STATE OF SOUTH CAROLINA COUNTY OF IN THE MATTER OF CASE NUMBER -GC- ) ) ) ) ) ) PROBATE COURT Petition for Appointment of Successor Custodian under the Uniform Transfer to Minors Act or Uniform Gift to Minors Act (Section 63-5-570, et. seq.) The undersigned affiant, being duly sworn, states that the above referenced minor is in possession of funds which are on deposit at in account number which was previously established under the Uniform Gift to Minors Act or the Uniform Transfer to Minors Act, pursuant to Section 63-5-570, et. seq. The current account balance is $ . The previous custodian, , for the above referenced account: Died on (date), and a copy of the death certificate is attached. Became or was adjudicated incapacitated on or about (date), and a copy of the court order, finding of incapacity, or physician's affidavit is attached. The account makes no provision for a successor custodian. The undersigned is related to the minor as: Parent, natural or adoptive Guardian appointed by the family court Legal Representative of Custodian Adult member of minor's family (relation): The undersigned petitions the court to appoint the affiant as a successor custodian pursuant to Section 63-5-570 (D), and the affiant would affirm that affiant is willing to serve as successor custodian for the account. Name: Address: Phone: FORM 573PC (10/10) 63-5-570, 62-1-302 (c)(6) Supp.1997 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Sworn to and Subscribed Before me on this day of , 20 Notary Public for South Carolina My Commission Expires: ORDER OF HEARING It is hereby ordered that a hearing in this matter be set for the day of , 20 at PM/AM. Notice shall be given to the following persons: Name Address Relation Judge of Probate, day of , South Carolina ORDER OF APPOINTMENT The court finds that serve as Successor Custodian for account number . Accordingly, successor custodian. IT IS SO ORDERED. Judge of Probate, day of , South Carolina , 20 , 20 County is the proper person to , which is on deposit at is appointed County FORM 573PC (10/10) 63-5-570, 62-1-302 (c)(6) Supp.1997 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com