Fill and Sign the I Am Applying for an Allowance for a Years Support for the Persons Named and State Form

SPOUSE AND CHILD(REN)* ENTITLED TO ALLOWANCE STATE OF NORTH CAROLINA County File No. In The General Court Of JusticeSuperior Court DivisionBefore The Clerk APPLICATION AND ASSIGNMENT YEAR’S ALLOWANCE IN THE MATTER OF THE ESTATE OF Name Of Decedent Date Of Death G.S. 30-15, 30-17, 30-21 I am applying for an allowance for a year’s support for the person(s) named and state: 1. The decedent died a resident of this county on the date shown above. 2. The surviving spouse, if any, named below is entitled to an allowance from the personal property of the decedent of the value of sixty thousand dollars ($60,000), for a year’s support if the surviving spouse has not forfeited that right. The child(ren), if any, named below is/are entitled to an allowance of �ve thousand dollars ($5,000) for a year’s support.* 3. I request assignment of Sixty thousand dollars ($60,000) from the funds or other personal property of the decedent for a year’s support to the surviving spouse. Five thousand dollars ($5,000) from the funds or other personal property of the decedent for a year’s support to each child named below. Full Name Complete Address (including zip code) Age Relationship Spouse ChildChildChildChildChildChildChildChild Name And Address Of Applicant (type or print) Telephone No. Of Applicant Date Signature Of Applicant Date Signature Of Person Authorized To Administer Oaths Date Commission Expires County Where Notarized Notary Deputy CSC Assistant CSC CSC Magistrate Spouse Of Decedent Child/Full-Time Student Personal Representative Next Friend Of Child Guardian Other: SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME SEAL Original-File Copy-Applicant (Over) *NOTE: For a child to be entitled to receive an allowance, he or she must be one of the following: (1) a child under the age of 18 years, including an adopted child or a child with whom the widow was pregnant at the death of her husband; (2) a child who is less than 22 years of age who is a full-time student in any educational institution; (3) a child under 21 years of age who has been declared mentally incompetent; (4) a child under 21 years of age who is totally disabled; (5) a person under the age of 18 years who resided with the deceased parent at the time of death and to whom the deceased parent or the surviving parent stood in loco parentis. See G.S. 30-17 and G.S. 12-3(16), (17). AOC-E-100, Rev. 1/19 © 2019 Administrative Of�ce of the Courts ASSIGNMENT OF YEAR’S ALLOWANCE I have examined the above application and have determined the money and other personal property of the decedent. I �nd that the allegations in the application are true and that each person(s) named in the application is entitled to the allowance requested. I ASSIGN to the applicant the funds or other items of the personal property of the decedent listed below, which I have valued as indicated. This property is assigned free and clear of any lien by judgment or execution against the decedent and is to be paid by the applicant to the person(s) entitled. I assess as a DEFICIENCY the amount, if any, shown below, which is to be paid or delivered to the proper person when any additional personal assets of the decedent are discovered. Personal Property AssignedValue $ $ DEFICIENCY TOTAL CERTIFICATION I hereby certify that the foregoing is a True and Correct copy of the report in the Assignment of Year’s Allowance in the matter of the above-referenced estate as recorded in this of�ce and shall be suf�cient to release the items listed as assigned to the surviving spouse or children of the deceased as provided under G.S. 30-15, 30-17, and 30-21. Date Date SignatureSignature Assistant CSC Clerk Of Superior Court Magistrate Deputy CSC Assistant CSC Clerk Of Superior Court SEAL SEAL AOC-E-100, Side Two, Rev. 1/19 © 2019 Administrative Of�ce of the Courts