STATE OF SOUTH CAROLINA PROBATE COURT COUNTY OF RICHLAND

IN THE MATTER OF: ______

CASE NUMBER: ______-GC-40-______

ACCEPTANCE OF SERVICE AND RENUNCIATION OF RIGHT TO SERVE AS CONSERVATOR

PLEASE SIGN BELOW BEFORE A WITNESS AND DATE YOUR SIGNATURE.

____ I accept service of a copy of the Summons and Petition in this matter. By selecting this statement I am agreeing that I have received a copy of the Summons and Petition.

PLEASE CHECK ONLY ONE OF THE TWO STATEMENTS BELOW:

____ I hereby exercise my right to nominate a Conservator for the above-named person. The name and address of the proposed nominated Conservator is:

____ I hereby waive my right to nominate anyone as Conservator.

Executed this _____ day of ______, ______.

Signature: ______Name (Print): ______Address: ______Telephone (Work): ______(Home): ______(Cell): ______(Email): ______Witnessed by:

______

Form #302PC (Modified for use in Conservatorship cases)