FORM #523GC (01/2019) 62-5-108 STATE OF SOUTH CAROLINA ) ) COUNTY OF ) ) IN THE MATTER OF: ) , ) an alleged incapacitated individual. ) PROBATE COURT USE ONLY ) ) IN THE PROBATE COURT , ) CASE NUMBER - GC - - Petitioner(s), ) vs. ) MOTION AND ORDER FOR APPOINTMENT , ) OF COUNSEL FOR Respondent(s). ) EMERGENCY OR TEMPORARY PROCEEDINGS I request that an attorney be appointed for , an alleged incapacitated individual (A.I.I.), for emergency or temporary proceedings pending before the Court. I understand that I am responsible for the fees and costs of the attorney unless otherwise ordered by the Court. Executed this day of , 20. Petitioner/Movant CONSENT I consent to appointment as attorney for in the above action and agree to serve in that capacity. I am licensed to practice law in the State of South Carolina and a member in good standing of the South Carolina Bar. Executed this day of , 20. Attorney Signature: Print Name: Firm Name: Bar Number: Address: Telephone: Email: Attorney for: ORDER APPOINTING ATTORNEY On consideration of the above motion, it is ordered that is appointed attorney for the A.I.I. to advocate for his/her expressed wishes. , Judge of Probate day of , 20 , South Carolina American LegalNet, Inc. www.FormsWorkFlow.com