Application For Appointment Of Guardian Ad Litem {42} | Pdf Fpdf Doc Docx | North Carolina

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Application For Appointment Of Guardian Ad Litem {42} | Pdf Fpdf Doc Docx | North Carolina

Application For Appointment Of Guardian Ad Litem {42}

This is a North Carolina form that can be used for Workers Comp.

Alternate TextLast updated: 3/30/2016

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North Carolina Industrial Commission IC File # APPLICATION FOR APPOINTMENT OF GUARDIAN AD LITEM The Use of This Form Is Required Under the Provisions of the Workers' Compensation Act Emp. Code # Carrier Code # Employer FEIN v. Plaintiff (s) Defendant (s) TO THE NORTH CAROLINA INDUSTRIAL COMMISSION: The undersigned Industrial Commission that respectfully shows unto the North Carolina Is an infant or incompetent without general or testamentary guardian in this State, and that by reason thereof can bring an action only by a guardian ad litem; that the person has a cause of action against the defendants on account of the following matter and things: The undersigned is a reputable person closely connected with the infant or incompetent having the relationship with the infant or incompetent as follows: WHEREFORE, the undersigned prays the Commission that a fit and proper person be appointed Guardian Ad Litem for the infant or incompetent for the purpose of bringing in his behalf an action as above set out. Signature of Applicant (Please complete page 2 of form) ORDER APPOINTING GUARDIAN AD LITEM It appearing to the North Carolina Industrial Commission from the above application that is an infant or incompetent having no general or testamentary guardian within this State and that said infant (or incompetent) appears to have a good cause of action against the defendant(s) ; and it further appearing to the Commission after due inquiry that is a fit and proper person to be appointed guardian ad litem for the infant or incompetent for the purpose of bringing this action in his or her behalf; IT IS THEREFORE ORDERED that hereby appointed guardian ad litem of This day of be and is to bring this action in his or her behalf. . Date Commissioner or Deputy Commissioner SEND TO: FORM 42 02/2016 PAGE 1 OF 2 EXECSEC@IC.NC.GOV OFFICE OF THE EXECUTIVE SECRETARY FORM 42 4333 MAIL SERVICE CENTER RALEIGH, NC 27699-4333 MAIN TELEPHONE: (919) 807-2500 HELPLINE: (800) 688-8349 WEBSITE: HTTP://WWW.IC.NC.GOV American LegalNet, Inc. www.FormsWorkFlow.com PLEASE TYPE OR PRINT: Full name and address of minor or incompetent: Birth date of minor: Full name and address of proposed guardian ad litem: DUTIES OF GUARDIAN AD LITEM In civil actions in North Carolina when any of the parties is an infant or incompetent person, he or she must appear by general or testamentary guardian, if he or she has any within this State, or by guardian ad litem. The guardian ad litem may take such steps as he or she deems appropriate to prosecute the action in behalf of the ward, and may take settlement of the ward's claim, subject to the approval of the Commission. THE GUARDIAN AD LITEM HAS NO AUTHORITY TO RECEIVE OR ACCEPT ANY FUNDS IN BEHALF OF HIS WARD. Only the Clerk of Superior Court or a general guardian appointed under the Clerk's jurisdiction has the authority to receive funds and disburse them for an incompetent or infant. SEND TO: FORM 42 02/2016 PAGE 2 OF 2 EXECSEC@IC.NC.GOV OFFICE OF THE EXECUTIVE SECRETARY FORM 42 4333 MAIL SERVICE CENTER RALEIGH, NC 27699-4333 MAIN TELEPHONE: (919) 807-2500 HELPLINE: (800) 688-8349 WEBSITE: HTTP://WWW.IC.NC.GOV American LegalNet, Inc. www.FormsWorkFlow.com

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