Fill and Sign the Standby Guardian Form

The undersigned, being duly sworn, petitions for the appointment of the person(s) named above as standby guardian(s) or alternate standby guardian(s) of the minor child named above, to serve in the capacity indicated, with authority to become effective upon the death, incapacity, debilitation with consent or written consent of the petitioner. In support of this Petition, the petitioner states : 1. The minor resides or is domiciled in this county. 2. The petitioner is: (a) the biological or adoptive parent of the minor. (b) the guardian of the person or general guardian of the minor. ( NOTE: If this option is checked, treat the petition as a motion in the cause in the original guardianship. ) 3. The petitioner suffers from a progressively chronic illness or irreversibly fatal illness, in that: (State the basis for this statement, such as date and source of medical diagnosis; illness in question need not be identi�ed.) 4. The biological or adoptive parent of the minor, who is not the petitioner is: 5. Other persons known to have an interest in this proceeding are: 6. The following is a list of all court proceedings, in any state, involving the minor. File No. STATE OF NORTH CAROLINA County In The General Court Of Justice Superior Court DivisionBefore The Clerk (Over) Name And Address Of Minor County Of Residence Of Minor Age Date Of Birth Telephone No. County Of Residence Of Petitioner Name And Street Address, P.O. Box, City, State And Zip Code Of Petitioner Social Security No. Of Minor (last four digits) G.S. 35A-1373 IN THE MATTER OF: GUARDIAN OF THE PERSON GENERAL GUARDIAN PETITION FOR APPOINTMENT OF STANDBY GUARDIAN FOR MINOR Name, Street Address, P.O. Box, City, State And Zip Code Of Proposed Standby Guardian(s) Name, Street Address, P.O. Box, City, State And Zip Code Of Proposed Alternate Standby Guardian(s) Telephone No. Telephone No. County Of Residence County Of Residence Name And Address Relationship To Minor Or Interest In Proceeding Name And AddressRelationship To Minor Or Interest In Proceeding Name And Address Of Parent Plaintiff File No. Defendant State, County And Court Mother Father AOC-E-209, Rev. 4/16, © 2016 Administrative Of�ce of the Courts Other resources available for the support of the minor (such as trust income, assets held by a custodian under the Uniform Transfer to Minors Act and Social Security Payments), which will not be administered by the standby guardian are: ASSETS LIABILITIES 7. The minor’s estimated assets, liabilities, income and receivables: (Complete if standby guardian will become general guardian.) $ $ $ $ TOTAL TOTAL Description Amount Description Amount b. Other a. Obligations Secured By Minor’s Property a. Cash And Uncashed Checks On Hand b. Bank Deposits c. Stocks And Bonds d. Rights Of Action For Injury To Minor e. Real Property f. Annual Interest And Dividends g. Annual Rental Income h. Other I, the undersigned petitioner, have read this Petition and state that its contents are true to my own knowledge, except as to those matters stated on information and belief, and these I believe to be true. VERIFICATION Signature Of Petitioner Date Date Commission Expires County Where Notarized Date Signature Of Person Authorized To Administer Oaths Deputy CSC Assistant CSC Clerk Of Superior Court SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME Notary SEAL Each of the undersigned hereby waives notice of a hearing on this Petition and consents to the appointment of the petitioner(s) as standby guardian(s) for the minor to serve in the capacity indicated. WAIVER OF NOTICE/CONSENT TO STANDBY GUARDIANSHIP Parent Other Parent Other Date Signature Name (type or print) Relationship To Minor Relationship To Minor Name (type or print) Date Signature Date Commission Expires Date Commission Expires County Where Notarized County Where Notarized Date Date Signature Of Person Authorized To Administer Oaths Signature Of Person Authorized To Administer Oaths Notary Notary Deputy CSC Assistant CSC Clerk Of Superior Court Deputy CSC Assistant CSC Clerk Of Superior Court SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME SEAL SEAL NOTE: A copy of this Petition and written notice of the time, date, and place set for a hearing, shall be served on any biological or adoptive parent of the minor who is not a petitioner and who does not sign the waiver and consent above, and any other person the clerk may direct, including the minor. Service shall be as provided by Rule 4 of the Rules of Civil Procedure unless the clerk directs otherwise. G.S. 35A-1373(c). AOC-E-209, Side Two, Rev. 4/16, © 2016 Administrative Of�ce of the Courts