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 # T- __________

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 or Deputy Commissioner ____________________

 

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.

 

SEND TO:

dockets@ic.nc.gov

Office of the Clerk

1236 Mail Service Center

Raleigh, NC 27699-1236

Main telephone: (919) 807-2500

Helpline (800) 688-8349

Website: http://www.ic.nc.gov

 

FORM T-42

 

(b) A copy of the form described in Paragraph (a) of this Rule can be accessed at http://www.ic.nc.gov/formt42.pdf. The form shall be reproduced only in the format available at http://www.ic.nc.ogv/forms/formt42.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.