South Carolina Probate Form 540GC

Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory)

Everything you need to know about South Carolina Form 540GC, including helpful tips, fast facts & deadlines, how to fill it out, where to submit it and other related SC probate forms.

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About Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory)

There are all sorts of forms executors, beneficiaries, and probate court clerks have to fill out and correspond with during probate and estate settlement, including affidavits, letters, petitions, summons, orders, and notices.

Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory) is a commonly used form within South Carolina. Here’s an overview of what the form is and means, including a breakdown of the situations when (or why) you may need to use it:

View Form 540GC

SC Form 540GC, which may also referred to as Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory), is a probate form in South Carolina. It is used by executors, personal representatives, trustees, guardians & other related parties during the probate & estate settlement process.

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Atticus Fast Facts About Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory)

Sometimes it’s tough to find a quick summary— here’s the important details you should know about Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory):

  • This form pertains to the State of South Carolina

  • The official South Carolina source for this form is here.

Government forms are not typically updated often, though when they are, it often happens rather quietly. While Atticus works hard to keep this information about ’s Form 540GC - Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory) up to date, certain details can change from time-to-time with little or no communication.

How to file Form 540GC

Step 1 - Download the correct South Carolina form based on the name and ID if applicable

Double check that you have both the correct form name and the correct form ID. Some South Carolina probate forms can look remarkably similar, so it’s best to double, even triple-check that you’re using the right one! Keep in mind that not all States have a standardized Form ID system for their probate forms.

Step 2 - Complete the Document

Fill out all relevant fields in Form 540GC, take a break, and then review. Probate and estate settlement processes in SC are long enough to begin with, and making a silly error can push your timeline even farther back. No thank you!

Note: If you don’t currently know all of the answers and are accessing Form 540GC online, be sure to avoid closing the browser tab and potentially losing all your progress (or use a platform like Atticus to help avoid making mistakes).

Step 3 - Have Form 540GC witnessed or notarized (if required)

Some States and situations require particular forms to be notarized. If you have been instructed to get the document notarized or see it in writing on the document, then make sure to hire a local notary. There are max notary fees in the United States that are defined and set by local law. Take a look at our full guide to notary fees to make sure you aren’t overpaying or getting ripped off.

Step 4 - Submit Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory) to the relevant office

This is most often the local probate court where the decedent (person who passed away) is domiciled (permanently resides) or the institution involved with this particular form (e.g. a bank). Some offices allow you to submit forms online, other’s don’t, and we while we generally recommend going in-person to expedite the process, sometimes that simply isn’t an option.

It’s also a generally good idea to establish a positive working relationship with any probate clerk (unfortunately there’s enough people & process out there making things more difficult and unnecessarily confusing for them), so a best practice is to simply ask the probate clerk proactively exactly how and where they’d prefer you to submit all forms.

Need help getting in touch with a local probate court or identifying a domicile probate jurisdiction?

👉 Find and Contact your Local Probate Court

👉 What is a Domicile Jurisdiction?

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When Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory) is due

Different probate forms or processes can require different deadlines or response times for completing the appropriate form.

While some steps in the process are bound to specific deadlines (like petitioning for probate, having to submit an inventory of assets, or filing applicable notices to creditors and beneficiaries), many probate forms or processes are not tied to a specific deadline since the scope of work can vary based on situational factors or requirements involved.

Either way, there are a bunch of practical reasons why personal representatives should work to complete each step as thoroughly and quickly as possible when completing probate in South Carolina.

5 reasons you should submit 540GC as quickly as possible:

  1. The sooner you begin, the faster South Carolina can allow heirs and beneficiaries to get their share of assets subject to probate. Acting promptly can also decrease the costs & overall mental fatigue through an otherwise burdensome process.

    Helpful Context: What’s the Difference Between Probate and Non-Probate Assets?

  2. In general, creditors of an estate usually have around 3-6 months from the time you file notice to creditors to file any claims for debt against the deceased’s assets. If they don’t, then that debt is forfeited (and more importantly, the executor won’t be held personally responsible). So doing this sooner means you have a better idea of who is owed what and ensures you won’t get a surprise collector months later.

  3. Not filing a will within 30 days (on average) could mean that the probate process proceeds according to intestate laws (laws that govern what happens to someone's stuff without a will) or is subject to unnecessary supervision by the probate court. And if you aren't directly related to the deceased (a.k.a. next of kin), this could also mean you lose your inheritance.

  4. It’s important to file any necessary state tax returns on behalf of the deceased or estate by the following tax season in South Carolina. If you don’t, you could owe penalties and interest. This also includes any necessary federal tax returns such as Forms 1040, 1041, or even a Form 706 estate tax return.

  5. If a house in the State of South Carolina is left empty (or abandoned) for a while, insurance can get dicey. For example, if the house burns down and no one has been there for a year, an insurance company may get out of paying your claim.

If you’re not using Atticus to get specific forms, deadlines, and timelines for South Carolina probate, then try and stay as organized as possible, pay close attention to the dates mentioned in any correspondence you have with the State’s government officials, call the local South Carolina probate clerk or court for exact answers regarding Form 540GC, and when in doubt— consult a qualified trust & estates lawyer for that area.

How to Download, Open, and Edit Form 540GC Online

Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory) is one of the many probate court forms available for download through Atticus.

It may also be available through some South Carolina probate court sites, such as . In order to access the latest version, be updated with any revisions, and get full instructions on how to complete each form, check out the Atticus Probate & Estate Settlement software or consider hiring a qualified legal expert locally within South Carolina.

While Atticus automatically provides the latest forms, be sure to choose the correct version of Form 540GC - Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory) f using any other site or resource in order to avoid having to re-complete the form process and/or make another trip to the South Carolina probate court office.

Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory) is a .pdf, so opening it should be as simple as clicking “View Form” from within the Atticus app or by clicking the appropriate link found on any South Carolina-provided government platform. Once you’ve opened the form, you should be able to directly edit the form before saving or printing.

View Form 540GC

SC Form 540GC, which may also referred to as Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory), is a probate form in South Carolina. It is used by executors, personal representatives, trustees, guardians & other related parties during the probate & estate settlement process.

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Did you know?

  • Form 540GC - Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory) is a probate form in South Carolina.

  • South Carolina has multiple types of probate and the necessary forms depend on the unique aspects of each estate, such as type and value of assets, whether there was a valid will, who is serving as the personal representative or executor, and even whether or not they also live in South Carolina.

  • During probate, all personal representatives and executives in are required to submit a detailed inventory of assets that must separate non-probate assets from probate assets.

  • Probate in South Carolina, especially without guidance, can take years to finish and cost upwards of $14,000.

Frequently Asked Questions about Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory)

Probate is the government’s way of making sure that when a person dies, the right stuff goes to the right people (including the taxes the government wants).

All of that stuff is collectively known as someone’s “estate”, and it’s the job of the executor or personal representative to fill out all the forms and complete all the required steps to formally dissolve the estate. 

To get instant clarity on the entire probate process and get an idea of the steps, timeline, and best practices, read the Atticus Beginner’s Guide to Probate

The best place? Create an account in Atticus to start getting estate-specific advice. 

You may need a lawyer, you may not, and paying for one when you didn’t need it really hurts. Atticus makes sure you make  the best decisions (plus you can write it off as an executor expense).

We’ve also created a list of other probate services. Be sure to check it out!

An executor is named in someone’s will, and if the deceased didn’t have a will, then the spouse or other close family relative usually steps up to fulfill the role. If no one wants to do it, then a judge will appoint someone. 

The executor is responsible for the complete management of the probate process, including major responsibilities such as:

  • Creating an inventory of all probate assets.

  • Filling out all necessary forms

  • Paying off all estate debts and taxes

  • Submitting reports to the court and beneficiaries as requested

And much more. This process often stretches longer than a year. 

For an idea of what separates executors who succeed from those who make this way harder than it should be, visit our article, Executors of an Estate:
What they do & secrets to succeeding
.

The Exact Text on Form 540GC

Here’s the text, verbatim, that is found on South Carolina Form 540GC - Petition For Protective Order And/or Appointment Of Conservator For An Adult (Mandatory). You can use this to get an idea of the context of the form and what type of information is needed.

SCCA401PC (08/2021) STATE OF SOUTH CAROLINA ) ) COUNTY OF __________________________________ ) ) IN THE MATTER OF: ) , ) Decedent Alleged Incapacitated Individual Minor Other: _________________ ) PROBATE COURT USE ONLY ) ) IN THE PROBATE COURT , ) ) ) CASE NUMBER _____-GC-_____- _____ Petitioner(s), ) vs. ) , ) ) SUMMONS Respondent(s).* ) *For Guardianship/Conservatorship matters, you must include the alleged incapacitated individual as a Respondent. TO THE RESPONDENT(S) LISTED ABOVE: YOU ARE HEREBY SUMMONED and required to Answer the Petition in this action, a copy of which is herewith served upon you, and to serve a copy of your Answer upon the Petitioner(s) listed above at the following address(es): Please Type or Print. (Name of Petitioner/Attorney for Petitioner) (Street Address or Mailing Address) (City, State, and Zip Code) Your Answer must be served on the Petitioner at the above address within thirty (30) days after the service of this Summons and Petition upon you, exclusive of the day of such service; and if you fail to answer the Petition within that time, judgment by default will be rendered against you for the relief demanded in the Petition. ____________________________________________ Signature of Petitioner(s)/Attorney for Petitioner(s) Date: __________________________ FORM #540GC (08/2021) 62-5-401, 62-5-404, 62-5-405, 62-5-407, 62-5-410, 62-5-411,62-5-412, 62-5-413, 62-5-414. 23-31-1040D Page 2 of 8 INSTRUCTION SHEET FOR FORM #540GC PETITION FOR FINDING OF INCAPACITY, PROTECTIVE PROCEEDING, APPOINTMENT OF CONSERVATOR FOR AN ADULT This petition is intended to be used when a petitioner is seeking the appointment of a Conservator for an alleged incapacitated individual (A.I.I.). It can also be used when a petitioner seeks to have an A.I.I. found to be incapacitated for one of the other reasons stated below. The following actions may be requested with the filing of the attached petition: • FINDING OF INCAPACITY • The Petitioner may seek to have the A.I.I. found to be an incapacitated for the purpose of appointing a Conservator or the issuance of another protective order. Incapacity is determined by the court based on a medical examination and report and other relevant evidence. Generally, if there is no finding of incapacity, the court will not be able to proceed with any other action regarding the person who is alleged to be incapacitated. • A finding of incapacity may be made by the court because of the A.I.I.’s inability to meet the essential requirements for his or her physical health, safety, or self-care and/or the inability to manage his or her property or financial affairs or provide for his or her support or for that of his or her legal dependents. This could be because of allegations of incapacity that are based on, but not limited to, mental illness, significant intellectual disability, physical illness or disability, brain injury, a cognitive impairment such as dementia, chronic use of and/or addiction to illicit or prescription drugs, or chronic intoxication and/or addiction to alcohol. The presence of one or more of these conditions does not automatically prove incapacity, but it may be what prompts the filing of the petition. • If authority is needed to manage financial affairs and/or assets, please read below for available options and check the appropriate box(es) in the Petition: • APPOINTMENT OF CONSERVATOR (including appointment on an EMERGENCY or TEMPORARY basis; see Forms 512GC and 513GC) - Can be used to request permanent appointment of an individual or professional fiduciary and, if needed, appointment of a Conservator on a temporary basis before the permanent appointment can be made. • PROTECTIVE ORDER - Can be used to establish incapacity, assist in establishing a Special Needs Trust, or to ratify (confirm) a durable power of attorney for business and/or financial affairs. • APPOINTMENT OF SPECIAL CONSERVATOR - Can be used to request appointment of an individual or professional fiduciary to complete specific tasks within a specific period of time. • APPOINTMENT OF SUCCESSOR CONSERVATOR - Can be used to request appointment of a successor to the previously appointed permanent Conservator. • EFFECT OF EXISTING POWER OF ATTORNEY (POA) FOR FINANCES AND BUSINESS AFFAIRS - An existing, valid Durable General POA creates the presumption that there is a “support and assistance” (see Section 62-5-101(23)) that would eliminate the need for a conservatorship. If the petitioner wants to have the court confirm or ratify the POA, he or she may request a protective order. Otherwise, the Petitioner must show by clear and convincing evidence why that document is not valid, is not sufficient to meet the needs of the A.I.I., or present other issues that would support voiding that document, if the appointment of a conservator is requested. • RIGHTS AND POWERS OF THE ALLEGED INCAPACITATED INDIVIDUAL • S.C. Code Ann. § 62-5-403(B)(7) requires the petitioner to indicate in the petition what rights the Court is being asked to remove from the A.I.I. For protective proceedings, those rights are stated in S.C. Code Ann. § 62-5- 407(B). The burden of proof will be on the petitioner to show why certain rights should be removed. Rights not asked to be removed or not stated as being removed in the court order will be retained. • If the A.I.I. is found to be incapacitated based on mental illness, “mental deficiency,” “mental defect,” or an impairment other than solely a physical impairment or disability, the court is required to report the name of the incapacitated individual to the S.C State Law Enforcement Division (SLED), pursuant to S.C. Code Ann. § 23-31- 1020. He or she will not be allowed to purchase, possess, or have access to firearms or ammunition, pursuant to S.C. Code Ann. § 23-31-1040(A). FORM #540GC (08/2021) 62-5-401, 62-5-404, 62-5-405, 62-5-407, 62-5-410, 62-5-411,62-5-412, 62-5-413, 62-5-414. 23-31-1040D Page 3 of 8 STATE OF SOUTH CAROLINA ) ) COUNTY OF ________________________ ) ) IN THE MATTER OF: ) ___________________________________, ) an alleged incapacitated individual. ) PROBATE COURT USE ONLY ) ) IN THE PROBATE COURT ___________________________________, ) ) ) Petitioner(s), ) CASE NUMBER _____-GC-______- ________ vs. ) ) ___________________________________, ) ) Respondent(s).* ) *You must include the alleged incapacitated individual (A.I.I.) as a Respondent. PETITION FOR (check all that apply): FINDING OF INCAPACITY PROTECTIVE ORDER APPOINTMENT OF: CONSERVATOR(S) SPECIAL CONSERVATOR(S) SUCCESOR CONSERVATOR TEMPORARY CONSERVATOR (on Emergency or Temporary Basis) or LIMITED CONSERVATOR 1. Information about Petitioner(s): Petitioner(s): __________________________________________________________________________________ Address(es): __________________________________________________________________________________ Telephone (preferred): ________________________ Telephone (secondary): _______________________________ Email: __________________________________________________________________________________________ Relationship to A.I.I. or proceeding: _______________________________________________________________ 2. Information about A.I.I.: A.I.I. Full Legal Name (include all known names): __________________________________________________ Date of Birth: _________________________ Last 4 digits of Social Security #: XXX-XX-_________________ Address: _______________________________________________________________________________________ This address is a: Private Home Facility Other (specify): __________________________________ Telephone (preferred): ________________________ Telephone (secondary): _______________________________ Email: _________________________________________________________________________________________ Hair Color: ___________________ Eye Color: ___________________________________________ Height: _________________________ Weight: ____________________________________________ 3. Existing legal documents and/or legal appointments relating to the A.I.I. To my knowledge, the A.I.I: Does have Does not have a Will Does have Does not have a general Durable Power of Attorney (POA) Does have Does not have a Health Care POA Does have Does not have a Living Will Does have Does not have a Guardian Does have Does not have a Conservator or Trustee FORM #540GC (08/2021) 62-5-401, 62-5-404, 62-5-405, 62-5-407, 62-5-410, 62-5-411,62-5-412, 62-5-413, 62-5-414. 23-31-1040D Page 4 of 8 If the A.I.I. does have any of the above-named documents, copies must be provided with this Petition or an explanation provided as to why the document is not available. The Petitioner has the burden of showing why a conservatorship is needed if the A.I.I. has a Durable General POA. 4. Jurisdiction: The A.I.I. has been physically present in South Carolina for the six (6) month period immediately preceding the filing of this petition or for at least six (6) consecutive months ending within the six (6) month period immediately preceding the filing of this petition. If the A.I.I. has not been physically present in South Carolina for the period of time described above, explain what connections the A.I.I. has to South Carolina. Please refer to S.C. Code Ann. §§ 62-5-700 through 62-5-711. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 5. Venue (check all that apply): Venue for this proceeding is proper in this county because the A.I.I.: resides in this county and has resided in this county for more than six (6) months; resides in this county (this is his/her county of residence); is physically present in this county at this time; does not reside in this state but owns real or personal property in this county; or does not reside in this state but has the right to take legal action in this county (a copy of the pleadings will be required). If the A.I.I. has not resided in this county for the six (6) months preceding this action, state the address where the A.I.I. did reside or is currently residing: _____________________________________________________________________________________________ _____________________________________________________________________________________________ 6. Information about family of the A.I.I. – You must provide information about the spouse and any children of the A.I.I.; if there is no spouse or adult children, then list his/her parents. If no parents are living, then list the closest adult relative(s). Spouse**: Address: Year of Birth: **If deceased, a certified death certificate is required. Children of A.I.I.: Full Legal Name Year of Birth Full Address See attached for additional children (check if applicable). FORM #540GC (08/2021) 62-5-401, 62-5-404, 62-5-405, 62-5-407, 62-5-410, 62-5-411,62-5-412, 62-5-413, 62-5-414. 23-31-1040D Page 5 of 8 (IF REQUIRED) Living Parents of A.I.I.: Full Legal Name Year of Birth Full Address (IF REQUIRED) Closest Living Adult Relative(s) of A.I.I. – use additional paper if needed: Name: Address: Relationship to A.I.I.: 7. Information about any other interested parties such as a Guardian, Conservator, Trustee, representative payee, agent under a general durable power of attorney, or a health care agent under a health care power of attorney. Name Relation to A.I.I. Full Address 8. Rights and Powers of the A.I.I. (See S.C. Code Ann. § 62-5-407(B)): (If you are the A.I.I. in this matter, you should be prepared to defend the assertion that any of the following rights should be removed; however, the burden is on the Petitioner to show why.) Do you believe the A.I.I. should retain the following rights to: A. Buy, sell, or transfer real property? YES NO B. Buy, sell, or transfer personal property? YES NO C. Make, modify, or terminate contracts? YES NO D. Make significant purchases? YES NO E. Transact business of any type? YES NO F. Bring or defend a lawsuit? YES NO G. Pay his or her bills? YES NO H. Make gifts? YES NO I. Vote? YES NO If you answered NO to any of the above-listed rights, please explain: _____________________________________________________________________________________________ _____________________________________________________________________________________________ 9. Any other rights and powers not specifically stated here that the Court should address: _____________________________________________________________________________________________ _____________________________________________________________________________________________ 10. Please note any of the rights in Question 8 you believe should be given to the Conservator (vested in the Conservator) to exercise on behalf of the incapacitated person. (Some rights, such as voting, cannot be given to a Conservator.): _____________________________________________________________________________________________ _____________________________________________________________________________________________ FORM #540GC (08/2021) 62-5-401, 62-5-404, 62-5-405, 62-5-407, 62-5-410, 62-5-411,62-5-412, 62-5-413, 62-5-414. 23-31-1040D Page 6 of 8 11. AUTHORITY TO MANAGE FINANCIAL AFFAIRS OF THE A.I.I.: A. Why do you believe the A.I.I. needs a Conservator or protective order? Provide a brief description of the nature and extent of the alleged incapacity. (See S.C. Code Ann. § 62-5-403(B)(6)). __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ B. Is there a less restrictive alternative? If so, please explain. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ C. In what ways is the A.I.I. able to provide for health, education, maintenance, and support for himself/herself and his or her dependents? __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ D. Is any type of emergency or temporary proceeding needed to protect the funds, assets, or business affairs of the A.I.I.? (If seeking emergency or temporary relief, use Forms #512GC or #513GC.) No. Yes. If yes, please explain: __________________________________________________________________________________________ __________________________________________________________________________________________ E. Has the A.I.I. been rated incapable of handling his estate and monies after examination by the Department of Veterans Affairs (VA)? (See S.C. Code Ann. § 62-5-403(B)(9)). No. Yes. If yes, please explain: _____________________________________________________________________________________________ __________________________________________________________________________________________ F. The following is a list of the real and personal property owned by the A.I.I., business affairs of the A.I.I., funds available to the A.I.I., or legal action necessary for the benefit of the A.I.I. and an estimate of the value: (An Inventory & Appraisement, Form #550GC, shall be filed with the Court within thirty (30) days of the date of appointment.) Description Value G. I request the appointment of (if someone other than Petitioner): Name: Address: Preferred Phone: Email: Relationship to A.I.I.: FORM #540GC (08/2021) 62-5-401, 62-5-404, 62-5-405, 62-5-407, 62-5-410, 62-5-411,62-5-412, 62-5-413, 62-5-414. 23-31-1040D Page 7 of 8 H. Priority for the requested appointee(s) (either the Petitioner(s) or person(s) named in 11G., above) is: Previously appointed Conservator, Guardian of property, or Guardian of assets appointed by a court of another county or state; Individual nominated by the A.I.I., who is deemed mentally capable of making such choice; Agent designated in power of attorney relating to the management of A.I.I’s property, financial affairs, or assets; Spouse of A.I.I.; Adult Child of A.I.I.; Parent of A.I.I.; Closest adult relative (specify relationship): ________________________________________________; Person with whom the A.I.I. resides (specify relationship): _____________________________________; Nominee of any of the above (specify who made nomination): _________________________________; or Other (specify): ______________________________________________________________________ I. Does the proposed Conservator plan on receiving any fees for serving as Conservator? No. Yes. If yes, indicate the hourly rate or desired compensation amount: $ _______________________ Occupation of proposed Conservator: ___________________________________________________________ VERIFICATION The Petitioner, being sworn, states: That the facts set forth in the foregoing Petition are true to the best of the Petitioner’s knowledge, information, and belief. SWORN to me this day of , 20___ Signature of Petitioner: _________________________ Print Name: _________________________ Signature: _________________________________ Address: _________________________ Printed Name of Notary: ______________________ _________________________ Preferred Telephone: _________________________ Notary Public for State of: _____________________ Secondary Telephone: _________________________ My commission expires: ______________________ Email: _________________________ SWORN to me this day of , 20___ Signature of Co-Petitioner: _________________________ Print Name: _________________________ Signature: _________________________________ Address: _________________________ Printed Name of Notary: ______________________ _________________________ Preferred Telephone: _________________________ Notary Public for State of: _____________________ Secondary Telephone: _________________________ My commission expires: ______________________ Email: _________________________ This section is to be signed by the individual(s) nominated to serve in one of the roles listed below. QUALIFICATION AND STATEMENT OF ACCEPTANCE I agree to serve as appointed and to perform the duties and discharge the trust of the office of (check the applicable choices): Conservator(s) Special Conservator(s) Successor Conservator(s) Temporary Conservator(s) Limited Conservator(s). Executed this day of , 20 . Signature: _________________________________ Signature: _________________________________ Printed Name: Printed Name: FORM #524GC (01/2019) 62-5-303A, 62-5-303B, 62-5-403A, 62-5-403B STATE OF SOUTH CAROLINA ) ) COUNTY OF __________________________ ) ) IN THE MATTER OF: ) _____________________________________, ) an alleged incapacitated individual. ) PROBATE COURT USE ONLY ) ) IN THE PROBATE COURT _____________________________________, ) CASE NUMBER _____-GC-_____-_____ Petitioner(s), ) vs. ) NOTICE OF RIGHT TO COUNSEL _____________________________________, ) Respondent(s). ) You, the alleged incapacitated individual, have the right to choose your own attorney to represent you in the above matter. If a notice of appearance by your own attorney has not been received by the Court within fifteen (15) days from the filing of the proof of service in this matter, the court will appoint an attorney for you. Executed this day of , 20 . Signature: Print Name: Address: Preferred Telephone: Secondary Telephone: Email: Attorney Signature: Print Name: Firm Name: Bar Number: Address: Telephone: Email: Attorney for: Note: This form must be served on the Alleged Incapacitated Individual, along with your Summons and Petition.

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