STATE OF NORTH CAROLINA County Name Of Respondent File No. IN THE MATTER OF: In The General Court Of Justice Superior Court Division Before The Clerk CERTIFICATE OF SERVICE (INCOMPETENT PROCEEDING) G.S. 35A-1109 I, the undersigned, certify that I mailed by first class mail a copy of the Notice Of Hearing On Incompetence And Order Appointing Guardian Ad Litem (AOC-SP-201) and a copy of the Petition For Adjudication Of Incompetence And Application For Appointment Of Guardian (AOC-SP-200) to the respondent's next of kin named in the Petition and to other persons designated by the Clerk, at the addresses listed below. This Notice was mailed within five (5) days after the Petition was filed as required by law. The address given below is the last known address of the person listed. Name And Address Of Person 1 Name And Address Of Person 2 Name And Address Of Person 3 Name And Address Of Person 4 Name And Address Of Person 5 Name And Address Of Person 6 Name And Address Of Person 7 Name And Address Of Person 8 SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME Date Signature Date Signature Of Petitioner Or Attorney Name Of Petitioner Or Attorney (Type Or Print) Deputy CSC Assistant CSC Clerk Of Superior Court SEAL Notary Date My Commission Expires AOC-SP-207, New 2/01 © 2001 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com