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Table of Contents

PERMANENCY PLANNING AND STANDBY GUARDIANSHIP

Standby Guardian Flow Chart ................................................................................................ 1

Standby Guardianship Statute ............................................................................................... 2

Standby Guardianship Checklist ........................................................................................... 10

Checklist of Planning Considerations in Permanency Planning Cases .................................... 17

Standby Guardian Intake ............................................................................................... 18

Standby Guardianship Brochure .......................................................................................... 22

Information for Designated Standby Guardian ..................................................................... 26

Authorization to Consent to Health Care for Minor ............................................................. 28

Joint Representation Informed Consent (SBG) ..................................................................... 29

Petition for Appointment of Standby Guardian for Minor (AOC-E-209) ................................. 30

Authorization of Student Representation ............................................................................. 32

Petition to Sue as an Indigent (AOC-G-106) .......................................................................... 33

Waiver of Bond ............................................................................................... 35

Estates Action Cover Sheet (AOC-E-650) ............................................................................... 36

Written Designation of Standby Guardian ............................................................................ 38

Notice of Hearing ............................................................................................... 41

Sheriff=s Return of Service ............................................................................................... 42

Affidavit of Service by Certified Mail .................................................................................... 43

Notice of Service by Publication ........................................................................................... 44

Due Diligence Affidavit ............................................................................................... 45

Checklist for Service by Publication ...................................................................................... 47

Generic Physician Affidavit for Use in SBG Proceeding ......................................................... 49

Standby Guardianship Hearing Guide ................................................................................... 50

Consent to Commencement of Standby Guardian=s Authority after Hearing ......................... 56

Order on Petition for Appointment of Standby Guardian for Minor (AOC-E-409) .................. 58

Letters of Appointment-Standby Guardian of the Person (AOC-E-412).................................. 59

Letters of Appointment Guardian of the Person (AOC-E-408) ............................................... 60

Letters of Appointment-Standby General Guardian (AOC-E-411) .......................................... 61

Oath (AOC-E-400) ............................................................................................... 62

Consent to Commencement of Guardianship after Written Designation Signed .................... 63

Standby Guardian=s Petition for Appointment as Guardian for Minor (AOC-E-210) ............... 65

Order on Standby Guardian=s Petition for Appointment as Guardian of Minor (AOC-E-410) .. 67

Appointment of Resident Process Agent and Acceptance of Appointment (AOC-E-500) ........ 68

Appendix A

STANDBY GUARDIANSHIP FLOW CHART

PARENT

STANDBY

GUARDIAN –

“Standing by”

Designation –

Parent designates

Standby Guardian –

Guardian has no

legal authority

Parent files

Petition

Triggering event

(consent, death,

incapacity

)

SBG has 90

days authority

Guardian files Petition, designation

and evidence of triggering event, within

90 days – authority continues until

hearing

Hearing before Clerk

of Court

Order, letters issued.

Authority continues

indefinitely.

Hearing before

Clerk

Order, letters issued.

Guardian is “standing

by”

Triggering event

(consent, death,

incapacity

)

Evidence of triggering

event attached to letters:

Guardian has legal

authority.

Parent serves

petition on absent

parent

Guardian serves

petition on absent

parent

-1-

NC General Statutes - Chapter 35A Article 21 1

SUBCHAPTER IV. STANDBY GUARDIANS FOR MINOR CHILDREN.

Article 21.

Standby Guardianship.

§ 35A-1370. Definitions.

For purposes of this Article:

(1) "Alternate standby guardian" means a person identified in either a petition or

designation to become the guardian of the person or, when appropriate, the

general guardian of a minor child, pursuant to G.S. 35A-1373 or to G.S.

35A-1374, when the person identified as the standby guardian and the

designator or petitioner has identified an alternate standby guardian.

(2) "Attending physician" means the physician who has primary responsibility

for the treatment and care of the parent or legal guardian. When more than

one physician shares this responsibility, or when a physician is acting on the

primary physician's behalf, any such physician may act as the attending

physician pursuant to this section. When no physician has this responsibility,

a physician who is familiar with the petitioner's medical condition may act as

the attending physician pursuant to this Article.

(3) "Debilitation" means a chronic and substantial inability, as a result of a

physically debilitating illness, disease, or injury, to care for one's minor

child.

(4) "Designation" means a written document voluntarily executed by the

designator pursuant to this Article.

(5) "Designator" means a person who suffers from a progressive chronic illness

or an irreversible fatal illness and who is the biological or adoptive parent,

the guardian of the person, or the general guardian of a minor child. A

designation under this Article may be made on behalf of a designator by the

guardian of the person or the general guardian of the designator.

(6) "Determination of debilitation" means a written determination made by the

attending physician which contains the physician's opinion to a reasonable

degree of medical certainty regarding the nature, cause, extent, and probable

duration of the debilitation of the petitioner or designator.

(7) "Determination of incapacity" means a written determination made by the

attending physician which contains the physician's opinion to a reasonable

degree of medical certainty regarding the nature, cause, extent, and probable

duration of the incapacity of the petitioner or designator.

(8) "Incapacity" means a chronic and substantial inability, as a result of mental

or organic impairment, to understand the nature and consequences of

decisions concerning the care of one's minor child, and a consequent

inability to make these decisions.

(9) "Minor child" means an unemancipated child or children under the age of 18

years.

(10) "Petitioner" means a person who suffers from a progressive chronic illness

or an irreversible fatal illness and who is the biological parent, the adoptive

parent, the guardian of the person, or the general guardian of a minor child.

A proceeding under this Article may be initiated and pursued on behalf of a

petitioner by the guardian of the person, the general guardian of the

petitioner, or by a person appointed by the clerk of superior court pursuant to

Rule 17 of the Rules of Civil Procedure as guardian ad litem for the purpose

of initiating and pursuing a proceeding under this Article on behalf of a

petitioner.

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(11) "Standby guardian" means a person appointed pursuant to G.S. 35A-1373 or

designated pursuant to G.S. 35A-1374 to become the guardian of the person

or, when appropriate, the general guardian of a minor child upon the death of

a petitioner or designator, upon a determination of debilitation or incapacity

of a petitioner or designator, or with the consent of a petitioner or designator.

(12) "Triggering event" means an event stated in the designation executed or

order entered under this Article which empowers the standby guardian, or

the alternate standby guardian, if one is identified and the standby guardian

is unwilling or unable to serve, to assume the duties of the office, which

event may be the death of a petitioner or designator, incapacity of a

petitioner or designator, debilitation of a petitioner or designator with the

petitioner's or designator's consent, or the consent of the petitioner or

designator, whichever occurs first. (1995, c. 313, s. 1.)

§ 35A-1371. Jurisdiction; limits.

Notwithstanding the provisions of Subchapter II of this Chapter, the clerk of superior court

shall have original jurisdiction for the appointment of a standby guardian for a minor child

under this Article. Provided that the clerk shall have no jurisdiction, no standby guardian may

be appointed under this Article, and no designation may become effective under this Article

when a district court has assumed jurisdiction over the minor child in an action under Chapter

50 of the General Statutes or in an abuse, neglect, or dependency proceeding under Subchapter

I of Chapter 7B of the General Statutes, or when a court in another state has assumed such

jurisdiction under a comparable statute. (1995, c. 313, s. 1; 1998-202, s. 13(g).)

§ 35A-1372. Standby guardianship; applicability.

This Article provides two methods for appointing a standby guardian: by petition pursuant

to G.S. 35A-1373 or by designation pursuant to G.S. 35A-1374. If a standby guardian is

unwilling or unable to serve as a standby guardian and the designator or petitioner has

identified an alternate standby guardian, then the alternate standby guardian shall become the

standby guardian, upon the same conditions as set forth in this Article. (1995, c. 313, s. 1.)

§ 35A-1373. Appointment by petition of standby guardian; petition, notice, hearing,

order.

(a) A petitioner shall commence a proceeding under this Article for the appointment of

a standby guardian of a minor child by filing a petition with the clerk of superior court of the

county in which the minor child resides or is domiciled at the time of filing. A petition filed by

a guardian of the person or a general guardian of the minor child who was appointed under this

Chapter shall be treated as a motion in the cause in the original guardianship, but the provisions

of this section shall otherwise apply.

(b) A petition for the judicial appointment of a standby guardian of a minor child shall:

(1) Identify the petitioner, the minor child, the person designated to be the

standby guardian, and the person designated to be the alternate standby

guardian, if any;

(2) State that the authority of the standby guardian is to become effective upon

the death of the petitioner, upon the incapacity of the petitioner, upon the

debilitation of the petitioner with the consent of the petitioner, or upon the

petitioner's signing of a written consent stating that the standby guardian's

authority is in effect, whichever occurs first;

(3) State that the petitioner suffers from a progressively chronic illness or an

irreversible fatal illness, and the basis for such a statement, such as the date

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and source of a medical diagnosis, without requiring the identification of the

illness in question;

(4) State whether there are any lawsuits, in this or any other jurisdiction,

involving the minor child and, if so, identify the parties, the case numbers,

and the states and counties where filed; and

(5) Be verified by the petitioner in front of a notary public or another person

authorized to administer oaths.

hearing shall be served upon any biological or adoptive parent of the minor child who is not a

petitioner, and on any other person the clerk may direct, including the minor child. Service

shall be made pursuant to Rule 4 of the Rules of Civil Procedure, unless the clerk directs

otherwise. When service is made by the sheriff, the sheriff shall make such service without

demanding his fees in advance. Parties may waive their right to notice of the hearing and the

clerk may proceed to consider the petition upon determining that all necessary parties are

before the court and agree to have the petition considered.

(d) If at or before the hearing any parent entitled to notice under subsection (c) of this

section presents to the clerk a written claim for custody of the minor child, the clerk shall stay

further proceedings under this Article pending the filing of a complaint for custody of the

minor child under Chapter 50 of the General Statutes and, upon the filing of such a complaint,

shall dismiss the petition. If no such complaint is filed within 30 days after the claim is

presented, the clerk shall conduct a hearing and enter an order as provided for in this section.

(e) The petitioner's appearance at the hearing shall not be required if the petitioner is

medically unable to appear, unless the clerk determines that the petitioner is able with

reasonable accommodation to appear and that the interests of justice require that the petitioner

be present at the hearing.

(f) At the hearing, the clerk shall receive evidence necessary to determine whether the

requirements of this Article for the appointment of a standby guardian have been satisfied. If

the clerk finds that the petitioner suffers from a progressive chronic illness or an irreversible

fatal illness, that the best interests of the minor child will be promoted by the appointment of a

standby guardian of the person or general guardian, and that the standby guardian and the

alternate standby guardian, if any, are fit to serve as guardian of the person or general guardian

of the minor child, the clerk shall enter an order appointing the standby guardian named in the

petition as standby guardian of the person or standby general guardian of the minor child and

shall issue letters of appointment to the standby guardian. The order may also appoint the

alternate standby guardian named in the petition as the alternate standby guardian of the person

or alternate general guardian of the minor child in the event that the person named as standby

guardian is unwilling or unable to serve as standby guardian and shall provide that, upon a

showing of that unwillingness or inability, letters of appointment will be issued to the alternate

standby guardian.

(g) Letters of appointment issued pursuant to this section shall state that the authority of

the standby guardian or alternate standby guardian of the person or the standby guardian or

alternate standby general guardian is effective upon the receipt by the guardian of a

determination of the death of the petitioner, upon receipt of a determination of the incapacity of

the petitioner, upon receipt of a determination of the debilitation of the petitioner and the

petitioner's consent, whichever occurs first, and shall also provide that the authority of the

standby guardian may earlier become effective upon written consent of the petitioner pursuant

to subsection (l) of this section.

(h) If at any time prior to the commencement of the authority of the standby guardian

the clerk, upon motion of the petitioner or any person entitled to notice under subsection (c) of

this section and after hearing, finds that the requirements of subsection (f) of this section are no

longer satisfied, the clerk shall rescind the order.

-4-

(i) Where the order provides that the authority of the standby guardian is effective upon

receipt of a determination of the death of the petitioner, the standby guardian's authority shall

commence upon the standby guardian's receipt of proof of death of the petitioner such as a copy

of a death certificate or a funeral home receipt. The standby guardian shall file the proof of

death in the office of the clerk who entered the order within 90 days of the date of the

petitioner's death or the standby guardian's authority may be rescinded by the clerk.

(j) Where the order provides that the authority of the standby guardian is effective upon

receipt of a determination of the incapacity of the petitioner, the standby guardian's authority

shall commence upon the standby guardian's receipt of a copy of the determination of

incapacity made pursuant to G.S. 35A-1375. The standby guardian shall file a copy of the

determination of incapacity in the office of the clerk who entered the order within 90 days of

the date of the receipt of such determination, or the standby guardian's authority may be

rescinded by the clerk.

(k) Where the order provides that the authority of the standby guardian is effective upon

receipt of a determination of the debilitation of the petitioner, the standby guardian's authority

shall commence upon the standby guardian's receipt of a copy of the determination of

debilitation made pursuant to G.S. 35A-1375, as well as a written consent signed by the

petitioner. The standby guardian shall file a copy of the determination of debilitation and the

written consent in the office of the clerk who entered the order within 90 days of the date of the

receipt of such determination, or the standby guardian's authority may be rescinded by the

clerk.

(l) Notwithstanding subsections (i), (j), and (k) of this section, a standby guardian's

authority shall commence upon the standby guardian's receipt of the petitioner's written consent

to such commencement, signed by the petitioner in the presence of two witnesses who are at

least 18 years of age, other than the standby guardian or the alternate standby guardian, who

shall also sign the writing. Another person may sign the written consent on the petitioner's

behalf and at the petitioner's direction if the petitioner is physically unable to do so, provided

such consent is signed in the presence of the petitioner and the two witnesses. The standby

guardian shall file the written consent in the office of the clerk who entered the order within 90

days of the date of such written consent, or the standby guardian's authority may be rescinded

by the clerk.

(m) The petitioner may revoke a standby guardianship created under this section by

executing a written revocation, filing it in the office of the clerk who entered the order, and

promptly providing the standby guardian with a copy of the revocation.

(n) A person appointed standby guardian pursuant to this section may at any time

before the commencement of the person's authority renounce the appointment by executing a

written renunciation and filing it with the clerk who entered the order and promptly providing

the petitioner with a copy of the renunciation. Upon the filing of a renunciation, the clerk shall

issue letters of appointment to the alternate standby guardian, if any. (1995, c. 313, s. 1.)

§ 35A-1374. Appointment by written designation; form.

(a) A designator may designate a standby guardian by means of a written designation,

signed by the designator in the presence of two witnesses at least 18 years of age, other than the

standby guardian or alternate standby guardian, who shall also sign the writing. Another person

may sign the written designation on the behalf of and at the direction of the designator if the

designator is physically unable to do so, provided that the designation is signed in the presence

of the designator and the two witnesses.

(b) A designation of a standby guardian shall identify the designator, the minor child,

the person designated to be the standby guardian, and the person designated to be the alternate

standby guardian, if any, and shall indicate that the designator intends for the standby guardian

-5-

or the alternate standby guardian to become the minor child's guardian in the event that the

designator either:

(1) Becomes incapacitated;

(2) Becomes debilitated and consents to the commencement of the standby

guardian's authority;

(3) Dies prior to the commencement of a judicial proceeding to appoint a

guardian of the person or general guardian of a minor child; or

(4) Consents to the commencement of the standby guardian's authority.

same conditions as set forth in G.S. 35A-1373(i) through (l).

(d) The standby guardian or, if the standby guardian is unable or unwilling to serve, the

alternate standby guardian shall commence a proceeding under this Article to be appointed

guardian of the person or general guardian of the minor child by filing a petition with the clerk

of superior court of the county in which the minor child resides or is domiciled at the time of

filing. The petition shall be filed after receipt of either:

(1) A copy of a determination of incapacity made pursuant to G.S. 35A-1375;

(2) A copy of a determination of debilitation made pursuant to G.S. 35A-1375

and a copy of the designator's written consent to such commencement;

(3) A copy of the designator's written consent to such commencement, made

pursuant to G.S. 35A-1373(l); or

(4) Proof of death of the designator, such as a copy of a death certificate or a

funeral home receipt.

(e) The standby guardian shall file a petition pursuant to subsection (d) of this section

within 90 days of the date of the commencement of the standby guardian's authority under this

section, or the standby guardian's authority shall lapse after the expiration of those 90 days, to

recommence only upon filing of the petition.

(f) A petition filed pursuant to subsection (d) of this section shall:

(1) Append the written designation of such person as standby guardian; and

(2) Append a copy of either (i) the determination of incapacity of the designator;

(ii) the determination of debilitation of the designator and the written

consent of the designator; (iii) the designator's consent; or (iv) proof of death

of the designator, such as a copy of a death certificate or a funeral home

receipt; and

(3) If the petition is by a person designated as an alternate standby guardian,

state that the person designated as the standby guardian is unwilling or

unable to act as standby guardian, and the basis for that statement; and

(4) State whether there are any lawsuits, in this State or any other jurisdiction,

involving the minor child and, if so, identify the parties, the case numbers,

and the states and counties where filed; and

(5) Be verified by the standby guardian or alternate standby guardian in front of

a notary public or another person authorized to administer oaths.

(g) A copy of the petition and written notice of the time, date, and place set for a

hearing shall be served upon any biological or adoptive parent of the minor child who is not a

designator, and on any other person the clerk may direct, including the minor child. Service

shall be made pursuant to Rule 4 of the Rules of Civil Procedure, unless the clerk directs

otherwise. When service is made by the sheriff, the sheriff shall make such service without

demanding his fees in advance. Parties may waive their right to notice of the hearing and the

clerk may proceed to consider the petition upon determining that all necessary parties are

before the court and agree to have the petition considered.

(h) If at or before the hearing any parent entitled to notice under subsection (c) of this

section presents to the clerk a written claim for custody of the minor child, the clerk shall stay

-6-

further proceedings under this Article pending the filing of a complaint for custody of the

minor child under Chapter 50 of the General Statutes and, upon the filing of such a complaint,

shall dismiss the petition. If no such complaint is filed within 30 days after the claim is

presented, the clerk shall conduct a hearing and enter an order as provided for in this section.

(i) At the hearing, the clerk shall receive evidence necessary to determine whether the

requirements of this section have been satisfied. The clerk shall enter an order appointing the

standby guardian or alternate standby guardian as guardian of the person or general guardian of

the minor child if the clerk finds that:

(1) The person was duly designated as a standby guardian or alternate standby

guardian;

(2) That (i) there has been a determination of incapacity; (ii) there has been a

determination of debilitation and the designator has consented to the

commencement of the standby guardian's authority; (iii) the designator has

consented to that commencement; or (iv) the designator has died, such

information coming from a document, such as a copy of a death certificate or

a funeral home receipt;

(3) That the best interests of the minor child will be promoted by the

appointment of the person designated as standby guardian or alternate

standby guardian as guardian of the person or general guardian of the minor

child;

(4) That the standby guardian or alternate standby guardian is fit to serve as

guardian of the person or general guardian of the minor child; and

(5) That, if the petition is by a person designated as an alternate standby

guardian, the person designated as standby guardian is unwilling or unable to

serve as standby guardian.

(j) The designator may revoke a standby guardianship created under this section by:

(1) Notifying the standby guardian in writing of the intent to revoke the standby

guardianship prior to the filing of the petition under this section; or

(2) Where the petition has already been filed, by executing a written revocation,

filing it in the office of the clerk with whom the petition was filed, and

promptly providing the standby guardian with a copy of the written

revocation. (1995, c. 313, s. 1.)

§ 35A-1375. Determination of incapacity or debilitation.

(a) If requested by the petitioner, designator, or standby guardian, an attending

physician shall make a determination regarding the incapacity or debilitation of the petitioner

or designator for purposes of this Article.

(b) A determination of incapacity or debilitation shall:

(1) Be made by the attending physician to a reasonable degree of medical

certainty;

(2) Be in writing; and

(3) Contain the attending physician's opinion regarding the cause and nature of

the incapacity or debilitation, as well as its extent and probable duration.

debilitation to the standby guardian, if the standby guardian's identity is known to the

physician.

(d) The standby guardian shall ensure that the petitioner or designator is informed of the

commencement of the standby guardian's authority as a result of a determination of incapacity

or debilitation and of the possibility of a future suspension of the standby guardian's authority

pursuant to G.S. 35A-1376. (1995, c. 313, s. 1.)

-7-

§ 35A-1376. Restoration of capacity or ability; suspension of guardianship.

In the event that the authority of the standby guardian becomes effective upon the receipt of

a determination of incapacity or debilitation and the petitioner or designator is subsequently

restored to capacity or ability to care for the child, the authority of the standby guardian based

on that incapacity or debilitation shall be suspended. The attending physician shall provide a

copy of the determination of restored capacity or ability to the standby guardian, if the identity

of the standby guardian is known to the attending physician. If an order appointing the standby

guardian as guardian of the person or general guardian of the minor child has been entered, the

standby guardian shall, and the petitioner or designator may, file a copy of the determination of

restored capacity or ability in the office of the clerk who entered the order. A determination of

restored capacity or ability shall:

(1) Be made by the attending physician to a reasonable degree of medical

certainty;

(2) Be in writing; and

(3) Contain the attending physician's opinion regarding the cause and nature of

the parent's or legal guardian's restoration to capacity or ability.

Any order appointing the standby guardian as guardian of the person or general guardian of

the minor child shall remain in full force and effect, and the authority of the standby guardian

shall recommence upon the standby guardian's receipt of a subsequent determination of the

petitioner's or designator's incapacity, pursuant to G.S. 35A-1373(j), or upon the standby

guardian's receipt of a subsequent determination of debilitation pursuant to G.S. 35A-1373(k),

or upon the receipt of proof of death of the petitioner or designator, or upon the written consent

of the petitioner or designator, pursuant to G.S. 35A-1373(l). (1995, c. 313, s. 1.)

§ 35A-1377. Authority concurrent to parental rights.

The commencement of the standby guardian's authority pursuant to a determination of

incapacity, determination of debilitation, or written consent shall not itself divest the petitioner

or designator of any parental or guardianship rights, but shall confer upon the standby guardian

concurrent authority with respect to the minor child. (1995, c. 313, s. 1.)

§ 35A-1378. Powers and duties.

A standby guardian designated pursuant to G.S. 35A-1374 and a guardian of the person or

general guardian appointed pursuant to this Article have all of the powers, authority, duties, and

responsibilities of a guardian appointed pursuant to Subchapter II of this Chapter. (1995, c. 313,

s. 1.)

§ 35A-1379. Appointment of guardian ad litem.

(a) The clerk may appoint a volunteer guardian ad litem, if available, to represent the

best interests of the minor child and, where appropriate, express the wishes of the minor child.

(b) The duties of the guardian ad litem, when appointed, shall be to make an

investigation to determine the facts, the needs of the minor child and the available resources

within the family to meet those needs, and to protect and promote the best interests of the minor

child until formally relieved of the responsibility by the clerk.

the fitness of the intended standby guardian and alternate standby guardian, if any, to perform

the duties of standby guardian. (1995, c. 313, s. 1.)

§ 35A-1380. Bond.

The bond requirements of Article 7 of this Chapter shall apply to a guardian of the person

or general guardian appointed pursuant to G.S. 35A-1373 or G.S. 35A-1374, provided that: (i)

the clerk need not require a bond if the bond requirement is waived in writing by the petitioner

-8-

or designator; and (ii) a general guardian appointed pursuant to G.S. 35A-1373 shall not be

required to furnish a bond until a triggering event has occurred. (1995, c. 313, s. 1.)

§ 35A-1381. Accounting.

The accounting requirements of Article 10 of this Chapter apply to a general guardian

appointed pursuant to this Article. (1995, c. 313, s. 1.)

§ 35A-1382. Termination.

Any standby guardianship created under this Article shall continue until the child reaches

18 years of age unless sooner terminated by order of the clerk who entered the order appointing

the standby guardian, by revocation pursuant to this Article, or by renunciation pursuant to this

Article. A standby guardianship shall terminate, and the authority of the standby guardian

designated pursuant to G.S. 35A-1374 or of a guardian of the person or general guardian

appointed pursuant to this Article shall cease, upon the entry of an order of the district court

granting custody of the minor child to any other person. (1995, c. 313, s. 1.)

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STANDBY GUARDIAN CHECKLIST

1. Designation Only:

These steps apply to a situation where the parent is not ready to go through the court process for

appointment of a Standby Guardian but wants to put her wishes in writing.

□ A. First meeting

□ Complete standby guardianship intake form and absent parent

questionnaire

□ If supervising attorney is available to review, have client sign a Written

Designation. Otherwise, prepare Written Designation after first meeting.

□ B. Second meeting

□ Have client sign Written Designation

□ Give client the Written Designation and “Information for Designated

Standby Guardian”

2. By Client=s Petition:

These steps apply when the client wants to go through the court process to have a Standby

Guardian appointed by the Clerk. If after the first meeting the client opts to have the Standby

Guardian follow-through with the court process (e.g. because of client’s poor health), skip to

part 3 of this checklist.

□ A. First meeting

□ Complete standby guardianship intake form and absent parent

questionnaire

□ Possibly have client sign a Written Designation

□ Obtain birth certificates for each child

□ B. Investigation:

□ Interview proposed Standby Guardian and evaluate commitment and

fitness

□ Interview proposed Alternate and evaluate commitment and fitness

□ Conduct other interviews as necessary

□ Follow-up on birth certificates, addresses, etc.

□ C. Get signed at second meeting:

□ Medical Release

□ Petition to Sue as an Indigent

□ Waiver of Bond

□ Written Designation (if not already prepared)

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□ D. Figure out service method (note, you may have to use different methods to serve

different absent parents)

□ certified mail

□ sheriff

□ publication in newspaper

□ no service if absent parent is deceased – in that event obtain death

certificate (see below)

□ E. Call Clerk to schedule hearing

□ Determine dates client, guardian and alternate are available

□ Prepare Notice of Hearing if serving by certified mail or the sheriff

□ Prepare a return of service if serving by the sheriff.

□ Prepare Notice of Service of Process by Publication if serving by

publication in newspaper).

□ F. Send to Clerk for filing: (original + 2 copies)

□ Petition to Appoint Standby Guardian

□ Petition to Sue as an Indigent

□ Estates Action Cover Sheet (not all counties require this)

□ Notice of Hearing (unless service is to be by publication)

□ Stamped envelope addressed to Legal Project

Note: Send all of this with a cover letter itemizing the documents enclosed and asking the

clerk to return the file-stamped copies to you.

□ G. After filed copies are returned by Clerk, serve biological parent with:

□ Petition to Appoint Standby Guardian

□ Notice of Hearing

Note: Discuss method of service with your supervising attorney. We serve most parents

by certified mail or by the sheriff. If address of biological parent cannot be found after a

due and diligent search to find it, the biological parent can be served by publication. This

involves a publication notice in a general circulation newspaper; no Notice of Hearing

need be prepared. Instead, prepare the Notice of Service of Process by Publication and

send it to newspaper.

□ H. Obtain death certificate, if the absent parent is deceased.

Ask the client if she has one; most clerks will accept a copy. If your client does not have

one, you will have to obtain it from the state agency that maintains them. In North

Carolina, it is: NC Vital Records, 1903 Mail Service Center, Raleigh, NC 27699-1903,

(919) 733-3526, Raleigh, NC 27626-0537. The cost is $10. You have to request it in

writing; no faxes or e-mails. See our web resources for link to find death certificates for

other states.

-11-

□ I. Obtain generic physician affidavit, or in cases where the client does not object to

disclosure of his/her illness, a copy of typed medical record showing diagnosis of

HIV/AIDS.

□ J. Prepare proof of service:

□ Sheriff: Make sure you have received Sheriff’s Return of Service

□ Certified mail: Affidavit of Service with return receipts attached. Send to

Clerk for filing or submit at hearing.

□ Publication (See Checklist for Service by Publication):

□ Obtain Affidavit of Service from newspaper.

□ Draft Affidavit of Due Diligence

□ K. Conduct additional investigation as necessary

□ L. Make sure standby guardian and witnesses are available for hearing.

□ M. Prepare Documents for hearing:

□ Student Representative Authorization signed by client

□ Consent to Commencement after Letter Issued (if applicable)

□ Order on Petition for Appointment of Standby Guardian

□ Letters of Appointment

□ Oath

□ Have Waiver of Bond ready.

□ N. Prepare client and witnesses for hearing

-12-

3. By Standby Guardian=s Petition

Note: cases in which the standby guardian is the petitioner tend to fall into two categories. The

Steps listed below will vary somewhat depending on what kind of case you have.

1. New case: We have a new case in which the designating parent and the guardian

have decided (usually with our guidance) that the standby guardian will be the

petitioner. These are often cases in which the designating parent is very sick

and/or where the standby guardian has already assumed primary parenting

responsibilities.

2. Reopened case: We are re-opening a case in which a parent has previously

designated a guardian but did not proceed to a hearing. The parent has typically

become sicker or died.

New Case (designating parent still living):

□ A. First meeting

□ Complete standby guardianship intake form and absent parent

questionnaire

□ Possibly have designating parent sign a Written Designation and Consent

to Commencement of Standby Guardian’s Authority. (In some cases,

either or both documents may be signed at a subsequent meeting.)

□ Possibly have designating parent sign Waiver of Bond

□ Obtain birth certificates for each child

□ Have parent sign Medical Release

□ If appropriate, have custodial parent and standby guardian sign dual

representation agreement

□ B. Investigation:

□ Interview proposed Standby Guardian

□ Interview proposed Alternate

□ Conduct other interviews as necessary

□ Follow-up on birth certificates, addresses, etc.

□ If designating parent is deceased, obtain death certificate

□ C. Get signed at next meeting:

□ Dual representation agreement (if not done already)

□ Medical Release

□ Petition to Sue as an Indigent

□ Waiver of Bond

□ Written Designation (if not already prepared)

□ Consent to Commencement of Standby Guardian’s Authority

-13-

Re-opened Case

□ A. First Meeting: Note: Schedule in time to file Petition within 90 days of Triggering

Event

□ Interview Standby Guardian and update information about children and

absent parent

□ If we don’t have them already, obtain birth certificates for children.

□ Obtain death certificate or other evidence of triggering event.

□ Have client sign Standby Guardian’s Petition for Appointment of Standby

Guardian

□ Have Standby Guardian sign Petition to Sue as an Indigent.

ALL CASES

Within 90 days of Consent or other Triggering Event:

□ A. Investigation:

□ Interview Alternate Standby Guardian

□ Conduct other interviews as necessary, to obtain witnesses, determine

addresses of absent parents

□ Follow-up on birth certificates, death certificate, etc.

□ B. Figure out service method (note, you may have to use different methods to serve

different absent parents)

□ certified mail

□ sheriff

□ publication in newspaper (See Checklist for Service by Publication)

□ no service if absent parent is deceased – in that event obtain death

certificate (see below)

□ C. Call Clerk to schedule hearing

□ Determine dates client, guardian and alternate are available

□ Prepare Notice of Hearing if serving by certified mail or the sheriff

□ Prepare a return of service if serving by the sheriff.

□ Prepare Notice of Service of Process by Publication if serving by

publication in newspaper).

□ D. Send to Clerk for filing: (original + 2 copies)

YOU MUST FILE WITHIN 90 DAYS OF THE TRIGGERING EVENT

□ Standby Guardian=s Petition w/Written Designation and evidence of

triggering event attached (i.e. death certificate or consent).

□ Petition to Sue as an Indigent

□ Estates Action Cover Sheet (not all counties require this)

□ Notice of Hearing (unless service is to be by publication)

-14-

□ Stamped envelope addressed to Legal Project

Note: Send all of this with a cover letter itemizing the documents enclosed and asking the

clerk to return the file-stamped copies to you.

□ E. After filed copies are returned by Clerk, serve absent parent with:

□ Standby Guardian’s Petition (including attachments)

□ Notice of Hearing

Note: Discuss method of service with your supervising attorney. We serve most parents

by certified mail or by the sheriff. If address of biological parent cannot be found after a

due and diligent search to find it, the biological parent can be served by publication. This

involves a publication notice in a general circulation newspaper; no Notice of Hearing

need be prepared. Instead, prepare the Notice of Service of Process by Publication and

send it to newspaper.

□ F. Obtain death certificate, if the absent parent is deceased.

Ask the client if she has one; most clerks will accept a copy. If your client does not have

one, you will have to obtain it from the state agency that maintains them. In North

Carolina, it is: NC Vital Records, 1903 Mail Service Center, Raleigh, NC 27699-1903,

(919) 733-3526, Raleigh, NC 27626-0537. The cost is $10. You have to request it in

writing; no faxes or e-mails. See our web resources for link to find death certificates for

other states.

□ G. Obtain generic physician affidavit, or in cases where the client does not object to

disclosure of his/her illness, a copy of typed medical record showing diagnosis of

HIV/AIDS. If designating parent is deceased, obtain death certificate.

□ H. Prepare proof of service:

□ Sheriff: Make sure you have received Sheriff’s Return of Service

□ Certified mail: Affidavit of Service with return receipts attached. Send to

Clerk for filing or submit at hearing.

□ Publication:

□ Obtain Affidavit of Service from newspaper.

□ Draft Affidavit of Due Diligence

□ I. Conduct additional investigation as necessary

□ J. Make sure standby guardian and witnesses are available for hearing.

-15-

□ K. Prepare Documents for hearing:

□ Student Representative Authorization signed by client

□ Consent to Commencement after Letter Issued (if applicable)

□ Order on Standby Guardian’s Petition for Appointment of Standby

Guardian

□ Letters of Appointment

□ Oath

□ Have Waiver of Bond ready.

□ L. Prepare client and witnesses for hearing

-16-

Checklist of Planning Considerations in Permanency Planning Cases

1. Biological Parent Available?

Paternity established?

2. Termination of Parental Rights.

--loss of right to obtain child support or other benefits through father.

3. Health Care Power of Attorney for Minor

4. General Power of Attorney for Minor

5. Guardianship and Trustee Clauses in Will.

6. Benefits available to minor.

Workfirst

Supplemental Security Income (SSI)

Social Security Disability Income (SSDI)

Food Stamps

VA benefits

Child Support

7. Standby Guardianship

Petition by client

Written Designation and petition by designated guardian

8. Adoption

-17-

Standby Guardianship Intake

INFORMATION ABOUT CLIENT

Name:

Address:

Phone:

Date Of Birth:

Client’s diagnosis:

☐ HIV ☐ Cancer ☐ Other (specify)

date of diagnosis:

Name and location of diagnosing physician:

Name and address of client=s current doctor:

INFORMATION ABOUT MINOR CHILDREN

Child 1 Name:

Nickname

DOB:

SSN:

Grade in school

Domicile (county)

Address, if different from client ☐ same as client

Absent Parent Name

Child’s Income/Assets: ☐ None

Lawsuits: (e.g. child support, custody, personal injury, etc.) ☐ None

Details:

Confirm that client is biological or adoptive parent, or guardian, of child.

☐ Yes ☐ No

If no, explain:

Child 2 Name:

Nickname

DOB:

SSN:

Grade in school

Domicile (county)

Address, if different from client ☐ same as client

Absent Parent Name

Child’s Income/Assets: ☐ None

Lawsuits: (e.g. child support, custody, personal injury, etc.) ☐ None

Details:

Confirm that client is biological or adoptive parent, or guardian, of child.

☐ Yes ☐ No

If no, explain:

-18-

Child 3 Name:

Nickname

DOB:

SSN:

Grade in school

Domicile (county)

Address, if different from client ☐ same as client

Absent Parent Name

Child’s Income/Assets: ☐ None

Lawsuits: (e.g. child support, custody, personal injury, etc.) ☐ None

Details:

Confirm that client is biological or adoptive parent, or guardian, of child.

☐ Yes ☐ No

If no, explain:

Child 4 Name:

Nickname

DOB:

SSN:

Grade in school

Domicile (county)

Address, if different from client ☐ same as client

Absent Parent Name

Child’s Income/Assets: ☐ None

Lawsuits: (e.g. child support, custody, personal injury, etc.) ☐ None

Details:

Confirm that client is biological or adoptive parent, or guardian, of child.

☐ Yes ☐ No

If no, explain:

INFORMATION ABOUT PROPOSED STANDBY GUARDIAN

Name

Address

Telephone:

County

Relationship to Parent

Age

How long has Parent known proposed SBG?

Has parent discussed plan with proposed SBG?

Has proposed SBG agreed to serve?

SBG’s marital status:

□ married □ single □ divorced □ separated

□ widowed

Is SBG a parent? If so, list children & ages

-19-

Name of SBG’s Spouse/Partner:

Is spouse/partner in agreement?

SBG’s living arrangements:

□ owns □ rents □ other

□ house □ apartment □ mobile home

Number of bedrooms: ____________

Who now lives in SBG’s household?

SBG’s source of income

□ Employed □ Social Security □ Pension

□ Spouse/partner □ other (specify)

SBG’s employer:

Work Schedule:

INFORMATION ABOUT PROPOSED ALTERNATE STANDBY GUARDIAN

Name

Address

Telephone:

County:

Relationship to Parent

Age

How long has Parent known proposed alternate?

Has parent discussed plan with proposed alternate?

Has proposed alternate agreed to serve?

Alternate’s marital status:

□ married □ single □ divorced □ separated

□ widowed

Name of alternate’s Spouse/Partner:

Is spouse/partner in agreement?

Is alternate a parent? If so, list children & ages

Alternate’s living arrangements:

□ owns □ rents □ other

□ house □ apartment □ mobile home

Number of bedrooms: ____________

Who now lives in alternate’s household?

Alternate’s source of income

□ Employed □ Social Security □ Pension

□ Spouse/partner □ other (specify)

Alternate’s employer:

Work Schedule:

Space for overflow information:

-20-

1BSBG INTAKE PART II: ABSENT PARENT QUESTIONNAIRE

(add additional sheets if more than one absent parent)

Parent of which child/children?

Absent parent=s full name:

Phone:

Current Address:

If unknown, last known address and possible

leads (e.g. relatives, friends, employment)

Social Security No.

Date of Birth:

2BLegal Relationship

Married to absent parent? Yes_____No_____

If so, when?________________________

Divorced? Yes ______No___________

When & where?_____________________

If divorced, get copy of judgment

Custody:

Has custody or visitation been judicially determined?

yes_____no______

When/where?______________________

If yes, get copy

Child Support:

Is there a child support order? yes____no_____

If yes, get copy

Child Support Payment History:

Other forms of support (gifts, etc.)

Contact between absent parent and child

Visits

how frequent?

where?

length?

supervised or unsupervised?

Telephone calls

how frequent? who initiates? length?

Letters/birthday-holiday cards?

Gifts?

Other involvement with child?

How is the absent parent=s health, if known?

Does client expect absent parent to oppose appointment of guardianship? (Explain)

Client=s feelings about relying on absent parent to care for child if s/he becomes ill, dies?

-21-

  PlanningforYourChildren

Whenyouhavea

SeriousIllness





AGuideto

StandbyGuardianship

inNorthCarolina



WhatisStandbyGuardianship?



StandbyguardianshipisalegalprocedureavailableinNorthCarolinathatallowsparents

withseriouschronicorterminalillnessestodecidewhowilltakecareoftheirchildren

whentheyarenolongerable.



Whoneedsit?



Anyparentwithaseriouschronicorterminalillnesswhowantssomeoneotherthanthe

child’sotherparenttocarefortheirchildcanapplyforastandbyguardianship.



Whatdoesastandbyguardiando?



Onceastandbyguardianisappointedandhasbeengivenlegal authority,thestandby

guardiancandoanyofthethingsthatyou,asaparent,cando,likeenrollyourchildin

school,takehertothedoctor,orpayhermedicalbills.Whileyouarestillable,youcan

dothesethings,too.

Youandthestandbyguardianarebothresponsibleforyourchild.



WhoshouldIchoosetobeastandbyguardian?



Thestandbyguardianshouldbesomeonethatyouandyourchildknowandhaveagood

relationshipwith.He/sheshouldbefinanciallyabletotakecareofyourchild’sbasic

needs,likefood,clothing,shelter,andmedicalcare.Thepersonyouappointasstandby

guardianhastowanttobeaguardianforyo

urchild.For

example,youmayappoint

-22-



yourmother,cousin,orothercloserelativeorfriendasastandbyguardianforyour

child.



Whendoestheguardianstarttocareformychild?



Thelawallowsyoutodecidewhenthestandbyguardianwillbegintocareforyour

child.Theguardianshipcanbeginwhenyouarenolongerabletocareforyourchild

becauseofillnessordeath.Or,itcanbeginwhenyoustateinwritingthatyouwantit

tobegin.



DoIlosemyrightstomychild?



NO!Whenyouappointastandbyguardian,youkeepallthelegalparentalrightsand

responsibilitiesthatyouhadbefore.Theonlydifferenceisthestandbyguardianhasthe

samerightsandresponsibilities,justlikeatwo‐parentfamily.



HowdoIgetastandbyguardianappointed?



Youbegintheprocessbyfilingapaperatthecountycourthousethatasksforthe

appointment.Itisbesttohavealawyerhelpwiththeprocess.TheDukeLegalProject

providesfreelegalservicestosomeparents.Ifyoudon’twanttogothroughthecourt

process,youcansignaformtha

tstates

whoyouwouldwantastheguardian.Thenthe

guardiancanapplylatertobeappointed.



Whendoesthestandbyguar dianshipend?



Thestandbyguardianisnolongerresponsibleforyourchildwhenyourchildturns18,or

whenyoustateinwritingthatyouwantittoend;or,thecourtcandecidetoendthe

guardianship.



Whatifthestandbyguardiancannotordoesnotwanttotakecareofmy

child?



Ifthepersonyouappointasstandbyguardianisunableorunwillingtoserve,he/shewill

nothavetoserve.That’swhyit’simportanttohaveanalternate(back‐up)standby

guardianifpossible.Ifyouknowsomeoneelsewhoisfittocareforyourchildandwho

wantstocarefor

yourchild,youshouldappointanalternatestandbyguardian.The

alternatewillautomaticallyreplacethefirststandbyguardianifhe/sheisunableto

serve.

-23-



WhathappensafterIfileforastandbyguardianship?



First,theotherparentofthechildmustbenotified.AhearingwiththeClerkofCourtis

scheduled.Atthathearing,theClerkofCourtcanappointthestandbyguardianandan

alternate.



Canmychild’sotherparentstopthestandbyguardianship?



Theotherparenthasseveraloptions.Heorshecan:(a)agreetoletyouappointa

standbyguardian,(b)showupatthehearingandstatereasonswhytheguardianshould

notbeappointed,(c)fileforcustody,or(d)donothing.



WhatifIdon’twanttonotifytheotherparent?



Youarerequiredtonotifytheotherparentifyouknowhowtogetintouchwith

him/her.Thisistrueeveniftheotherparentisnotinvolvedinyourchild’slife.The

courtcandecidetodismissyourcaseifitfindsthatyouhadawayofgettingincontact

withtheotherparentanddidnot.Even

ifyouonlyknowanoldworknumberor

perhapsarelative’saddress,youmusttellusifyouhaveawayofgettingincontactwith

theotherparentoryourcasecouldbedismissed.



Whathappensiftheotherparentfilesforcustody?



Theotherparentmustclaimcustodyatorbeforethestandbyguardianshiphearing

takesplace.Iftheotherparentdoesclaimarighttocustody,thecourtwillputyour

caseonholdandgivetheotherparent30daystofileforcustodyofyourchild.Ifa

claimofcu

stodyis

filed,thecourtwillsetadateforacustodyhearingtodecidewhich

parentshouldhavelegalcustody.



Istheotherparentlikelytogetcustody?



Firstofall,theotherparentmustwantcustody.Ifhe/shereallydoesnotwanttohave

custodyofyourchild,he/sheprobablywillnotfileforcustodyofyourchild.Second,the

otherparentmustbefittotakecareofyourchild.Ifyouknowtheotherparenthasnot

been

agoodparent,hasnotpaidchildsupportandhasnotkeptincontactwiththe

child,thecourtmaynotawardcustodytohim/her.Ifthereisproofthattheother

parenthasabusedorneglectedthechild,itmaybeverydifficultforthatparenttoget

custody.



-24-



ShouldIapplyforastandbyguardianshipifIknowtheotherpa rentwill

fileforcustody?



Thisisyourdecision.Youcangoaheadwiththestandbyguardianshipandwaittoseeif

theotherparentwillfightit.Eveniftheotherparentdoesfight,he/shestillhastowina

custodyhearinginordertogetlegalcustodyofyourchild.Anotheroptionmaybetotry

toterminate

theotherparent’srights.Thisisanimportanttopictodiscusswithyour

legalrepresentative.



Whathappensatthestandbyguardianshiphearing?



Atthehearing,thecourtmustdecideifyouhaveaseriouschronicorterminalillness,if

thestandbyguardianshipisinthebestinterestsofyourchild,andifthestandby

guardianis“fit,”orfinancially,physicallyandmentallyabletocareforyourchild.The

guardianshouldbeabletoprovideapositiveandnurturingenvironmentforyourchild.

Thecou

rtwill

decidewhetherornottoappointthestandbyguardian.



DoIhavetodisclosewhatmyillnessis?



No,yousimplymuststatethatyouhavea“progressivelychronicorirreversiblyfatal

illness.”Youarenotrequiredtoidentifytheillness.



WhatifIchangemymindafterthehearing?



Ifyouchangeyourmindatanytimeinthisprocess,youhavetherighttotakebackall

thepowersthatyougavethestandbyguardian.Ifwearerepresentingyou,youshould

notifyusandwewillexplainthatprocess.Youcanthenappointanalternatestandby

guardianifyouchoose.



Formoreinformation:



DukeHealthJusticeClinic

AprogramofDukeLawSchool

919‐613‐7169



-25-

DUKE HEALTH JUSTICE CLINIC

INFORMATION FOR DESIGNATED STANDBY GUARDIAN

The attached document is a ADesignation of Standby Guardian.@ In this document, you

have been chosen to be the standby guardian for certain children after the parent=s death or

during any times of the parent=s life that she or he is unable to handle the responsibilities of

being a parent.

Normally, a parent wishing to have a standby guardian appointed will file papers with

the Clerk of the Court requesting that a standby guardian be appointed and appear at a hearing

with the Clerk. However, some parents become too ill to complete that process. This

ADesignation of Standby Guardian@ allows the process to be completed in the event the parent

cannot complete it herself or himself. If the parent is able to complete the process, this

document will not be used.

This Designation, by itself, does not give you authority to act in the role of a parent to

the children. In order for you to have guardianship authority, several more things must

happen:.

1. Triggering Event: Before you can get authority, one of the following things must

happen. These events are called Atriggering events.@ These events are:

a. the parent=s death, or

b. the parent=s mental incapacity, or

c. the parent=s physical incapacity, or

d. the parent=s consent.

2. Proof of Triggering Event Attached to Designation: Proof of one of the triggering

events must be attached to the Designation. In the event of the parent=s death, a death

certificate must be attached. In the event of either the parent=s mental or physical incapacity, a

written determination of that incapacity made by the parent=s attending physician must be

attached. In the event of the parent=s consent, the written consent must be attached.

3. Papers filed with the Clerk of Superior County Within 90 Days of Triggering Event:,

The papers described above, plus the AStandby Guardian=s Petition for Appointment as

Guardian@ must be filed with the Clerk of Superior Court in the county where the children have

been living within 90 days of the date of one of the triggering events.

4. Hearing With the Clerk of Superior Court: A hearing with the Clerk of the Court must

be scheduled. At the hearing, the Clerk of Court will decide whether to officially appoint you as

the guardian. You should obtain the services of an attorney to assist with this process. The

Duke Health Justice Clinic may be available to assist. Please call us at (919) 613-7169

-26-

Note: During the time between the occurrence of one of the triggering events and the

filing with the Clerk of Court, you have the authority to act in the role of a parent. That

authority is ends if the papers are not filed with the Clerk of the Court within the required 90

days and the Clerk does not officially appoint you as guardian.

If you obtain authority during the parent=s lifetime, the parent continues to have the

authority to exercise parental rights, to the extent she or he is able to do so. Both you and the

parent have parental rights with regard to the children, in the same way two parents have joint

parental rights.

Please let us know if you have any questions.

Health Justice Clinic

Duke Law School

(919) 613-7169

-27-

NORTH CAROLINA

COUNTY OF

AUTHORIZATION TO CONSENT TO HEALTH CARE FOR MINOR

I, , of County, North Carolina, am the custodial parent

having custody of , a minor child, born . I

authorize , of County, North Carolina, to

do any acts which may be necessary or proper to provide for the health care of my minor child,

including, but not limited to, the power (i) to provide for such health care at any hospital or other

institution, or the employing of any physician, dentist, nurse, or other person whose services may

be needed for such health care, and (ii) to consent to and authorize any health care, including

administration of anesthesia, X-ray examination, performance of operations, and other

procedures by physicians, dentists, and other medical personnel except the withholding or

withdrawal of life sustaining procedures.

By signing here, I indicate that I have the understanding and capacity to communicate

health care decisions and that I am fully informed as to the contents of this document and

understand fully the import of this grant of powers to the agents named herein.

This ______ day of ________________, 20_____.

____________________________________

[client’s name]

NORTH CAROLINA

______________________ COUNTY

Sworn to and subscribed before me this _______day of ___________________20____.

_________________________________

NOTARY PUBLIC

My commission expires:_____________

SEAL

-28-

DUKE HEALTH JUSTICE CLINIC

Joint Representation Informed Consent

Duke Health Justice Clinic has agreed to be the lawyer for both [parent name] and [guardian

name]in having [guardian name] become the Standby Guardian of [parent name]’s minor children. This

is called “Joint Representation.” We need to make sure you understand how things work when two

people share a lawyer, and make sure you agree to this.

Goals of Your Legal Case: At this time, you agree that it is best for the children to live with

[guardian] and be under [guardian]’s care. You both want [guardian name] to become the children’s

Standby Guardian. [parent name] supports [guardian name] plan to file a court petition to become

Standby Guardian. [guardian] also supports [parent]’s role as a parent and will consult with [parent] in

making choices for the children, and will help maintain [parent]’s relationship with her children.

Confidentiality: A lawyer must treat all conversations with clients as secret and confidential.

When there are two clients, we keep your information confidential from other people, but we need to be

able to share that information between the clients. This means that because Duke Health Justice Clinic

will be representing both [parent] and [guardian] in the standby guardianship, each of you must allow us

to share what you say with the other person. In other words, we can tell [parent] anything [guardian]

tells us and we can tell [guardian] anything [parent] tells us. However, we will never tell anyone else

anything you tell us unless you give us permission.

Conflicts of Interest: Even though you both now agree about the goals of the case, it is

possible that in the future this may change. You may come to disagree about the standby

guardianship, the custody of the children, or something else we are helping you with. For example,

even though we don’t expect this to happen, [parent] could decide she doesn’t want guardian] to be the

children’s guardian. Or, [guardian] could try to keep [parent] from having any say about the children.

Or you could have a serious disagreement about schooling, discipline, or other things about the

children. If something like this happens, you may disagree about what you want us to do. Or, it may be

impossible for us to follow both of your wishes because you each want different things.

If you have a major disagreement about your case in the future, Duke Health Justice Clinic may

not be able to help either of you, and may have to stop from working with both of you. We hope this

does not happen, but need to make sure you know this before we start work.

Risks and Benefits of Joint Representation: There are risks and benefits to both of you

having the same lawyer. Benefits include convenience, cooperation, and cost savings. Risks include

the chance that after we have worked with you both, you will have a disagreement that could force us to

stop representing either of you. Then you would have to each find your own lawyer, and that may slow

things down or cause other problems. Another risk is that one of you may have a secret you want to

keep from the other. As your joint lawyer, we can’t do this. Since there are risks to having the same

lawyer, you should know that each of you is free to have your own lawyer and not use the Duke Health

Justice Clinic.

Understanding the risks of having one lawyer, you both still agree that Duke Health Justice

Clinic will help you in preparing a Designation of Standby Guardianship, Consent and/or Petition to

Appoint Standby Guardian.

Date:________________________

________________________________ ____________________________________

[parent] [guardian]

-29-

STATE OF NORTH CAROLINA

File No.

(a)

(b)

the biological or adoptive parent of the minor.

the guardian of the person or general guardian of the minor. (NOTE: If this option is checked, treat the petition as a motion

in the cause in the original guardianship.)

The minor resides or is domiciled in this county.

The petitioner is:

Other persons known to have an interest in this proceeding are:

Mother

Father

Name And Address Of Parent

4. The biological or adoptive parent of the minor, who is not the petitioner is:

The petitioner suffers from a progressively chronic illness or an irreversibly fatal illness, in that: (State the basis for this statement,

such as date and source of medical diagnosis; illness in question need not be identified.)

Relationship To Minor Or Interest In Proceeding

Name And AddressName And Address

6. The following is a list of all court proceedings, in any state, involving the minor.

Plaintiff Defendant File No. State, County And Court

The undersigned, being duly sworn, petitions for the appointment of the person(s) named above as standby guardian(s) or alternate

standby guardian(s) of the minor child named above, to serve in the capacity indicated, with authority to become effective upon the death,

incapacity, debilitation with consent or written consent of the petitioner. In support of this Petition, the petitioner states:

PETITION FOR APPOINTMENT OF

STANDBY GUARDIAN

FOR MINOR

County Of Residence Of Petitioner Telephone No.

Name, Street Address, PO Box, City, State And Zip Code Of Proposed Standby

Guardian(s)

County Of Residence Of Petitioner Telephone No. County Of Residence Telephone No.

Name And Street Address, PO Box, City, State And Zip Code Of Petitioner

County Of Residence Of Minor Age Date Of Birth

Social Security No. Of Minor (Last Four Digits)

IN THE MATTER OF:

Name And Address Of Minor

Name, Street Address, PO Box, City, State And Zip Code Of Proposed Alternate

Standby Guardian

(Over)

In The General Court Of Justice

Superior Court Division

Before The Clerk

County

G.S. 35A-1373

AOC-E-209, Rev. 7/06

GUARDIAN OF THE PERSON

GENERAL GUARDIAN

(TYPE OR PRINT IN BLACK INK)

TOTAL

TOTALTOTAL PART I. (base bond on this amount)

Relationship To Minor

Notary

Deputy CSC

Relationship To Minor

Parent

Other

Date

Name(Type Or Print)

Signature

WAIVER OF NOTICE/CONSENT TO GUARDIANSHIP

Each of the undersigned hereby waives notice of a hearing on this Application and consents to the appointment of the

applicant(s) as guardian(s) for the minor to serve in the capacity indicated.

Signature Date

Other

Name Of Applicant (Type Or Print)

A copy of this Application and written notice of the time, date and place set for a hearing, shall be served on any biological or adoptive parent of

the minor who is not a petitioner and who does not sign the waiver and consent above, and any other person the Clerk may direct, including the

minor. Service shall be as provided by Rule 4 of the Rules of Civil Procedure unless the Clerk directs otherwise. G.S. 35A-1373(c).

NOTE:

Clerk Of Superior Court

Assistant CSC

Date Commission Expires

Other

Other resources available for the support of the minor (such as trust income, assets held by a custodian under the Uniform Transfer to

Minors Act and Social Security Payments), which will not be administered by the guardian are:

Other

ASSETS LIABILITIES

INCOME AND RECEIVABLES

Cash And Uncashed Checks On Hand

Bank Deposits

Stocks And Bonds

Rights Of Action For Injury To Minor

Real Property

Other

Other Secured Loans Or Obligations

Mortgage Loans

AOC-E-209, Side Two, Rev. 7/06

SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME

VERIFICATION

I, the undersigned applicant, have read this Application and state that its contents are true to my own knowledge except

those matters stated on information and belief, which I believe to be true.

Signature Of Petitioner

The minor's estimated assets, liabilities, income and receivables: (Complete if standby guardian will become general guardian)

Amount

Description

Obligations Secured By Minor's Property

Description

$ $

SEAL

Title

Signature Of Person Authorized To Administer OathsDate

Date

County Where Notarized

0.00

STATE OF NORTH CAROLINA

COUNTY OF

IN THE MATTER OF:

Child's Name

)

IN THE GENERAL COURT OF JUSTICE

SUPERIOR COURT DIVISION

BEFORE THE CLERK

FILE NO.

AUTHORIZATION OF STUDENT

REPRESENTATION PURSUANT TO

N.C. STATE BAR RULES

SUBCHAPTER C .0200

This is to acknowledge that I, [Client's Name], have been informed that [Student's Name] is a

law student who has completed at least three semesters and is in good standing at Duke

University School of Law. I understand that [Student's Name] is appearing in civil proceedings

in the Courts of the State in accordance with the North Carolina State Bar Rules, Subchapter C,

Rule .0200. I hereby authorize the above-named student to represent me.

___________________________

[Client's Name]

I, [Supervising Attorney], am the supervising attorney of the above-named student, and

hereby approve

her

representation of the above-named client.

_________________________________

Date [Supervising Attorney]

Bar number:

Duke Health Justice Clinic

Duke University School of Law

Box 90360

Durham, NC 27708-0360

-32-

Assistant CSC

Judge

Clerk Of Superior Court

Magistrate (for appeal only)

the petition is denied.

I am presently a recipient of

I am represented by a legal services organization that has as its primary purpose the furnishing of legal services to

indigent persons, or I am represented by private counsel working on behalf of such a legal services organization.

(Attach a letter from your legal services attorney or have your attorney sign the certificate below.)

Although I am not a recipient of food stamps, AFDC, or SSI, nor am I represented by legal services, I am financially

unable to advance the costs of filing this action or appeal.

Aid to Families With Dependent Children (AFDC).food stamps.

Petition To Appeal - As the individual appellant in the above entitled small claims action, I affirm that I am financially

unable to pay the cost for the appeal of this action from small claims to district court. Therefore, I now petition the Court

for an order allowing me to appeal this action to district court as an indigent.

the required costs for the prosecution of this action. Therefore, I now petition the Court for an order allowing me to

bring suit in this action as an indigent.

I am an inmate in the custody of the Division of Adult Correction.

(Note To Clerk: If this block is checked, this Petition must be submitted to a Superior Court Judge for disposition provided on the reverse.)

STATE OF NORTH CAROLINA

CERTIFICATE OF LEGAL SERVICES/PRO BONO REPRESENTATION

ORDER

Supplemental Security Income (SSI).

(Over)

SWORN AND SUBSCRIBED TO BEFORE ME

Signature Signature Of Petitioner

County

VERSUS

AS AN INDIGENT

I certify that the above named petitioner is represented by a legal services organization that has as its primary purpose the

furnishing of legal services to indigent persons or is represented by private counsel working on behalf of or under the

auspices of such legal services organization.

G.S. 1-110; 7A-228

AFFIDAVIT

SEAL

Signature

Based on the Affidavit appearing above, it is ORDERED that:

Signature

NOTE TO CLERK:

If the petitioner is NOT a recipient of food stamps, AFDC, SSI or is NOT represented by legal services or a private attorney on

behalf of legal services, you may ask for additional financial information to determine whether the petitioner is unable to pay the costs.

(check one or more of the boxes below as applicable)

In The General Court Of Justice

District

Superior Court Division

Name Of Plaintiff

Name Of Defendant

Date

Name And Address Of Petitioner (Type Or Print)Title Of Person Authorized To Administer Oaths

Date Commission Expires

Date

Name And Address (Type Or Print)

Date

File No.

unable to advance the required costs to file a motion. Therefore, I now petition the Court for an order allowing me to file

my motion as an indigent.

2012 Administrative Office of the Courts

(check one of the three boxes below)

PETITION TO SUE/APPEAL/FILE MOTIONS

the petitioner is authorized to bring suit, to appeal, or file motions in this action as an indigent.

Petition To Sue - As

a plaintiff in the above entitled action, I affirm that I am financially unable to advance

Petition To File Motions - As

a defendant debtor

in the above entitled action, I affirm that I am financially

AOC-G-106, Rev. 1/12

-33-

Clerk Of Superior CourtAssistant CSCDeputy CSC

the petitioner is authorized to sue in this action as an indigent.

the petitioner is not authorized to sue as an indigent.

the action is dismissed.

is not frivolous.

is frivolous.

The undersigned superior court judge of this district finds that the petitioner is an inmate in the custody of the Division of Adult Correction

and that the complaint

It is ORDERED that

ORDER - DAC INMATES

CERTIFICATION

G.S. 1-110(b) provides: "The Clerk of Superior Court shall serve a copy of the order of dismissal upon the prison inmate."

I certify that this Petition has been served on the party named by depositing a copy in a post-paid properly addressed

envelope in a post office or official depository under the exclusive care and custody of the United States Postal Service.

Signature Of Superior Court Judge

Signature

NOTE:

Name Of Superior Court Judge (Type Or Print)

Date

2012 Administrative Office of the Courts

AOC-G-106, Side Two, Rev. 1/12

-34-

STATE OF NORTH CAROLINA

COUNTY OF

IN THE GENERAL COURT OF JUSTICE

SUPERIOR COURT DIVISION

Before the Clerk

File No.

In the Matter of

[Child's Name]

)

WAIVER OF BOND REQUIREMENT

FOR STANDBY GUARDIAN

I, Designator as designator in the above action, waive the need for a bond to be placed on

designator as designated standby guardian of the person of child's name.

____________________________ __________________________

designator's name Date

I certify that the Designator signed this Waiver of Bond in front of me.

_____________________________ __________________________

Witness Date

-35-

Power Of Attorney (POAT)

Probate, Letters Testamentary - Administration CTA (PROB)

Renunciation Of Interest - Estate (RNIE)

Renunciation of Interest - No Estate (RNUN)

Renunciation Of Testamentary Trustee (RNTT)

Resignation Of Trustee (RSNT)

Removal/Substitution Of Administrator (RRFD)

Removal/Substitution Of Guardian (RRFD)

Removal/Substitution Of Trustee (RSOT)

Standby General Guardianship - Minor (SGUG)

Standby Guardianship Of Person - Minor (SGUP)

Summary Administration (SUMA)

Summary Removal Of Personal Representative

(Without Hearing)

Trust - Cemetery (TCEM)

Trust (TRST)

Trust Under Will - Qualification Required, No Accountings

(TRNQ)

Trust Under Will - Qualification And Accounting Required

(TRUW)

Voluntary Dismissal - With Or Without Prejudice (VOLD)

Will For Probate - No Qualification (WLPR)

Year’s Allowance (YEAL)

Other:

(specify and list each separately)

ESTATES ACTION

COVER SHEET

STATE OF NORTH CAROLINA

File No.

Change of Address

Initial Appearance in Case

Fax No.

Telephone No.

Attorney Bar No.

Name Of Firm

Name, Mailing Address. PO Box, City,State And Zip Of Attorney (complete for initial

appearance or change of address)

APPLICATION

All persons listed below may be entitled to share in the decedent's estate

(Continue on back if necessary.)

1. 4.

2. 5.

3. 6.

(check appropriate box)

Signature Of Attorney/Applicant

Date

Name Of Fiduciary 2

Name Of Fiduciary 1

IN THE MATTER OF THE ESTATE OF:

Rule 5(b), Rules of Practice For Superior and District Courts

Date Of Death

Name Of Decedent/Minor/Incompetent

Date Of Birth, If Minor

All filings in estates shall include as the first page of the filing a cover sheet summarizing the critical elements of the filing in a format prescribed by

the Administrative Office of the Courts, and the Clerk of Superior Court shall require a party to refile a filing which does not include the required

cover sheet. For subsequent filings the filing party must either include an Estates (AOC-E-650), Motion (AOC-CV-752), or Court Action

(AOC-CV-753) cover sheet.

(Over)

In The General Court Of Justice

Superior Court Division

Before The Clerk

County

NOTE:

AOC-E-650, Rev. 1/14

Affidavit For Collection Of Personal Property - Intestate (AFCP)

Affidavit For Collection Of Personal Property - Testate (AFCT)

Amend (AMND)

(see NOTE)

Ancillary Administration (ANCL)

Appointment Of Receiver (APRC)

Assignment Of Title (ASOT)

Attorney Fee (ATFE)

Caveat (CAVT)

Collector (COLL)

Court Costs (COST)

Continue (CNTN)

Dismiss (Involuntary) (DISM)

Emergency Removal Of Guardian (Without Hearing)

Exemplified Administration (EXAD)

Extension Of Time (EXTM)

(see NOTE)

General Guardianship - Incompetent (GUIN)

General Guardianship - Minor (GUMI)

Guardianship Of The Estate - Incompetent (GUEI)

Guardianship Of The Estate - Minor (GUEM)

Guardianship Of The Person (GUPE)

Interim Guardianship (INGU)

Letters Of Administration (LOAD)

Limited Personal Representative (LTPR)

Modify Guardianship (GUMO)

Payments To Clerks 28A-25.6 (PYCL)

Petition To Sue As Indigent (OTHR)

Proceeding Exam To Discover Assets (PEDA)

-36-

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

41.

42.

43.

44.

45.

46.

47.

48.

49.

50.

51.

52.

53.

54.

55.

56.

ADDITIONAL PERSON(S) WHO MAY BE ENTITLED TO SHARE IN DECEDENT'S ESTATE

AOC-E-650, Side Two, Rev. 1/14

-37-

STATE OF NORTH CAROLINA

COUNTY OF

)

DESIGNATION OF

STANDBY GUARDIAN

NOTICE: This Designation of Standby Guardian is made pursuant to N.C.G.S. 35A-1370 et seq. It

may be used by the parent or guardian of a minor child when that parent or guardian has an irreversibly

fatal illness or a progressively chronic illness and wishes to name a standby guardian for his or her

minor children.

Name of Designator

Telephone number of Designator

Address of Designator

Date of Birth of Designator

Name of Minor Child

Telephone Number of Minor Child

Address of Minor Child

Date of Birth of Minor Child

Name of Standby Guardian

Name of Alternate Standby Guardian

Address of Standby Guardian

Address of Alternate Standby Guardian

Telephone Number of Standby Guardian

Telephone Number of Alternate Standby Guardian

Name of Parent who is not the Designator

Address of Parent who is not the Designator

-38-

Statement of Designator:

I, the Designator, state that I have a progressively chronic or irreversibly fatal illness and that I wish

to name a standby guardian for my minor child. It is my intent for the person named as the standby

guardian, or the alternate standby guardian, to become my child’s guardian in the event I either:

1. Become mentally incapacitated;

2. Become debilitated and consent to the commencement of the standby guardian’s authority;

3. Die prior to the commencement of a legal proceeding to appoint the guardian; or

4. Consent to the commencement of the standby guardian’s authority.

Minor’s Finances

Assets: To the best of my knowledge, my minor child has the following assets (i.e., money, stocks,

bonds, property):

Liabilities: To the best of my knowledge, my minor child has the following liabilities (e.g. debts

secured by child’s property):

Sources of Support: To the best of my knowledge, my minor child has the following sources of

support (i.e. trust income, Social Security payments, SSI, child support):

Lawsuits: To the best of my knowledge there are no lawsuits involving my child

Qualifying Illness:

I was diagnosed with my illness by

(doctor or health clinic)

in approximately .

(location) (month and year)

Signature of Designator

___________________________ ______________________________________

Date Signed Designator

WITNESSES

WITNESS #1: I certify that the Designator signed this Designation in front of me and one other

witness, named below, OR that the Designator, being physically unable to sign this Designation, in my

presence, directed another person to sign this Designation on his/her behalf and that person signed

this Designation in front of the Designator, myself, and one other witness, named below.

____________________________________ ____________________________________

PRINT NAME OF WITNESS #1 SIGNATURE OF WITNESS #1

WITNESS #2: I certify that the Designator signed this Designation in front of me and one other

witness, named above, OR that the Designator, being physically unable to sign this Designation, in my

presence, directed another person to sign this Designation on his/her behalf and that person signed

this Designation in front of the Designator, myself, and one other witness, named above.

____________________________________ ____________________________________

PRINT NAME OF WITNESS #2 SIGNATURE OF WITNESS #2

SIGNATURE OF STANDBY GUARDIAN:_________________________________________

-39-

-40-

STATE OF NORTH CAROLINA

COUNTY OF [COUNTY]

IN THE GENERAL COURT OF JUSTICE

SUPERIOR COURT DIVISION

File No.

In the Matter of:

[CHILD'S NAME]

)

NOTICE OF HEARING

TO:

[name and address of person being notified]

Take notice that the petitioner, [Petitioner's Name] has filed a Petition for

Appointment of Standby Guardian of the Person of [Child's Name] in the above-entitled

action. The petitioner will bring this Petition on for hearing before the Clerk of [County]

County, at the [County Name] County Courthouse on [Date of Hearing] at [Time of

Hearing], or as soon afterward as the court can hear the Petition.

This day of , 200 .

Respectfully Submitted,

By:________________________

[Name of Attorney]

Attorney for Petitioner

Duke Health Justice Clinic

Duke University School of Law

P.O. Box 90360

Durham, NC 27708

-41-

RETURN OF SERVICE

I certify that the attached [Papers being served] were received and served as follows:

Date Served:_______________Name of Person Served: [Name of Person Being Served]

_____By delivering to [Name of Person Being Served] a copy of the [Papers being served].

_____By leaving a copy of the [Papers being served] at the dwelling house or usual place of

abode of [[Papers being served] with a person of suitable age and discretion then residing

therein.

Name of person with whom copies left:_______________________________

Address where copies delivered or left:________________________________

_______________________________________________________________

______Service accepted by [Name of person being served].

Date accepted:_____________________ Signature:______________________

_______Other manner of service (specify)______________________________

_______[Name of person being served] was not served for the following

reason:__________________________________________________________

________________________________________________________________

Office Use Only

Name of Sheriff:

Service Fee Paid:

Date Received:

County:

By:

Date of Return:

Deputy Sheriff

Making Return:

-42-

STATE OF NORTH CAROLINA

COUNTY OF ________________

IN THE GENERAL COURT OF JUSTICE

SUPERIOR COURT DIVISION

Before the Clerk

File No: __________

In the Matter of

[Name of child]

)

Affidavit of Service

By Certified Mail

I, [Name of Supervising Attorney], after being duly sworn, depose and say:

1. That I am the attorney for the petitioner in the above-entitled action.

2. That upon information and belief the biological [mother/father], [absent parentname],

resides at [address].

3. That I deposited a copy of the Petition and Notice of Hearing in the above-entitled

action in the post office for mailing by certified mail to the biological [mother/father] at [absent

parent’s address], return receipt requested, dated [date mailed].

4. As evidenced by the attached return receipt, the Petition and Notice of Hearing were

fact received by [absent parent] on [date received].

Date:

Sworn to and subscribed before me

this ____day of _______________, 20____.

___________________________________

Notary Public

My Commission Expires: ______________

____________________________________

[name of Supervising Attorney]

Bar number ____________

Attorney for Petitioner

Duke Health Justice Clinic

Box 90360

Durham, NC 27708-0360

-43-

NOTICE OF SERVICE OF PROCESS BY

PUBLICATION STATE OF NORTH CAROLINA

[County of Action] COUNTY

In the Superior Court, Before the Clerk

In the Matter of: [Child's name]

File No:

To: [Person being served]

Take notice that a pleading seeking relief against you has been filed in the above-entitled action.

The nature of the relief being sought is as follows: The petition seeks the appointment of a

guardian of the person for

You are required to make a defense to this proceeding no later than [Date 40 days from date of

first publication], and upon your failure to do so the party seeking service against you will apply

to the court for the relief sought.

This, the day of , 20 .

[Supervising Attorney Name]

Attorney for [Name of Petitioner]

Duke Health Justice Clinic

Duke University School of Law

Box 90360, Durham, NC 27708-0360

Commented [CS1]: This date should be the date of first

publication.

-44-

STATE OF NORTH CAROLINA

COUNTY OF [COUNTY NAME]

IN THE GENERAL COURT OF JUSTICE

SUPERIOR COURT DIVISION

BEFORE THE CLERK

File No.

In the Matter of

[NAME OF MINOR CHILD]

)

AFFIDAVIT

I, [Name of Affiant], being duly sworn, say as follows:

1. The petitioner herein, [Name of Petitioner], was unable to provide the Duke

Health Justice Clinic with the address, Social Security Number, date of birth, or other

personal information regarding [Name of biological parent], the natural father of [Name

of child].

2. In accordance with Rule 4(j1) of the North Carolina Rules of Civil Procedure, I

served [Name of biological parent] the biological father of the minor herein, by

publication. Notice of service of process by publication was published in the [Name of

publication]on [date of publication].

3. I made the following efforts to locate [Name of biological parent]:

-45-

This _____ day of _________________________, 20____ .

_____________________________

[Supervising Attorney Name]

Attorney for Petitioner

N.C. Bar Number:____________

Duke Health Justice Clinic

Duke university School of Law

Box 90360

Durham, NC 27708-0360

Sworn to and subscribed

Before me on____day of _____________, 20____ .

____________________________________ (SEAL)

Printed name of Notary Public

____________________________________ My commission expires:__________

Signature of Notary Public

-46-

Checklist for Service by Publication

Name of Child(ren)

Name of Absent Parent:

SSN:

Date of Birth:

Driver’s license number

Last Known Address/phone

When did client last have contact with absent parent?

Due Diligence: Please document your efforts to locate the absent parent (use extra pages to

detail efforts if necessary). Please initial each item as the case may extend into another

semester

 Letter(s) sent to possible addresses

o Date sent _______________

o regular mail ________ certified ____________

o Returned? (keep copy in file) yes _______ no ____________

o Other results

 Efforts made to track down absent parent through third parties (client’s friends/family,

absent parent’s family, friends, social workers, etc.) (please record date and contact;

put details in CFW)

 Phone book (or online phone listings) / date ___________/ results

 Reverse look-up of phone number / date ____________ /results

 Real property records / date __________________ / results

-47-

 Criminal Record check / date _______________/results

 Internet search (which search engine? Results)/ date _______________ /results

 Voter registration records / date __________________/results

 Other efforts / date ___________________

Publication (please refer to Rule 4(j) of the NC Rules of Civil Procedure for details)

Name/contact information for legal publisher in county:

On which days of the week does paper publish? _______________________________

Paper’s deadline for publication? _________________ cost _____________________

Notice to be submitted by: fax __________ e-mail_________ other ______________

 Notice prepared_________________ (date)

 Notice submitted to newspaper: _________________ (date)

 Confirmed receipt by newspaper: __________________ (date)

Date of first publication ___________________

 If we have a post office address, copy of notice mailed to absent parent

____________(date)

 Affidavit of service received_______________ (date)

 Bill given to Carolyn

 Affidavit of Due Diligence prepared? ________________ (date)

-48-

STATE OF NORTH CAROLINA

COUNTY OF

)

AFFIDAVIT

I, Dr. [Dr.=s Name], M.D., being duly sworn, say as follows:

1. I am a physician practicing at [Name of medical facility].

2. I have been [Name of client]=s treating physician.

3. I certify that [Name of client] suffers from a progressively chronic or irreversibly fatal

illness.

_________________________________

[Dr.=s name]

Sworn to and subscribed before me

this ______ day of _______________ 200_____

(SEAL)

_______________________________________

Notary Public

My commission expires: __________________

-49-

Standby Guardianship Hearing Guide

Before the Hearing: Paperwork and collecting necessary evidence to prove case:

-notice to absent parent

-qualifying illness

-best interests

-fitness of guardian

-if guardian is petitioner, also need to prove:

-designation by parent

-triggering event

1. Petition filed & hearing scheduled

2. Obtain service of process and PROOF of service

-sheriff

-certified mail

-publication

-waiver of notice by absent parent

-documenting that service not required (eg other parent is deceased)

Whatever the method, we’ll need to provide proof at the hearing that notice was given

or not required. So before the hearing we have to prepare necessary

documentation.

Sometimes the clerk serves the papers and proof of service will already be in the

court file. You’ll need only to verify that service has been accomplished.

Proof of Service:

-sheriff – return of service signed by sheriff

-certified mail – affidavit of service signed by supervising attorney, attaching green

return receipt

-publication – copy of newspaper ad and affidavit of due diligence showing efforts

made to locate the absent parent

-waiver -

3. Documentation of qualifying illness

-Doctor’s affidavit – will be submitted at hearing

-Death certificate – often used in case where parent has died

-50-

4. Determining how you will prove best interest and fitness of guardians – identifying needed

witnesses.

-generally done by testimony of parent, guardian, and alternate

-you’ll need to interview each of these people to gather necessary information

-in some cases, a third party may be needed to bolster best interest/fitness (eg

SBG is not a family member, is an older sibling, or there is some reason to

think the clerk may have reservations about the arrangement

-possible third parties: social workers, case managers, friends, family

5. Preparing witnesses

A. Investigation interview

-call each potential witness and interview (note that guardian and alternate must attend the

hearing and be a witness)

-ask open ended questions about topics that will get at the questions of best interest/fitness.

Your objective is to get a good understanding of the child’s situation, needs,

relationship with the proposed guardian as well as any absent parent, Including:

-guardian’s relationship with the child

-how often do they see each other? Talk on phone?

-involvement with child – what do they do together? Sports? School? Homework?

Doctor visits?

-how they get along, bond with child

-guardian’s ability to care for child

-guardian’s age, health, employment, living situation

-where child would stay, have own room? Bed?

-would child have to change schools?

-any special needs of child? Could guardian handle?

-can guardian get child on health insurance?

-continued involvement of other family members, including absent parent?

-guardian’s track record to date

-what can witness tell us about the absent parent?

-does the witness know the absent parent?

-know anything about absent parent’s fitness? Involvement with the child?

-how often does absent parent see the child?

-child support?

-any safety issues with absent parent?

-when service has been a problem, does the witness know anything about absent

parent’s whereabouts?

-51-

B. Selecting witnesses and preparing them for the hearing

-determine which witnesses will be most helpful

-usually the parent (if living), guardians, and at most one other additional witness

-Draft direct examination for the witness, based on what was learned in the interview:

-The Direct Exam questions should include the FULL ANSWER that you anticipate.

Focus on the ANSWERS rather than the questions.

-basic principals of direct examination:

-generally ask open questions

-in this setting, to move things along, use leading questions for more

mundane information (eg address, relationship to parent, etc)

-first establish relation to the parent, child, and case (eg, witness is the

client’s social worker, mother, etc)

-follow a logical order that touches on the topics on which the witness

has knowledge

-We have many cases with sample questions, but don’t merely copy what was asked in a

previous hearing – it may not fit

-Review the direct exam questions with supervising attorney

-Call the witness back and go through the questions, noting responses, explaining the

purpose of the question if necessary.

-Adjust the questions based on the way the witness answers them.

-Explain to the witness how the hearing will happen, what the order of events will be,

setting, etc.

6. If the absent parent may be at the hearing, prepare a cross examination

7. Preparing documents for the hearing

-Using the protocols, determine which documents are needed for the hearing. Note,

this will depend on whether parent or guardian is petitioner, and whether a petitioning

parent wants to trigger the guardianship by consent. There are different Order

forms, depending on who is petitioner.

-Typically, these documents are prepared:

-Student authorization

-Order

-Oath

-Letters of Appointment

-Consent (if parent is triggering guardianship at hearing)

-Proof of Service

-52-

-Fill the forms out completely, including checking necessary boxes.

-Make sufficient copies –

-generally five copies of Letters and Evidence of Triggering Event

-two copies (original plus one) for other documents

THE HEARING:

1. Attire: interview attire

2. Setting: may be in a small courtroom, conference room, or the clerk’s office.

3. Arrange for your client and all witnesses to be at the hearing at least a half hour before the

hearing.

4. What to bring to the hearing:

-your notes for the hearing (a binder can help you stay organized)

-the case file with all pleadings

-any exhibits/documents you will be submitting during the hearing

-papers to be signed by the clerk at the hearing

-a copy of the SBG statute and any other law that might be relevant (eg Rule 4 of the

rules of civil procedure if there will be a question re service)

4. Your supervising attorney will be present but will try to stay in the background – this is

YOUR show.

5. Stages of the Hearing:

1. Identify yourself to the clerk – name, law student, introduce supervising attorney

2. The clerk may have questions about what kind of case this is, what has happened thus

far, who are the players, whether service has been obtained. Answer any questions.

The clerk may also just immediately turns things over to you. You are the master of

ceremonies.

3. Opening Statement:

-make a brief opening statement.

-What kind of case this is (reference the statute)

-who you represent

-brief overview of the facts, including who the child is, who’s petitioned, who

the absent parent is.

-53-

5. Closing Statement: Make a brief statement reiterating what you have proven and what

you want the clerk to give you.

6. After the clerk issues the favorable order, pass up your prepared Order, etc. You’ll need

to wait around while all the copies are signed, stamped, and distributed.

7. Give the client 4 or 5 copies of the letters of appointment and explain any next steps.

8. PARTY!

-55-

STATE OF NORTH CAROLINA

COUNTY OF

IN THE GENERAL COURT OF JUSTICE

SUPERIOR COURT DIVISION

Before the Clerk

File No.

In the Matter of:

[Child’s name]

)

CONSENT TO COMMENCEMENT OF

STANDBY GUARDIAN’S AUTHORITY

This Consent to Commencement of the Standby Guardian=s Authority is made pursuant

to N.C.G.S. '35A-1373(l).

I, [Petitioner/Designator=s name], as Petitioner in this action, understand that I may

enable my standby guardian to take guardianship of my minor child by written consent to the

commencement of the standby guardian=s authority.

An Order on Petition for Appointment of Standby Guardian for Minor along with Letters

of Appointment of Standby Guardian of the Person were entered in the above-referenced case on

[Date Order entered in SBG case]. .

I understand that my standby guardian=s authority shall commence upon the standby

guardian=s receipt of my written consent to the commencement of the standby guardian=s

authority. It is further my understanding that the named standby guardian must file this AConsent

to Commencement of the Standby Guardian=s Authority,@with the Clerk of Superior Court within

90 days of receiving my consent or the standby guardian=s authority may be rescinded by the

clerk.

Name of Minor Child:

Address of Minor Child:

Telephone Number of Minor Child:

Date of Birth of Minor Child:

Name of Appointed Standby Guardian:

Address of Appointed Standby Guardian:

Telephone Number of Standby Guardian:

-56-

I, [Petitioner/Designator=s name], intend, by this written consent, for my appointed standby

guardian=s authority as standby guardian of the person of my child, [Child=s Name], to commence

effective upon receipt of this written consent by my appointed standby guardian.

Signed, this the __________day of ________________________, 20____ .

_______________________________________

[Petitioner/Designator=s name]

WITNESS #1: I certify that the Petitioner signed this Consent in front of me and one other witness,

named below.

___________________________________________

SIGNATURE OF WITNESS #1

___________________________________________

PRINT NAME OF WITNESS #1

WITNESS #2: I certify that the Petitioner signed this Consent in front of me and one other witness,

named above.

__________________________________________

SIGNATURE OF WITNESS #2

__________________________________________

PRINT NAME OF WITNESS #2

___________________________________________

SIGNATURE OF STANDBY GUARDIAN:

[name of SBG]

-57-

serve without bond.

furnish a bond immediately upon the occurrence of one of the events specified in Paragraph 2 of this Order.

The petitioner is the biological or adoptive parent, or the guardian of the person or general guardian, of the minor

named above.

The petitioner does does not suffer from a progressive chronic illness or an irreversible fatal illness.

The best interests of the minor child will will not be promoted by the appointment of a standby guardian.

Each person named above is fit to serve as standby guardian or alternate standby guardian of the minor.

It is ORDERED that:

STATE OF NORTH CAROLINA

File No.

serve without bond.

furnish a bond immediately upon the occurrence of one of the events specified in Paragraph 2 of this Order.

Of The Person

This matter is before the Court on a petition for the appointment of a standby guardian for the minor named above. This

Court has subject matter jurisdiction over this proceeding and personal jurisdiction over the minor, and this county is a

proper venue. Upon due notice and hearing, or upon waiver of notice and hearing by all parties entitled thereto and upon

their consent, the Court finds from the evidence presented that:

General Guardian

Name And Address Of Alternate Standby Guardian(s)

Assistant CSC

Clerk Of Superior Court

Film No.

the petition is denied.

the alternate standby guardian(s) shall:

In The General Court Of Justice

Superior Court Division

Before The Clerk

County

IN THE MATTER OF:

ORDER ON PETITION

FOR APPOINTMENT OF

STANDBY GUARDIAN

FOR MINOR

G.S. 35A-1373

Signature

AOC-E-409, New 2/96

Date

Name Of Minor

Date Of Application

Name And Address Of Standby Guardian(s)

each person named above is appointed as standby guardian or alternate standby guardian of the minor named

above to serve in the capacity designated; letters of appointment shall be issued to each person named as

standby guardian when that person properly qualifies to serve; and letters of appointment shall be issued to each

person named as alternate standby guardian when that person properly qualifies to serve after showing that all

persons named as standby guardians are unwilling or unable to serve.

the authority of the standby guardian(s) or the alternate standby guardian(s) will commence upon that person's

receipt of any of the following: proof of the death of the petitioner, written determination of the incapacity of the

petitioner, written determination of the debilitation of the petitioner and the petitioner's written consent, or written

consent of the petitioner.

the standby guardian(s) shall:

Name And Address Of Standby Guardian 2 Of The Person

Name And Address Of Standby Guardian 1 Of The Person

Signature

Deputy CSC Assistant CSC Clerk Of Superior Court

File No.

STATE OF NORTH CAROLINA

Clerk Of Superior Court

Name Of Minor

The Court in the exercise of its jurisdiction for the appointment of guardians of minors, and upon proper petition by a

biological or adoptive parent or guardian of the person or general guardian of the minor named above, has appointed the

person(s) named below as Standby Guardian(s) of the Person of the minor named above and has ordered that these

Letters Of Appointment be issued.

These Letters of Appointment are not effective until the standby guardian of the person receives one of the following,

which shall be exhibited along with these letters as evidence of the standby guardian of the person's authority:

Upon receipt of such a writing, the standby guardian of the person is fully authorized and entitled under the laws of

North Carolina to have the custody, care and control of the minor, but has no authority to receive, manage or

administer the property, estate or business affairs of the minor.

The authority of the standby guardian of the person shall cease upon the entry of an order of the district court granting

custody of the minor child to any person.

These Letters are issued to attest to that authority and to certify that it will come into full force and effect as provided

above.

Witness my hand and the Seal of the Superior Court.

AOC-E-412, Rev. 4/11

In The General Court Of Justice

Superior Court Division

Before the Clerk

County

A written determination of the incapacity of the petitioner, or

A written determination of the debilitation of the petitioner and the petitioner's consent to the commencement of the

standby guardian of the person's authority, or

The petitioner's written consent to the commencement of the standby guardian of the person's authority, or

A written determination of the death of the petitioner.

IN THE MATTER OF THE ESTATE OF:

LETTERS OF APPOINTMENT

STANDBY GUARDIAN

OF THE PERSON

G.S. 35A-1373

Date Of Qualification

Date Of Issuance

EX OFFICIO JUDGE OF PROBATE

SEAL

NOTE: This letter is not valid without the official seal of the Clerk of Superior Court.

Name And Address Of Guardian 1 Of The Person

Name And Address Of Guardian 2 Of The Person

Deputy CSC Assistant CSC Clerk Of Superior Court

STATE OF NORTH CAROLINA

File No.

AOC-E-408, Rev. 4/11

Incompetent Person

Minor

Signature

Date Of Issuance

Clerk Of Superior Court

Date Of Qualification

EX OFFICIO JUDGE OF PROBATE

SEAL

The Court in the exercise of its jurisdiction for the appointment of guardians of incompetent persons and minors, and upon

proper application, has appointed the person(s) named below as Guardian(s) of the Person of the ward named above and

has ordered that these Letters Of Appointment be issued.

The guardian of the person is fully authorized and entitled under the laws of North Carolina to have the custody, care and

control of the ward, but has no authority to receive, manage or administer the property, estate or business affairs

of the ward.

These Letters are issued to attest to that authority and to certify that it is now in full force and effect.

Witness my hand and the Seal of the Superior Court.

Name Of Ward

IN THE MATTER OF THE ESTATE OF:

LETTERS OF APPOINTMENT

GUARDIAN OF THE PERSON

G.S. 35A-1203, 35A-1206, 35A-1251

In The General Court Of Justice

Superior Court Division

Before the Clerk

County

NOTE: This letter is not valid without the official seal of the Clerk of Superior Court.

Name And Address Of Standby General Guardian 2

Name And Address Of Standby General Guardian 1 Date Of Qualification

Signature

Date Of Issuance

STATE OF NORTH CAROLINA

File No.

Deputy CSC Assistant CSC Clerk Of Superior Court

Clerk Of Superior Court

EX OFFICIO JUDGE OF PROBATE

Name Of Minor

The Court in the exercise of its jurisdiction for the appointment of guardians of minors, and upon proper petition by a

biological or adoptive parent or guardian of the person or general guardian of the minor named above, has appointed the

person(s) named below as Standby General Guardian(s) of the minor named above and has ordered that these Letters Of

Appointment be issued.

These Letters of Appointment are not effective until the standby general guardian receives one of the following, which

shall be exhibited along with these letters as evidence of the standby general guardian's authority:

Upon receipt of such a writing, the standby general guardian is fully authorized and entitled under the laws of North

Carolina to receive, manage and administer the property, estate and business affairs of the minor and to have the

custody, care and control of the minor.

The authority of the standby general guardian shall cease upon the entry of an order of the district court granting custody

of the minor child to any person.

These Letters are issued to attest to that authority and to certify that it will come into full force and effect as provided

above.

Witness my hand and the Seal of the Superior Court.

In The General Court Of Justice

Superior Court Division

Before the Clerk

County

AOC-E-411, Rev. 4/11

IN THE MATTER OF THE ESTATE OF:

LETTERS OF APPOINTMENT

STANDBY GENERAL GUARDIAN

G.S. 35A-1373

A written determination of the incapacity of the petitioner, or

A written determination of the debilitation of the petitioner and the petitioner's consent to the commencement of the

standby guardian's authority, or

The petitioner's written consent to the commencement of the standby general guardian's authority, or

A written determination of the death of the petitioner.

SEAL

NOTE: This letter is not valid without the official seal of the Clerk of Superior Court.

Signature Of Person Authorized To Administer Oaths Signature Of Person Authorized To Administer Oaths

Deputy CSC Assistant CSC Clerk Of Superior Court

Date My Commission Expires

County Where Notarized

Name Of Fiduciary 2

Signature Of Fiduciary

Date

STATE OF NORTH CAROLINA

File No.

I swear affirm that I will faithfully and honestly discharge the duties reposed in me according to the best of

my skill and ability, and according to law;

so help me, God. and this is my solemn affirmation.

OATH OF ADMINISTRATOR

Name Of Decedent/Minor/Incompetent/Trust

Deputy CSC Assistant CSC Clerk Of Superior Court

Notary

SEAL

AOC-E-400, Rev. 3/07

Notary

Date My Commission Expires

SEAL

County Where Notarized

SWORN

I swear affirm that I believe this paper writing to be and contain the Last Will and Testament of the above

named decedent; and that I will well and truly execute the same by first paying the decedent's debts and then the

decedent's legacies, as far as the said estate shall extend or the law shall charge me; and that I will well and

faithfully execute the office of an administrator cta to the best of my skill and ability and according to the law;

so help me, God. and this is my solemn affirmation.

OATH OF ADMINISTRATOR CTA

OATH OF FIDUCIARY

Name Of Fiduciary 1

Signature Of Fiduciary

Date

AFFIRMED AND SUBSCRIBED TO BEFORE ME

I swear affirm that I believe this paper writing to be and contain the Last Will and Testament of the above

named decedent; and that I will well and truly execute the same by first paying the decedent's debts and then the

decedent's legacies; as far as the said estate shall extend or the law shall charge me; and that I will well and

faithfully execute the office of an executor, agreeably to the trust and confidence reposed in me, and according to

law; so help me, God. and this is my solemn affirmation.

I swear affirm that I believe that the above named decedent died without leaving

any Last Will and

Testament; that I will well and truly administer all and singular the goods and chattels, rights and credits of the

deceased and a true and perfect inventory thereof return according to law; and that all other duties appertaining to

the charge reposed in me, I will well and truly perform, according to law and with my best skill and ability;

so help me, God. and this is my solemn affirmation.

I, the undersigned, do solemnly swear affirm that I will support and maintain the Constitution and laws

of the United States, and the Cons

titution and l

aws of North Carolina not inconsistent therewith; that I will be faithful

and bear true allegiance to the State of North Carolina, and to the constitutional powers and authorities which are or

may be established for the government thereof; and that I will endeavor to support, maintain and defend the

Constitution of said State, not inconsistent with the Constitution of the United States, to the best of my knowledge and

ability; and that I will faithfully discharge the duties of my office as indicated below;

so help me, God. and this is my solemn affirmation.

IN THE MATTER OF THE ESTATE OF:

OATH OF EXECUTOR

(check office below)

Original-File

OATH/AFFIRMATION

In The General Court Of Justice

Superior Court Division

Before The Clerk

County

N.C. Constitution, Art. VI., Sec. 7; G.S.11-7, 11-11; 28A-7-1

SWORN AFFIRMED AND SUBSCRIBED TO BEFORE ME

-62-

[This document was prepared by the Duke Health Justice Clinic, 919-613-7169.]

STATE OF NORTH CAROLINA

COUNTY OF

)

CONSENT TO COMMENCEMENT

OF THE STANDBY GUARDIAN=S

AUTHORITY

This Consent of Commencement of the Standby Guardian=s Authority is made pursuant

to N.C.G.S. 35A-1373(l) and N.C.G.S. 35A-1374(b)(4) and (c).

I, [Designator], as designator of the standby guardianship, understand that I may enable

my standby guardian to take guardianship of my minor child by written consent to the

commencement of the standby guardian=s authority.

I understand that my standby guardian=s authority shall commence upon the standby

guardian=s receipt of my written consent to the commencement of the standby guardian=s

authority. It is further my understanding that the named standby guardian must file the original

ADesignation of Standby Guardian,@ this AConsent to Commencement of the Standby Guardian=s

Authority,@ and the AStandby Guardian=s Petition for Appointment as Guardian of the Person or

General Guardian@ with the Clerk of Superior Court within 90 days of receiving my consent in

order to receive the official Letters of Appointment as standby guardian from the court.

Name of Minor Child:

Address of Minor Child:

Telephone Number of Minor Child:

Date of Birth of Minor Child:

Name of Designated Standby Guardian:

Address of Designated Standby Guardian:

Telephone Number of Designated

Standby Guardian:

-63-

I, [Designator], intend by this written consent of commencement for my designated standby

guardian, [Name of Designated Standby Guardian], to become my minor child=s, [Name of

Minor Child], standby guardian, effective upon receipt of this written consent by my designated

standby guardian.

Signed, this the _______ day of __________________________, 200_____.

____________________________________________

[Name of Designator]

WITNESS #1: I certify that the Designator signed this Consent in front of me and one other

witness, named below.

_____________________________________

SIGNATURE OF WITNESS #1

_____________________________________

PRINT NAME OF WITNESS #1

WITNESS #2: I certify that the Designator signed this Consent in front of me and one other

witness, named above.

_____________________________________

SIGNATURE OF WITNESS #2

_____________________________________

PRINT NAME OF WITNESS #2

_____________________________________

SIGNATURE OF STANDBY GUARDIAN

-64-

STATE OF NORTH CAROLINA

File No.

Mother

Father

(a)

(b)

(c)

(d)

(a)

(b)

Relationship To Minor Or Interest In Proceeding

Name And Address

The biological or adoptive parent of the minor, who is not the designator, is:

Name And Address

Name And Address Of Parent

Other persons know to have an interest in this proceeding are:

The following is a list of all court proceedings, in any state, involving the minor.

Plaintiff Defendant File No.

State, County And Court

The undersigned, being duly sworn, petitions to be appointed guardian of the minor named above, to serve in the capacity indicated, and,

in support of this Petition, the petitioner states:

The minor resides or is domiciled in this county.

The petitioner is the standby guardian or alternate standby guardian named in a written designation executed by:

a determination of the designator's incapacity.

a determination of the designator's debilitation.

the designator's written consent to the commencement of this standby guardianship.

proof of the death of the designator.

(NOTE: Check this option if petitioner is alternate standby guardian.) All persons named in the designation as standby guardians are

unwilling or unable to serve.

the biological or adoptive parent of the minor.

the guardian of the person or general guardian of the minor. (NOTE: If this option is checked, treat the petition as a motion in the

cause in the original guardianship.)

The petitioner has received the following, a copy of which is attached:

AOC-E-210, Rev. 7/06

STANDBY GUARDIAN'S

PETITION FOR APPOINTMENT AS

MINOR

IN THE MATTER OF:

Name And Address Of Minor

Name And Street Address, PO Box, City, State And Zip Of Petitioner(s)

(Over)

County Of Residence Of Minor

County Of Residence Of Petitioner

Social Security No. (Last Four Digits)

G.S. 35A-1374

Age Date Of Birth

GUARDIAN OF THE PERSON

GENERAL GUARDIAN

Telephone No.

In The General Court Of Justice

Superior Court Division

Before The Clerk

County

(TYPE OR PRINT IN BLACK INK)

Name Of Applicant (Type Or Print)

Date Commission Expires

County Where Notarized

TOTALTOTAL PART I. (base bond on this amount)

TOTAL

Other

Other resources available for the support of the minor (such as trust income, assets held by a custodian under the Uniform

Transfer to Minors Act and Social Security Payments), which will not be administered by the guardian are:

Cash And Uncashed Checks On Hand

Bank Deposits

Stocks And Bonds

Rights Of Action For Injury To Minor

Real Property

Other

Signature Of Person Authorized To Administer Oaths

Title

Date

Relationship To Minor

Parent

Relationship To Minor

Name(Type Or Print)

Date

Parent

Other

A copy of this Application and written notice of the time, date and place set for a hearing, shall be served on any biological or adoptive parent of

the minor who is not a petitioner and who does not sign the waiver and consent above, and any other person the Clerk may direct, including the

minor. Service shall be as provided by Rule 4 of the Rules of Civil Procedure unless the Clerk directs otherwise. G.S. 35A-1374(g).

NOTE:

Signature

WAIVER OF NOTICE/CONSENT TO GUARDIANSHIP

Each of the undersigned hereby waives notice of a hearing on this Application and consents to the appointment of the

applicant(s) as guardian(s) for the minor to serve in the capacity indicated.

Signature

Other

Date

Rental Income

Interest And Dividends

AOC-E-210, Side Two, Rev. 7/06

SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME

VERIFICATION

I, the undersigned applicant, have read this Petition and state that its contents are true to my own knowledge except

those matters stated on information and belief, which I believe to be true.

Signature Of Petitioner

The minor's estimated assets, liabilities, income and receivables: (Complete if standby guardian will become general guardian)

Amount

ASSETS LIABILITIES

Description

Obligations Secured By Minor's Property

Description

Other

INCOME AND RECEIVABLES

$ $

Date

Notary

Deputy CSC

Clerk Of Superior Court

Assistant CSC

SEAL

0.00

There has been a written determination of the incapacity of the person who designated the petitioner as

standby guardian.

There has been a written determination of the debilitation of the person who designated the petitioner as

standby guardian and that person has consented to the commencement of the standby guardian's authority.

The person who designated the petitioner as standby guardian has consented in writing to the commencement

of the standby guardian's authority.

The person who designated the petitioner as standby guardian has died.

No triggering event for the commencement of the standby guardian's authority has occurred.

standby guardian of the minor named above.

alternate standby guardian of the minor named above and all persons designated as standby guardians are

unwilling or unable to serve.

Of The Person Of The Person General Guardian General Guardian

each person named above is appointed as guardian of the minor to serve in the capacity designated, and letters of

appointment shall be issued to each such person when that person properly qualifies to serve.

the petition is denied.

Assistant CSC

Clerk Of Superior Court

The best interests of the minor child will will not be promoted by the appointment of each of the petitioner's

as a guardian of the minor.

Each petitioner is fit to serve as a guardian of the minor.

STATE OF NORTH CAROLINA

Signature

The petitioner was duly designated as:

(Check one option.)

In The General Court Of Justice

Superior Court Division

Before The Clerk

County

IN THE MATTER OF:

ORDER ON STANDBY GUARDIAN'S

PETITION FOR APPOINTMENT

AS GUARDIAN OF MINOR

G.S. 35A-1374

It is ORDERED that:

File No.

Film No.

AOC-E-410, New 2/96

1997 Administrative Office of the Courts

This matter is before the Court on an application for the appointment of a guardian for the minor named above. This Court

has subject matter jurisdiction over this proceeding and personal jurisdiction over the minor, and this county is a proper

venue. Upon due notice and hearing, or upon waiver of notice and hearing by all parties entitled thereto and upon their

consent, the Court finds from the evidence presented that:

Name Of Minor

Date Of Application

Name And Address Of Guardian Name And Address Of Guardian

Date

Deputy CSC Assistant CSC Clerk Of Superior Court

STATE OF NORTH CAROLINA

File No.

Name Of Decedent/Incompetent

AOC-E-500, Rev. 1/14

Name Of Resident Process Agent (Type Or Print)

Notary

Date

Date My Commission Expires

Signature Of Personal Representative Or Guardian

Date

Telephone County Of Residence

Name Of Personal Representative Or Guardian (Type Or Print)

I accept this appointment as resident process agent for the above named personal representative or guardian, and

agree to notify the personal representative or guardian of all citations, notices and processes served on me as his

resident process agent.

In The General Court Of Justice

Superior Court Division

Before The Clerk

County

G.S. 28A-4-2(4); 35A-1213(b)

I, the qualified personal representative or guardian of the above named estate, submit to the jurisdiction of the North

Carolina Courts in the above captioned matter, and appoint the resident process agent named below on whom may be

served citations, notices and processes in all actions or proceedings with respect to this estate.

Signature Of Resident Process Agent

Name, Street Address, PO Box, City, State And Zip Code Of Resident Process Agent

SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME

Signature Of Person Authorized To Administer Oaths

Date

SEAL

County Where Notarized

APPOINTMENT OF

RESIDENT PROCESS AGENT

IN THE MATTER OF THE ESTATE OF:

ACCEPTANCE OF APPOINTMENT

-68-

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