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STATE OF SOUTH CAROLINA COUNTY OF IN THE MATTER OF CASE NUMBER -GC-

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PROBATE COURT

Petition for Appointment of Successor Custodian under the Uniform Transfer to Minors Act or Uniform Gift to Minors Act (Section 20-7-140, et. seq.) The undersigned affiant, being duly sworn, states that the above referenced minor is in possession of funds which are on deposit at ______________________________ in account number ______________________ which was previously established under the Uniform Gift to Minors Act or the Uniform Transfer to Minors Act, pursuant to Section 20-7-140, et. seq. The current account balance is $________________. The previous custodian, ____________________________, for the above referenced account: Died on _________________(date), and a copy of the death certificate is attached. Became or was adjudicated incapacitated on or about _________________(date), and a copy of the court order, finding of incapacity, or physician's affidavit is attached. The account makes no provision for a successor custodian. The undersigned is related to the minor as: Parent, natural or adoptive Guardian appointed by the family court Legal Representative of Custodian Adult member of minor's family (relation: __________________) The undersigned petitions the court to appoint the affiant as a successor custodian pursuant to Section 20-7-210 (4) (Supp. 2002), and the affiant would affirm that affiant is willing to serve as successor custodian for the account. _______________________________ Name: _______________________________ Address: _______________________________ _______________________________ Phone: _______________________________ Sworn to and Subscribed Before me this
_____ day of ________________, 2004
_________________________ Notary Public for South Carolina
My Commission Expires:_________

FORM 573PC (12/04) 20-7-140, 62-1-302 (c)(6) Supp.1997 Page 1 of 2

ORDER FOR HEARING It is hereby ordered that a hearing in this matter be set for the _____ day of __________________, 200___ at ________ PM/AM. Notice shall be given to the following persons: Name ________________________ ________________________ ________________________ ________________________ ________________________ Address ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ Relation ____________ ____________ ____________ ____________ ____________

___________________________________ Judge of Probate, _____________ County _______ day of __________________, 200___ ______________________, South Carolina

ORDER OF APPOINTMENT The court finds that ________________________ is the proper person to serve as Successor Custodian for account number __________________________ which is on deposit at ______________________________. Accordingly, _____________________ is appointed successor custodian. IT IS SO ORDERED.

___________________________________ Judge of Probate, _____________ County _______ day of __________________, 200___ ______________________, South Carolina

FORM 573PC (12/04) 20-7-140, 62-1-302 (c)(6) Supp.1997

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