FORM #552GC (9/11) 62-5-409, 62-5-424 STATE OF SOUTH CAROLINA ) IN T HE PROBATE COURT ) COUNTY OF ) ) EX PARTE: ) ) ) Conservator/Applicant ) APP APPLICATION FOR EXPENDITURE(S) IN RE: Protected Person ) ) ) ) ) ) CASE NUMBER Applicant is the duly appointed Conservator for the Minor/Incapacitated Person and is now actively engaged in the duties as such. The Minor/Incapacitated Person currently resides at , . S(he) has total cash assets of $. Said Minor/Incapacitated Person is now in need of certain items, and your Petitioner requests permission of the Court to purchase the following: Item Estimated Cost Reason for Purchase 1. 2. 3. If available, documentation supporting each requested expenditure is attached. SWORN to before me this day of Signature: , 20 . Print Name: Address: Print Name: Preferred Telephone: Notary Public for: Secondary Telephone: (State) Email: My Commission Expires: (Date) ORDER Upon consideration of the above Application and any matters deemed appropriate by the Court and determining that the requested expenditure(s) is/are in the best interest of the Protected Person, IT IS ORDERED , that the said Conservator have permission to use $ specifically fo r the purpose so stated in the Application . Receipts to be filed with the Court within 30 days from the date of this Order. Given under my hand and seal this day of , 20. , Judge of Probate American LegalNet, Inc. www.FormsWorkFlow.com