The following named parties, interested person or entities have been found to be indigent and relieved of their obligations to pay any of the mediator's fees. 3. NAME OF PARTY/INTERESTED PERSON/FIDUCIARY ADDRESS OF PARTY/INTERESTED PERSON/FIDUCIARY For the following reasons, it is justifiable for the estate/trust/or fiducia ry of to pay some or all of the mediator's fees: 4. Based upon the foregoing findings of fact, the Clerk concludes as a matter of law that the following named parties, interested persons, and fiduciaries shall have responsibility for paying the fees: 1. NAME OF PARTY/INTERESTED PERSON/FIDUCIARY ADDRESS OF PARTY/INTERESTED PERSON/FIDUCIARY CONCLUSION OF LAW A. B. C. D. Total time spent in mediation: hours, minutes @ $ per hour. 1. ORDER FOR APPORTIONMENT OF MEDIATOR FEE IN GUARDIANSHIP OR ESTATE MATTER The above named mediator has advised the Clerk of the need for a pportionment of the following fees: Name Of Respondent/Decedent Name And Address of Mediator G.S. 7A-38.3B, Rule 7.C. Of Rules Implementing Mediation In Matters Before The Clerk Of Supeiror Court FINDINGS OF FA CT Amount due for mediation services (CMP Rule 7.A and 7.B).................................................................................... a. VERSUS (IN THE MATTER OF:) Amount due for administrative fee (CMP Rule 7.B)................. ................................................................................. Amount due for postponement fee (CMP Rule 7.F. .............. ................................................................................... c. $ Amount due for out-of-pocket expenses or other agreed upon fee s (not applicable to Clerk appointed mediator) ........... d. $ Total amount due mediator................................ ........................................................................................................ $ b. $ $ The named parties, interested persons and fiduciaries listed below were orde red to attend the mediation. 2. In The General Court Of Justice Superior Court DivisionBefore The Clerk Count y Original - Clerk Copy - Petitioner Copy - Respondent Copy - Mediator (Over) AOC-G-304T, New 3/06 © 2006 Administrative Office of the Courts A. B. C. D. A. B. C. D. Assistant CSC Clerk Of Superior Court It is hereby ordered that the following person or entities pay the costs of mediation as allocated: ORDER NAME AMOUT OWED Signature 1. 2. 3. 4. Date Name (Type Or Print) AOC-G-304T, Side Two, New 2/06 © 2006 Administrative Office of the Courts The Court concludes that the payment of the costs of mediation by t he estate, trust, or fiduciary is justified based on the foregoing findings of fact. 2. .