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

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Application For Appointment Of Guardian Ad Litem {42} | Pdf Fpdf 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: 2/4/2019

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FORM 42 10/2017 PAGE 1 OF 2 SEND TO: EXECSEC@IC.NC.GOV OFFICE OF THE EXECUTIVE SECRETARY 1236 MAIL SERVICE CENTER RALEIGH, NC 27699-1236 MAIN TELEPHONE: (919) 807-2500 HELPLINE: (800) 688-8349 WEBSITE: HTTP://WWW.IC.NC.GOV FORM 42 North Carolina Industrial Commission IC File # A PPLICATION FOR APPOINTMENT OF GUARDIAN Emp. Code # A D LITEM Carrier Code # The Use of This Form Is Required Under the Provisions of the Workers' Compensation ActEmployer FEIN v. Plaintiff (s) Defendant (s) TO THE NORTH CAROLINA INDUSTRIAL COMMISSION: The undersigned respectfully shows unto the North Carolina Industrial Commission that 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 a g ainst the defendants on account of the followin g matter and thin g s: The undersi g ned is a reputable person closel y connected with the infant or incompetent havin g the relationship with the infant o r incompetent as follows: WHEREFORE, the undersi g ned pra y s 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 Date (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 thatis a fit and proper person to be appointed g uardian ad litem for the infant or incompetent for the pu r pose of brin g in g this action in his or her behalf; IT IS THEREFORE ORDERED that be and ishereby appointed guardian ad litem of to bring this action in his or her behalf. This day of . Commissioner or Deputy Commissioner American LegalNet, Inc. www.FormsWorkFlow.com FORM 42 10/2017 PAGE 2 OF 2 SEND TO: EXECSEC@IC.NC.GOV OFFICE OF THE EXECUTIVE SECRETARY 1236 MAIL SERVICE CENTER RALEIGH, NC 27699-1236 MAIN TELEPHONE: (919) 807-2500 HELPLINE: (800) 688-8349 WEBSITE: HTTP://WWW.IC.NC.GOV FORM 42 PLEASE TYPE OR PRINT: Full name and address of minor or incompetent: Birth date of minor: Full name and address of proposed g uardian 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 o r 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 Clerk222s jurisdiction has the authority to receive funds and disburse them for an incompetent or infant. American LegalNet, Inc. www.FormsWorkFlow.com

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