SCCA 401PC (01/2019) STATE OF SOUTH CAROLINA ) ) COUNTY OF: ) ) IN THE MATTER OF: ) ) Decedent Alleged Incapacitated Individual ) PROBATE COURT USE ONLY ) ) IN THE PROBATE COURT ) ) CASE NUMBER - - - Petitioner(s), ) vs. ) SUMMONS ) Respondent(s).* ) *For Guardianship/Conservatorship matters, you must include the alleged incapacitated individual as a Respondent. TO THE RESPONDENT(S) LISTED ABOVE: YOU ARE HEREBY SUMMONED and required to Answer the Petition in this action, a copy of which is herewith served upon you, and to serve a copy of your Answer upon the Petitioner(s) listed above at the following address(es): Please Type or Print. (Name of Petitioner/Attorney for Petitioner) (Street Address or Mailing Address) (City, State, and Zip Code) Your Answer must be served on the Petitioner at the above address within thirty (30) days after the service of this Summons and Petition upon you, exclusive of the day of such service; and if you fail to answer the Petition within that time, judgment by default will be rendered against you for the relief demanded in the Petition. Signature of Petitioner(s)/Attorney for Petitioner(s) Date: American LegalNet, Inc. www.FormsWorkFlow.com Case Number: FORM #540GC (01/2019) 62-5-401, 62-5-404, 62-5-405, 62-5-407, 62-5-410, 62-5-411, 62-5-412, 62-5-413, 62-5-414 Page 2 of 7 INSTRUCTION SHEET FOR FORM #540GC PETITION FOR FINDING OF INCAPACITY, PROTECTIVE PROCEEDING, APPOINTMENT OF CONSERVATOR FOR AN ADULT This petition is intended to be used when a petitioner is seeking the appointment of a Conservator for an alleged incapacitated individual (A.I.I.). It can also be used when a petitioner seeks to have an A.I.I. found to be incapacitated for one of the other reasons stated below. The following actions may be requested with the filing of the attached petition: FINDING OF INCAPACITY The petitioner may be seeking to have the A.I.I. found to be an incapacitated individual for the purpose of a protective proceeding or the appointment of a Conservator. The court makes this determination, based in part and report and other relevant evidence. Generally, if there is no finding of incapacity, the court will not be able to proceed with any other action regarding the person who is alleged to be incapacitated. If authority is needed to manage financial affairs, please read below for available options and check the appropriate box(es) in the Petition: PROTECTIVE ORDER - Can be used to establish incapacity, allow for appointment of a special Conservator, establish a special needs trust, or to have a durable power of attorney for business and/or financial affairs ratified by the Court. APPOINTMENT OF SPECIAL CONSERVATOR - Can be used to request appointment of an individual or professional fiduciary to complete specific tasks within a specific period of time. APPOINTMENT OF CONSERVATOR (including appointment on an EMERGENCY or TEMPORARY basis; see Forms #512GC and #513GC) - Can be used to request permanent appointment of an individual or professional fiduciary and, if needed, appointment of a Conservator on an emergency or temporary basis before the permanent appointment can be made. APPOINTMENT OF SUCCESSOR CONSERVATOR - Can be used to request appointment of a successor to the permanent Conservator. RIGHTS AND POWERS OF THE ALLEGED INCAPACITATED INDIVIDUAL S.C. Code Ann. 247 62-5-403(B)(7) requires the petitioner to indicate in the petition what rights the Court is being asked to remove from the A.I.I. For protective proceedings, those rights are stated in S.C. Code Ann. 247 62-5-407(B). The burden of proof will be on the petitioner to show why certain rights should be removed. Rights not asked to be removed or not stated as being removed in the court order will be retained. If the A.I.I. is found to be incapacitated based oother than solely a physical impairment or disability, the court is required to report the name of the incapacitated individual to the S.C State Law Enforcement Division (SLED), pursuant to S.C. Code Ann. 247 23-31-1020. He or she will not be allowed to purchase, possess, or have access to firearms or ammunition, pursuant to S.C. Code Ann. 247 23-31-1040(A). American LegalNet, Inc. www.FormsWorkFlow.com FORM #540GC (1/2019) 62-5-401, 62-5-404, 62-5-405, 62-5-407, 62-5-410, 62-5-411, 62-5-412, 62-5-413, 62-5-414 Page 3 of 7 STATE OF SOUTH CAROLINA ) ) COUNTY OF ) ) IN THE MATTER OF: ) ) an alleged incapacited individual. ) PROBATE COURT USE ONLY ) ) IN THE PROBATE COURT , ) ) ) CASE NUMBER - GC - - PETITION FOR (check all that apply): Petitioner(s), ) FINDING OF INCAPACITY vs. ) ) PROTECTIVE ORDER APPOINTMENT OF : , ) ) CONSERVATOR SPECIAL CONSERVATOR Respondent(s).* ) ) SUCCESSOR CONSERVATOR *You must include the alleged incapacitated individual (A.I.I.) as a Respondent. 1. Petitioner(s): Relationship to the A.I.I., if any, or your interest in this proceeding: 2. Information about A.I.I. Name: Age: Date of Birth: Last 4 digits of Social Security Number: XXX-XX- Address: City/State/Zip: Preferred Telephone: Secondary Telephone: Email: The address provided for the A.I.I. is his/her: Home ; a Facility ; Other (please specify) 3. Existing legal documents and/or legal appointments relating to the A.I.I. To my knowledge, the A.I.I: Does have Does not have a Will Does have Does not have a general Durable Power of Attorney (POA) Does have Does not have a Health Care POA Does have Does not have a Living Will Does have Does not have a Guardian Does have Does not have a Conservator or Trustee If the A.I.I. does have any of the above-named documents, copies must be provided with this Petition or an explanation provided as to why the document is not available. 4. Jurisdiction: The A.I.I. has been physically present in South Carolina for the six (6) month period immediately preceding the filing of this petition or for at least six (6) consecutive months ending within the six (6) month period immediately preceding the filing of this petition. American LegalNet, Inc. www.FormsWorkFlow.com Case Number: FORM #540GC (01/2019) 62-5-401, 62-5-404, 62-5-405, 62-5-407, 62-5-410, 62-5-411, 62-5-412, 62-5-413, 62-5-414 Page 4 of 7 If the A.I.I. has not been physically present in South Carolina for the period of time described above, explain what connections the A.I.I. has to South Carolina. Please refer to S.C. Code Ann. 247247 62-5-700 through 62-5-711. 5. Venue (check all that apply): Venue for this proceeding is proper in this county because the A.I.I.: resides in this county and has resided in this county for more than six (6) months; resides in this county (this is his/her county of residence); is physically present in this county at this time; does not reside in this state but owns real or personal property in this county; or does not reside in this state but has the right to take legal action in this county (a copy of the pleadings will be required). If the A.I.I. has not resided in this county for the six (6) months preceding this action, state the address where the A.I.I. did reside or is currently residing: 6. Information about family of the A.I.I. You must provide information about the spouse and any children of the A.I.I.; if there is no spouse or adult children, then list his/her parents. If no parents are living, then list the closest adult relative(s). **Spouse: Address: City/State/Zip: Preferred Telephone: Secondary Telephone: Email: **If deceased, a certified death certificate is required. Children of A.I.I.: Name Address Year of Birth (IF REQUIRED) Living Parents of A.I.I.: Name Address (IF REQUIRED) Closest Living Adult Relative(s) of A.I.I. use additional paper if needed: Adult Relative: Address: City/State/Zip: Preferred Telephone: Secondary Telephone: Email: American LegalNet, Inc. www.FormsWorkFlow.com Case Number: FORM #540GC (01/2019) 62-5-401, 62-5-404, 62-5-405, 62-5-407, 62-5-410, 62-5-411, 62-5-412, 62-5-413, 62-5-414 Page 5 of 7 7. Information about any other interested parties such as a Guardian, Conservator, trustee, representative payee, agent under a general durable power of attorney, or a health care agent under a health care power of attorney. Name Address Relationship to A.I.I. 8. Rights an