AOC-SP-200, Petition for Adjudication of Incompetence and Application for Appointment of Guardian or Limited Guardian Instructions

Enter the total dollar value of the respondent's real property (land and buildings) as an amount.

Enter the total dollar value of the respondent's tangible personal property (vehicles, furniture, equipment, etc.) as an amount.

Enter the total dollar value of the respondent's other personal property (collections, jewelry, investments not listed elsewhere, etc.) as an amount.

Enter the attorney's full name (and law firm name if applicable) who is representing the petitioner.

Enter the attorney's primary street address or P.O. box for mailing.

Enter additional address information such as apartment, suite, unit number, or other secondary address details.

Enter the city for the attorney's mailing address.

Enter the state for the attorney's address (commonly the two-letter state abbreviation).

Enter the ZIP or postal code for the attorney's mailing address.

Enter the attorney's primary telephone number for contact, including area code.

Enter the attorney's state bar number as issued by the licensing authority.

Check this box when the respondent understands/participates in conversations, can read and write, and demonstrates functional language and communication ability for the listed tasks. Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive' is 'No'.

Check this box when the respondent does not understand/participate in conversations, cannot read and write, or otherwise lacks the language and communication ability described. Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive' is 'No'.

Enter a brief narrative comment describing the respondent’s ability to understand and participate in conversations, read and write, and understand simple signs or words (for example, specific examples of retained or lacking communication skills). Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive', 'A. Language and Communication — lacks capacity' 61 is 'No' and 63 is 'Yes' (all).

Enter any additional notes or clarifying information about the respondent’s language and communication capacity, such as frequency, context, or examples that support the assessment above. Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive', 'A. Language and Communication — lacks capacity' 61 is 'No' and 63 is 'Yes' (all).

Check this box when the respondent makes independent decisions about eating, prepares or purchases food, and demonstrates capacity for nutrition-related tasks. Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive' is 'No'.

Check this box when the respondent cannot independently make decisions or perform tasks related to eating, preparing food, or purchasing food. Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive' is 'No'.

Enter a brief comment about the respondent’s nutrition capacity (e.g., a short note about ability to eat, prepare or purchase food) to explain the selected capacity box. Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive', 'B. Nutrition - lacks capacity' 61 is 'No' and 67 is 'Yes' (all).

Enter a more detailed explanation of the respondent’s nutrition abilities and limitations, including examples or observations about eating, food preparation, or food procurement as needed. Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive', 'B. Nutrition - lacks capacity' 61 is 'No' and 67 is 'Yes' (all).

Check this box if the respondent is able to bathe, brush their teeth, and use proper hygiene when using the restroom independently (i.e., demonstrates adequate personal hygiene abilities). Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive' is 'No'.

Check this box if the respondent is unable to bathe, brush their teeth, or maintain proper hygiene when using the restroom and therefore requires assistance or supervision for personal hygiene. Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive' is 'No'.

Enter a brief explanatory comment describing the respondent’s ability (or lack thereof) to bathe, brush teeth, and use proper hygiene when using the restroom, including examples or specific limitations as needed. Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive', 'C. Personal Hygiene — lacks capacity' 61 is 'No' and 71 is 'Yes' (all).

Provide any additional details or continuation of the comment about the respondent’s personal hygiene capacity, such as frequency of assistance required, adaptive equipment used, or recent changes in hygiene ability. Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive', 'C. Personal Hygiene — lacks capacity' 61 is 'No' and 71 is 'Yes' (all).

Check this box when the respondent is able to make and communicate health care choices (e.g., understands medical treatment, follows medication instructions, notifies others of illness, and can reach emergency care). Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive' is 'No'.

Check this box when the respondent is unable to make or communicate health care choices or cannot reliably understand or follow medical instructions and reach emergency care. Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive' is 'No'.

Enter the first part of your explanation about the respondent’s capacity to make and communicate health care decisions (for example: ability to consent to medical treatment, follow medication instructions, select caregivers, and notify others in emergencies). Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive', 'D. Health Care — lacks capacity' 61 is 'No' and 75 is 'Yes' (all).

Enter any additional or continued details to complete the comment about the respondent’s capacity regarding health care decisions and related observations. Fill only if 'Coma / Persistent Vegetative State / Non‑Responsive', 'D. Health Care — lacks capacity' 61 is 'No' and 75 is 'Yes' (all).

Check this box if the respondent is currently in a coma, a persistent vegetative state, or otherwise non‑responsive (if checked, proceed to Item 11).

Enter the official case or file number assigned to this matter as shown on court or agency documents.

Enter the respondent's full legal name (the person or entity the case concerns).

Enter the court file number assigned to this case as it appears on court documents.

Enter the name of the county where this case is filed (e.g., Wake County).

Check this box if no court interpreter is needed for any party, victim, or witness.

Check this box if a court interpreter is needed for any party, victim, or witness, and provide an explanation identifying the person(s) and language(s).

If an interpreter is needed, provide the name(s) of the person(s) who need an interpreter and specify the language(s) required, including any brief explanatory details. Fill only if 'Yes (Court interpreter needed) — explain' is 'Yes'.

Check this box if the respondent currently has a durable power of attorney instrument in place.

Check this box if the respondent does not currently have a durable power of attorney instrument in place.

Check this box when the person recognizes danger, seeks assistance as needed, and is able to protect themselves from exploitation or personal harm (i.e., demonstrates adequate personal safety capacity). Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Check this box when the person does not recognize danger, fails to seek assistance as needed, or cannot protect themselves from exploitation or personal harm (i.e., demonstrates inadequate personal safety capacity). Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Enter brief comments about the individual's personal safety capacity, noting observations about danger recognition, help-seeking, or protection from exploitation or harm. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Provide any additional details or examples that expand on the comment above regarding the person's ability to recognize danger and seek or accept assistance to protect themselves. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Check this box when the person is able to make and communicate decisions about residence/roommates and maintains safe shelter. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Check this box when the person is not able to make or communicate decisions about residence/roommates or maintain safe shelter. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Enter a brief comment describing the person's capacity to make and communicate decisions about residence, roommates, and maintaining safe shelter (e.g., specific examples of ability or limitations). Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Provide any additional details or expansion of the comment about residential decision‑making, living situation, or need for supports related to shelter and roommates. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Provide detailed facts that demonstrate why the respondent is incompetent to manage his or her person, family, or property, including causes (for example mental illness, intellectual disability, dementia, injury, or other conditions) and specific examples showing lack of capacity.

Check this box when the individual is able to make and communicate decisions about employment and demonstrates vocational skills (e.g., punctuality, neatness, completing or dictating application forms). Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Check this box when the individual is unable to make or communicate decisions about employment or does not demonstrate necessary vocational skills for employment-related tasks. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Enter the first line of comments describing the individual's employment-related capacity, including observations about decision-making, vocational skills, punctuality, or ability to complete application forms. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Enter a continuation or additional comments about the individual's employment-related capacity if more space is needed to record observations or examples. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Check this box when the person follows a daily schedule, conducts housekeeping chores, and appropriately uses community resources (bank, store, post office), indicating they have capacity for independent living. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Check this box when the person is unable to follow a daily schedule, perform household tasks, or use community resources appropriately, indicating they lack capacity for independent living. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Enter a brief comment describing the individual’s current independent living capacity, including examples or observations that justify whether they have or lack the ability to follow a daily schedule and manage household tasks. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Provide any additional details or elaboration about the person’s independent living skills, supports needed, use of community resources, or relevant incidents that further explain their functional abilities. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Check this box if the respondent does have health insurance (through Medicaid, Medicare, or a private insurer).

Check this box if the respondent does not have any health insurance (no Medicaid, Medicare, or private insurer coverage).

Check this box if the respondent currently has a healthcare (medical) power of attorney established.

Check this box if the respondent does not have a healthcare (medical) power of attorney established.

Check this box when the person demonstrates civil capacity (e.g., knows to contact an advocate if being exploited, understands consequences of committing a crime, and registers to vote). Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Check this box when the person does not demonstrate the civil capacity described (cannot identify when to contact an advocate, does not understand consequences of criminal acts, or cannot manage voter registration decisions). Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Enter a brief clinician comment about the individual's civil capacity (ability to contact an advocate if exploited, understand consequences of crimes, register to vote, etc.). Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Enter additional or more detailed observations and notes about the individual's civil capacity, expanding on the brief comment above as needed. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Enter the amount of wages and salaries the respondent receives.

Enter the amount of rental income the respondent receives.

Enter the amount of pension income the respondent receives.

Enter the amount of any allowances the respondent receives.

Enter the amount of insurance benefits and compensation the respondent receives.

Enter the amount of other income the respondent receives, including SSI/SSDI.

Check this box if there are no other past or pending incompetence proceedings involving the respondent in any court or agency of a state or foreign country.

Check this box if there is at least one past or pending incompetence proceeding involving the respondent in any court or agency of a state or foreign country, and complete the details below.

Enter the full legal name of the interested person (first name, middle initial if any, and last name).

Enter the street address for this person, including apartment or unit number if applicable.

Enter any additional address information such as P.O. Box, suite, care-of, or other second-line address details.

Enter the city of residence for the interested person.

Enter the state of residence (use the two-letter postal abbreviation if possible).

Enter the ZIP or postal code for the address (5-digit or ZIP+4 as available).

Enter the name of the county where the interested person resides.

Enter a daytime telephone number where the person can be reached, including area code and any extension if applicable.

Describe the person's relationship to the respondent or their interest in the proceeding (for example: spouse, parent, attorney, creditor).

Enter the full legal name of the second interested person (first name, middle initial if any, and last name).

Enter the primary street address or P.O. box for the second interested person.

Enter additional address details such as apartment, suite, unit number, or any continuation of the street address.

Enter the city of residence for the second interested person.

Enter the state or province (abbreviation is acceptable) for the second interested person's address.

Enter the ZIP or postal code for the second interested person's address.

Enter the county where the second interested person resides.

Enter the best telephone number to reach the second interested person, including area code.

Describe the second interested person's relationship to the respondent or their interest in the proceeding (for example, spouse, creditor, friend).

Enter the full name of Interested Person 3 (first and last name).

Enter the street address (number and street name) for Interested Person 3.

Enter additional address information for Interested Person 3, such as apartment, suite, unit, or care-of details.

Enter the city of residence for Interested Person 3.

Enter the state or province of residence for Interested Person 3.

Enter the ZIP or postal code for Interested Person 3's address.

Enter the county where Interested Person 3 resides.

Enter the telephone number for Interested Person 3, including area code.

Describe Interested Person 3's relationship to the respondent or their interest in this proceeding (for example, spouse, attorney, creditor).

Enter the first line of Interested Person 4's name and mailing address (typically the person's full name).

Enter the second line of Interested Person 4's mailing address (typically street address).

Enter the third line of Interested Person 4's mailing address (city, neighborhood, or additional address details).

Enter any remaining address information for Interested Person 4 such as apartment/suite, building, or other delivery details.

Enter the city of residence for Interested Person 4.

Enter the state abbreviation and ZIP code for Interested Person 4 (for example: CA 90001).

Enter the county where Interested Person 4 resides.

Enter the telephone number for Interested Person 4, including area code and any necessary extension.

Describe Interested Person 4's relationship to the respondent or their interest in the proceeding (for example: 'daughter', 'attorney', 'creditor').

Check this box when the person makes and communicates decisions about paying bills and spending discretionary money (and can make change for $1, $5, and $20). Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Check this box when the person is unable to make or communicate decisions about paying bills and spending discretionary money (cannot reliably make change for $1, $5, and $20). Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Enter the assessor's brief comment explaining the subject's ability to make and communicate decisions about paying bills, spending discretionary money, and making change for $1, $5, and $20 (justify the capacity selection). Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Enter any additional details, examples, or observations that further explain or support the comment about the subject's financial capacity for paying bills and handling discretionary money. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Check this box when the person can make and communicate decisions about managing a personal bank account, savings, investments, real estate, and other substantial assets. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Check this box when the person cannot make or communicate decisions about managing a personal bank account, savings, investments, real estate, or other substantial assets. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Enter a brief comment explaining the individual's ability to make and communicate decisions about managing a personal bank account, savings, investments, real estate, and other substantial assets (e.g., examples, concerns, or specific observations). Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Provide any additional details or elaboration related to the person's capacity to manage bank accounts and substantial assets, such as context, supporting facts, limitations, or recommended supports. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Check this box when the person is able to recognize and appropriately resist attempts by others to exploit them financially. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Check this box when the person is unable to recognize or resist attempts by others to exploit them financially. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Enter a concise explanation describing the individual's ability to resist attempts at financial exploitation by others, including examples, observed behaviors, or relevant circumstances. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Enter any additional details or continuation of the comment about the individual's capacity to resist financial exploitation, such as supporting observations, risk factors, or recommended safeguards. Fill only if 'in a coma, persistent vegetative state, or non-responsive' is 'No'.

Describe the less restrictive alternatives you considered prior to seeking adjudication of incompetence, listing each alternative and the specific reasons it was considered and why it was insufficient to meet the respondent’s needs.

Enter the total amount currently owed on any mortgage loans secured against the respondent's property.

Enter the total amount currently owed on any other secured loans (e.g., car loans, home equity loans) against the respondent.

Enter the total amount currently owed on any unsecured loans or debts (e.g., credit cards, personal loans) for the respondent.

Enter the county, state, and country where the past or pending incompetence proceeding was filed (e.g., Wake County, North Carolina, United States). Fill only if 'b. Past or pending incompetence proceeding(s) exist' is 'Yes'.

Describe the type of incompetence proceeding and indicate whether it was past or pending (for example, 'Guardianship — Past' or 'Conservatorship — Pending'). Fill only if 'b. Past or pending incompetence proceeding(s) exist' is 'Yes'.

Provide the court file number or docket number assigned to that incompetence proceeding as it appears on court records. Fill only if 'b. Past or pending incompetence proceeding(s) exist' is 'Yes'.

Enter the county, state (or territory) and country where the past or pending incompetence proceeding was filed or is pending. Fill only if 'b. Past or pending incompetence proceeding(s) exist' is 'Yes'.

Describe the type of incompetence proceeding (for example, guardianship, conservatorship) and indicate whether it was past or pending. Fill only if 'b. Past or pending incompetence proceeding(s) exist' is 'Yes'.

Provide the court file or docket number assigned to that past or pending proceeding. Fill only if 'b. Past or pending incompetence proceeding(s) exist' is 'Yes'.

Enter the county, state, and country where the past or pending incompetence proceeding was filed (for example: Wake County, North Carolina, United States). Fill only if 'b. Past or pending incompetence proceeding(s) exist' is 'Yes'.

Provide the type of incompetence proceeding (and indicate whether it was Past or Pending), such as 'adjudication of incompetence — Past' or 'guardianship petition — Pending'. Fill only if 'b. Past or pending incompetence proceeding(s) exist' is 'Yes'.

Enter the court file, docket, or case number assigned to that incompetence proceeding. Fill only if 'b. Past or pending incompetence proceeding(s) exist' is 'Yes'.

Provide a clear, chronological summary of any past or pending incompetence proceedings involving the respondent, including locations (county/state/country), court or agency names, type of proceeding, approximate dates or filing periods, file or docket numbers if known, and the factual outcomes or current status of each proceeding. Fill only if 'b. Past or pending incompetence proceeding(s) exist' is 'Yes'.

Enter the petitioner's full legal name (first, middle, last) exactly as it should appear on court records.

Enter the petitioner's primary street address or P.O. Box for mailing purposes.

Enter additional address information such as apartment, suite, or unit number, or leave blank if not applicable.

Enter the city of the petitioner's residence.

Enter the state of the petitioner's residence (use the two-letter postal abbreviation or full state name).

Enter the petitioner's postal ZIP code (five-digit or ZIP+4) for the address provided.

Enter the county in which the petitioner resides.

Enter the petitioner's daytime telephone number, including area code and extension if applicable.

Enter the petitioner’s relationship to the respondent or their interest in this proceeding (for example: spouse, parent, adult child, attorney, guardian ad litem, concerned party, etc.).

Enter the starting date of the first period during which the respondent was physically present.

Provide the full street address (and any apartment or unit number) where the respondent was physically present during the first period described.

Enter the starting date of the second period during which the respondent was physically present.

Enter the ending date of the second period during which the respondent was physically present.

Provide the street address, city and state where the respondent was physically present during the second period.

Enter the start date for the third period during which the respondent was physically present.

Enter the end date (or indicate 'Present' if ongoing) for the third period during which the respondent was physically present.

Enter the address (city, state, and any applicable jurisdiction) where the respondent was physically present during the third period.

Enter the recommended guardian's full name (first, middle/initial, and last).

Enter the guardian's street address, P.O. box, and apartment or unit number as applicable.

Enter the city for the guardian's mailing address.

Enter the county or other additional address information (e.g., county, neighborhood, or extra address line).

Enter the guardian's state or province (typically the two-letter state abbreviation).

Enter the postal ZIP or postal code for the guardian's address.

Check this box when you are recommending the named person as guardian of the respondent's estate (to manage financial and property matters).

Check this box when you are recommending the named person as guardian of the respondent's person (to make decisions about personal care, health, and daily living).

Check this box when you are recommending the named person as a general guardian for the respondent (to serve as both guardian of the person and the estate).

Enter the full legal name (first, middle, last and any suffix) of the second recommended guardian.

Enter the second recommended guardian’s street address, including apartment or unit number if applicable.

Enter the city, state (use the two‑letter abbreviation), and ZIP code for the guardian’s mailing address.

Enter the guardian’s primary telephone number (include area code) for contact.

Enter 'Yes' or 'X' to indicate this recommended guardian is being proposed for guardianship of the estate.

Enter 'Yes' or 'X' to indicate this recommended guardian is being proposed for guardianship of the person.

Check this box when the recommended second guardian should be appointed as guardian of the estate (responsible for managing the respondent's finances and property).

Check this box when the recommended second guardian should be appointed as guardian of the person (responsible for the respondent's personal care, health, and daily needs).

Check this box when the recommended second guardian should be appointed as general guardian (responsible for both the person and the estate or as a combined guardianship role).

Check this box if there is a representative payee currently designated to receive and manage the respondent's government benefits.

Check this box if there is no representative payee designated to receive or manage the respondent's government benefits.

Enter the respondent's race (either the full descriptive name such as 'White' or 'Black or African American' or the form's short code if instructed).

Enter the respondent's sex as indicated on the form (for example 'Male' or 'Female' or the appropriate abbreviation).

Check this box if the respondent is indigent (unable to pay court costs or fees) and is requesting indigent status.

Enter the respondent's driver’s license number exactly as it appears on the license (include any letters, numbers, or punctuation).

Enter the name or postal abbreviation of the state that issued the respondent's driver's license.

Enter the respondent’s full legal name (first, middle, last) as it should appear on the record.

Enter the respondent’s primary telephone number, including area code and extension if applicable.

Enter the respondent’s street address (house number and street name) for their primary residence.

Enter additional address information such as apartment, suite, unit number, or PO box if needed.

Enter the city of the respondent’s residence.

Enter the state (abbreviation or full name) where the respondent resides.

Enter the respondent’s postal ZIP code for their residence.

Enter the county in which the respondent resides.

Enter the respondent’s date of birth.

Check this box if the respondent currently resides in this county.

Check this box if the respondent's legal domicile (permanent home) is in this county, even if they do not currently live here.

Check this box if the respondent is currently an inpatient at the facility identified elsewhere on the form.

Check this box if the respondent is physically present in this county and it is impossible to determine their county of residence or domicile.

Check this box if the respondent has a special needs trust or any other trust currently in place.

Check this box if the respondent does not have any special needs trust or other trust in place.

Enter the full name of the treatment facility where the respondent is admitted.

Enter the street address (number and street) of the treatment facility.

Enter any additional address information for the facility such as suite, floor, or PO box.

Enter the city in which the treatment facility is located.

Enter the state for the treatment facility (use the two‑letter abbreviation or full state name).

Enter the ZIP code for the treatment facility's address.

Enter the date the petitioner swore/affirmed and signed the verification statement attesting that the petition contents are true.

Enter the date when the person authorized to administer oaths officially swore or affirmed and subscribed the document before the officer.

Check this box when the person administering or witnessing the oath is a Deputy Clerk of Superior Court.

Check this box when the person administering or witnessing the oath is an Assistant Clerk of Superior Court.

Check this box when the person administering or witnessing the oath is the Clerk of Superior Court.

Check this box when the oath/signature is notarized by a notary public.

Enter the expiration date of the notary's commission as shown on their commission certificate. Fill only if 'Notary' is 'Yes'.

Enter the name of the county in which the document was notarized. Fill only if 'Notary' is 'Yes'.

Provide a detailed explanation describing why the less restrictive alternatives listed above are insufficient to meet the respondent's needs, including specific examples and facts that demonstrate why those alternatives would not adequately address the respondent’s care, safety, decision-making, or property concerns. Fill only if 'Less Restrictive Alternatives Considered — Details' has entries.