Fill and Sign the Court in the Exercise of Its Jurisdiction for the Appointment of Guardians of Minors and Upon Proper Petition by a Form

Name And Address Of Standby Guardian 2 Of The Person Name And Address Of Standby Guardian 1 Of The Person Signature Deputy CSC Assistant CSC Clerk Of Superior Court File No. STATE OF NORTH CAROLINA Clerk Of Superior Court Name Of Minor The Court in the exercise of its jurisdiction for the appointment of guardians of minors, and upon proper pet ition by a biological or adoptive parent or guardian of the perso n or general guardian of the minor named above, has a ppointed the person(s) named below as Standby Guardian(s) of the Perso n of the minor named above and has ordered that these Letters Of Appointment be issued. These Letters of Appointment are not effective until the standby guardian of the person receives one of the f ollowing, which shall be exhibited along with these letters as evid ence of the standby guardian of the person's authority: Upon receipt of such a writing , the standby guardian of the person is fully authorized and entitled under the laws of North Carolina to have the custody, care and control of t he minor, but has no authority to receive, manage or administer the property, estate or business affairs of t he minor. The authority of the standby guardian of the person shal l cease upon the entry of an order of the district court granting custody of the minor child to any person. These Letters are issued to attest to that authority and to certify that it will come into full force and effect as provided above. Witness my hand and the Seal of the Superior Court. AOC-E-412, Rev. 4/11 © 2011 Administrative Office of the Courts In The General Court Of Justice Superior Court DivisionBefore the Clerk County A written determination of the incapacity of the petit ioner, or A written determination of the debilitation of the petitioner and the petitioner's consent to the commencem ent of the standby guardian of the person's authority, or The petitioner's written consent to the commencement of the standby guardian of the person's authority, or A written determination of the death of the petitio ner. IN THE MATTER OF THE ESTATE OF: LETTERS OF APPOINTMENT STANDBY GUARDIANOF THE PERSON G.S. 35A-1373 l l l l Date Of Qualification Date Of Issuance EX OFFICIO JUDGE OF PROBATE SEAL NOTE: This letter is not valid without the official seal of the Clerk of Superior Court.