File No. STATE OF NORTH CAROLINA In The General Court Of Justice County District Court DivisionName Of Plaintiff APPLICATION AND ORDER VERSUS TO APPOINT GUARDIAN AD LITEM Name Of Defendant IN ACTION FOR DOMESTIC VIOLENCE PROTECTIVE ORDER G.S. 1A-1, Rule 17 APPLICATION FOR APPOINTMENT The plaintiff defendant in this action seeking a domestic violence protective order is a person under eighteen (18) years of age who has no general guardian. The court is requested to appoint a guardian ad litem for the plaintiff defendant. The undersigned applicant recommends that the court appoint the following person as as guardian ad litem. Name Of Person Recommended As Guardian Ad Litem Date Relationship Of Proposed Guardian Ad Litem To Plaintiff/Defendant Applicant ORDER OF APPOINTMENT Pursuant to the authority contained in G.S. 1A-1, Rule 17 and: in response to the written application above on the courts own motion the person named below is appointed as guardian ad litem for (name minor), a minor for the purpose of: appearing on behalf of the minor plaintiff in the above-captioned action for a domestic violence protective order. defending on behalf of the minor defendant in the above-captioned action for a domestic violence protective order. Name And Address Of Guardian Ad Litem Date Signature Assistant CSC Magistrate (if authorized to enter ex parte order) Clerk Of Superior Court District Court Judge AOC-CV-318, New 6/2000 2000 Administrative Office of the Courts