(TYPE OR PRINT IN BLACK INK) File No. STATE OF NORTH CAROLINA County IN THE MATTER OF THE ESTATE OF: Name And Address Of Minor In The General Court Of Justice Superior Court Division Before The Clerk APPLICATION FOR APPOINTMENT OF GUARDIAN OF THE ESTATE GUARDIAN OF THE PERSON GENERAL GUARDIAN Social Security No. (Last Four Digits) County Of Residence Of Minor Age Date Of Birth FOR A MINOR G.S. 35A-1221, 35A-1225 Name And Street Address, PO Box, City, State And Zip Of Applicant 2 Name And Street Address, PO Box, City, State And Zip Of Applicant 1 County Of Residence Of Applicant 2 County Of Residence Of Applicant 1 Telephone No. Name And Address Of Attorney For Applicant(s) Applicant(s)'s Relationship Or Interest In Proceeding Telephone No. Telephone No. The undersigned, being duly sworn, applies to be appointed guardian(s) for the minor named above, to serve in the capacity indicated, and in support of this Application state(s): 1. The minor resides or is domiciled in this county. 2. The parents of the minor are listed below. (Attach copy(ies) of death certificate(s) if parent(s) not living.) Name Of Mother, And Address If Living Name Of Father, And Address If Living Date Of Death, If Not Living County Of Estate Administration Date Of Death, If Not Living County Of Estate Administration 3. Other persons known to have an interest in this proceeding are: Name And Address Name And Address Relationship To Minor Or Interest In Proceeding Relationship To Minor Or Interest In Proceeding 4. If applicable in the proceeding identified below custody of the minor was awarded a guardian of the minor was appointed the Last Will and Testament of the minor's parent(s), recommending the applicant(s) as guardian(s) for the minor, was admitted to probate. (Attach copy of custody or guardianship order or probated will, if available.) Date Of Order Or Probate County Of Proceeding Name And Address Of Custodian Or Guardian, If Any File Or Other Identification No. 5. The reason for seeking a guardian, and information concerning the need, type and person(s) to appoint are: 6. A statement of the assets and liabilities of the minor, including any income and receivables to which the minor is entitled, is set forth on the reverse side of this Application. 7. I hereby acknowledge receipt of the 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. AOC-E-208, Rev. 4/11 � 2011 Administrative Office of the Courts (Over) American LegalNet, Inc. www.FormsWorkFlow.com PART I. PROPERTY OF MINOR'S ESTATE Description Estimated Value PART II. OTHER PROPERTY Description Estimated Value 1. Insurance Proceeds 2. Injury Settlements 3. Cash And Uncashed Checks On Hand 4. Accounts 5. Stocks And Bonds 6. Farm Products, Livestock And Equipment 7. Miscellaneous Personal Property 8. Estimated Annual Income Interest And Dividends,Etc....... Rental Income.......................... Annuity, Pension Or Retirement Benefits, Social Security, Disability Or Other Compensation, Insurance Proceeds, Injury Settlement Or Other Periodic Payments........... $ $ 1. Right Of Action For Injury, Etc. (NOTE: Increase bond before receipt.) $ 2. Interests In Real Property 3. Custodial Accounts, Trust Income Or Other Resources Available For Support Of Minor, NOT Administered Or Received By Guardian (Attach itemized list) TOTAL PART II. Custodian, Trustee, Attorney-in-fact, Etc. (Name) $ Major medical or similar insurance is in effect through: (Name Of Insurer) (Policy No.) PART III. LIABILITIES 1. Mortgage Loans 2. Other Secured Loans Or Obligations $ Subtotal Of Line 8 9. Other $ 3. Unsecured Obligations 4. Other TOTAL PART I. (base bond on this amount) $ TOTAL PART III. 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 Date Title Date Commission Expires County Where Notarized Signature Of Person Authorized To Administer Oaths SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME Date Signature Of Person Authorized To Administer Oaths Title County Where Notarized Date Commission Expires SEAL SEAL WAIVER OF NOTICE/CONSENT TO GUARDIANSHIP Each of the undersigned hereby waives notice of a hearing on this Application and consents to the appointment of the applicant(s) as guardian(s) for the minor to serve in the capacity indicated. Date Signature Date Signature Name Of Applicant 1 (Type Or Print) Name Of Applicant 2 (Type Or Print) Relationship To Minor Parent Custodian Guardian Relationship To Minor Parent Custodian Guardian SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME Date Title Date Commission Expires County Where Notarized Signature Of Person Authorized To Administer Oaths SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME Date Title County Where Notarized Date Commission Expires Signature Of Person Authorized To Administer Oaths SEAL SEAL NOTE: A copy of this Application and written notice of the time, date and place set for a hearing, shall be served on any parent, guardian or legal custodian of the minor who is not an applicant 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-1222. AOC-E-208, Side Two, Rev. 4/11 � 2011 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com