South Carolina > Statewide > Probate Court
Petition For Protective Order Or Appointment Of Conservator 540PC - South Carolina
| Petition For Protective Order Or Appointment Of Conservator Form. This is a South Carolina form and can be used in Probate Court Statewide . |
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STATE OF SOUTH CAROLINA COUNTY OF: _____________________________ IN THE MATTER OF: __________________________ ) ) ) ) ) IN THE PROBATE COURT CASE NUMBER: _________________________________ ____________________________________________ Petitioner vs. PETITION FOR: MINOR ADULT PROTECTIVE ORDER APPOINTMENT OF CONSERVATOR ____________________________________________ Respondent(s) Petitioner: ________________________________________________________________________________________ 1. Give your relationship to the alleged incapacitated person, if any, and your interest in this proceeding. 2. Information -- Minor/Allegedly Incapacitated Person Name: Date of Birth: Last Four Digits of Social Security Number: Address: City/State/Zip: Telephone (Home): Age: XXX-XX- (Office/other): DOES DOES DOES NOT have a Will DOES NOT have a Power of Attorney To my knowledge, the above-named To my knowledge, the above-named 3. Venue for this proceeding is proper in this county because the above minor/alleged incapacitated person: resides in this county does not reside in this county but has property in this county 4. The name and address of the above person's guardian, if any, is: 5. Information -- Family (list nearest relative first) of minor/alleged incapacitated person, including dates of birth of minors: Name Date of Birth Address Relationship FORM #540PC (9/11) 62-5-401, 62-5-404, 62-5-407, 62-5-410, 62-5-411, 62-5-412, 62-5-413, 62-5-414 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com (use additional sheet if necessary) 6. The following is a general statement of the property, assets, and income of the above person, together with an estimate of the value thereof: (A full inventory, Form #550PC, shall be completed and filed with the Court within thirty days of appointment.) Description Value 7. The appointment of a conservator for the above person is necessary because (state reasons justifying appointment): 8. I request the appointment of: Name: Address: Telephone (O): Telephone (H): Email: whose priority for appointment as conservator for the above person is as follows: fiduciary appointed or recognized by the appropriate court of any other jurisdiction in which the minor/alleged incapacitated person resides individual or corporation nominated by the minor/alleged incapacitated person (if fourteen or more years of age and deemed mentally capable of making such a choice) attorney-in-fact appointed by protected person (Pursuant to S.C. Code Ann. Section 62-5-501) spouse of protected person adult child of protected person parent of protected person or person nominated by Will of deceased parent other relative of protected person (specify): person nominated by the person who is caring for protected person or paying benefits to him/her nominated by one with priority to serve in his/her stead (specify): other (specify): 9. The following persons are required by statute to be given notice of the time and place of hearing on this Petition: Name Address Relationship FORM #540PC (9/11) Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 10. I request that the Court set a time and place of hearing on this Petition; that the Court determine that the above person is a person for whom appointment of a conservator is proper; that the Court appoint __________ as the conservator for the above minor/incapacitated person; and, that Letters of Conservatorship be issued to the conservator. Executed this ________ day of_______, 20________. Signature: VERIFICATION The undersigned, being sworn, states: That the facts set forth in the foregoing statement are true to the best of the undersigned's knowledge, information and belief. SWORN to before me this , 20 day of Signature: Name: Address: E-mail: Telephone (O): (H): Notary Public for South Carolina My Commission Expires: QUALIFICATION AND STATEMENT OF ACCEPTANCE I accept this appointment and agree to perform the duties and discharge the trust of the office of Conservator of the conservatorship of Executed this _________ day of ___________, 20___________. SWORN to before me this , 20 day of Signature: Name: Address: E-mail: Telephone (O): Telephone (H): Signature: Name: Address: E-mail: Telephone (O): Telephone (H): Signature: Name: Address: E-mail: Telephone (O): Telephone (H): Notary Public for South Carolina My Commission Expires: FORM #540PC (9/11) Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com
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