11 NCAC 23L .0105 Form T-42 – Application for Appointment of Guardian Ad Litem
(a) Persons seeking to appear on behalf of an infant or incompetent shall apply on a Form T-42, Application for Appointment of Guardian Ad Litem, in accordance with Rule 11 NCAC 23B .0203. The Form T-42, Application for Appointment of Guardian Ad Litem, shall read as follows:
North Carolina Industrial Commission
IC File # TA- __________
Application for Appointment of Guardian Ad Litem
The use of this Form is required under Rule 11 NCAC 23B .0203
___________ Plaintiff(s) v. _________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 infant or incompetent 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 on his or her 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 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 on his or her behalf;
It is therefore ordered that ____________________ be and is hereby appointed guardian ad litem of ____________________ to bring action on his or her behalf.
This __________ day of ____________________.
Commissioner, Deputy Commissioner, or Executive Secretary ______________________________________________________________________
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:
Important Information for Parties
Parties should take notice of the provisions set forth in Rule 11 NCAC 23B .0203.
11 NCAC 23B .0203 Infants and Incompetents
(a) Persons seeking to appear on behalf of an infant or incompetent, in accordance with G.S. 1A-1, Rule 17, shall apply on a Form T-42 Application for Appointment of Guardian ad Litem. The Commission shall appoint a fit and proper person as guardian ad litem, if the Commission determines it to be in the best interest of the minor or incompetent. The Commission shall appoint the guardian ad litem only after due inquiry as to the fitness of the person to be appointed.
(b) The Commission may assess a fee to be paid to an attorney who serves as a guardian ad litem for actual services rendered upon receipt of an affidavit of actual time spent in representation of the minor or incompetent as part of the costs.
ATTORNEYS: File via Electronic Document Filing Portal (“EDFP”)
UNREPRESENTED PLAINTIFFS: File via EDFP, https://www.ic.nc.gov/docfiling.html OR
Mail to: Industrial Commission Clerk’s Office, 1236 Mail Service Center, Raleigh NC 27699-1236 OR
File via hand delivery: Business days from 8 a.m. – 5 p.m., Dobbs Building, 6th floor, 430 N. Salisbury Street,
Raleigh NC 27603 OR Fax to (919) 715-0282 OR Email to firstname.lastname@example.org.
(b) A copy of the form described in Paragraph (a) of this Rule can be accessed at https://www.ic.nc.gov/forms/formt-42.pdf. The form shall be reproduced only in the format available at https://www.ic.nc.gov/forms/formt-42.pdf and shall not be altered or amended in any way.
History Note: Authority G.S. 143-291; 143-295; 143-300;
Eff. March 1, 2019;
Amended Eff. March 1, 2021.