Petition For Protective Order/appointment Of Conservator - State Of South Carolina Probate Court Page 3
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310.
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
day of
Signature:
, 20
Name:
Address:
Notary Public for South Carolina
E-mail:
My Commission Expires:
Telephone (O):
(H):
Signature:
Name:
Address:
E-mail:
Telephone (O):
(H):
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
day of
Signature:
, 20
Name:
Address:
Notary Public for South Carolina
E-mail:
My Commission Expires:
Telephone (O):
Telephone (H):
Signature:
Name:
Address:
E-mail:
Telephone (O):
Telephone (H):
FORM #540PC (4/13)
Page 3 of 3
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