Fill and Sign the Nc Application Form

(TYPE OR PRINT IN BLACK INK) STATE OF NORTH CAROLINA County IN THE MATTER OF THE ESTATE OF: Name And Address Of Incompetent Person File No. In The General Court Of Justice Superior Court Division Before The Clerk APPLICATION FOR LETTERS OF GUARDIANSHIP OF THE ESTATE LIMITED GUARDIANSHIP OF THE ESTATE GUARDIANSHIP OF THE PERSON LIMITED GUARDIANSHIP OF THE PERSON Social Security No. (Last Four Digits) County Of Residence Date Of Birth GENERAL GUARDIANSHIP LIMITED GENERAL GUARDIANSHIP FOR AN INCOMPETENT PERSON G.S. 35A-1210, -1212, 35A-1251 Date Of Adjudication Of Incompetence County Of Adjudication File Or Other ID No. Of Incompetence Proceeding Name And Street Address, PO Box, City, State And Zip Of Applicant 1 Name And Street Address, PO Box, City, State And Zip Of Applicant 2 County Of Residence Of Applicant 1 Telephone No. County Of Residence Of Applicant 2 Telephone No. Applicant(s) Relationship Or Interest In Proceeding Name And Address Of Attorney For Applicant(s) Attorney Bar No. Telephone No. 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. 1. The incompetent person was so adjudicated on the date and in the proceeding identified above. 2. 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.) 3. 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. 4. Other: (Give any other information requested by Clerk.) 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. Date Signature Of Applicant 1 Date Signature Of Applicant 2 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 Notary Date My Commission Expires Date My Commission Expires Notary County Where Notarized County Where Notarized SEAL SEAL AOC-E-206, Rev. 4/11 © 2011 Administrative Office of the Courts O r i g i n a l - F i l e C o p y - A p p l i c a n t ( O v e r ) PART I . PRELIMINARY INVENTORY OF THE INCOMPETENT'S ESTATEDescription Estimated Value 1. Cash And Undeposited Checks On Hand $ 2. A 3. S ccounts (list bank, etc.; each account number; balance & Interest) Account No. tocks 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 10. Estimated Annual Income Wages, Salaries, Etc.................................................................................. Rental Income............................................................................................ Other Investment Income........................................................................... Annuity, Pension Or Retirement Benefits, Social Security, Disability Or Other Compensation, Insurance Proceeds, Injury Settlement Or Other Periodic $ $ $ $ Subtotal of Line 10 $ 11. Other TOTAL PART I . (Base bond on this amount) $ PART II . OTHER PROPERTY Description 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 . $ Major medical or similar insurance is in effect through (Name Of Insurer) (Policy No.) Soc. Sec. Payee, VA Guardian, Attorney-in-fact, etc. (Name) Living Will, Heath Care P.O.A., etc. (Health Care Agent) PART III . LIABILITIES Description 1. Mortgage Loans $ 2. Other Secured Loans Or Obligations 3. Unsecured Obligations TOTAL PART III . $ AOC-E-206, Side Two, Rev. 4/11 © 2011 Administrative Office of the Courts