Aoc E 404 Form PDF Details

The Aoc E 404 form is a document used to report and document protected health information (PHI) breaches. The form is used to provide a detailed description of the breach, identify the individuals affected by the breach, and track follow-up actions taken in response to the breach. Any individual or organization that experiences a PHI breach must complete an Aoc E 404 form within 60 days of discovering the breach. Completing this form can help ensure that all necessary steps are taken to minimize the impact of the breach and protect sensitive information.

QuestionAnswer
Form NameAoc E 404 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesform aoc e404, nc aoc e 404 form, form aoc e 404, waiver devisee online

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STATE OF NORTH CAROLINA

County

File No.

In The General Court Of Justice

Superior Court Division

Before The Clerk

IN THE MATTER OF THE ESTATE OF:

Name Of Decedent

WAIVER OF

PERSONAL REPRESENTATIVE'S BOND

G.S. 28A-8-1(b)(6), (8)

I certify that I am an heir/devisee of the above named decedent, and I am over eighteen (18) years of age.

I waive the statutory requirement for bond for the personal representative named below of this estate, who resides in the State of North Carolina, and agree to relieve him/her from the necessity of giving the statutory bond. (NOTE: An express requirement in the will for a bond cannot be waived.)

Name Of Personal Representative

I understand that this means that there will be no bond to go against if the personal representative does not properly administer the estate and distribute the assets to the heirs.

I have read this Waiver, and I fully understand its meaning and effect.

Date

Date

 

 

Name Of Heir/Devisee (Type Or Print)

Name Of Heir/Devisee (Type Or Print)

 

 

 

 

Signature Of Heir/Devisee

Signature Of Heir/Devisee

 

 

SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME

SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME

 

 

 

 

 

 

 

 

 

Date

Signature

 

Date

 

Signature

 

 

 

 

 

 

 

 

 

 

 

Deputy CSC

Assistant CSC

Clerk Of Superior Court

Deputy CSC

Assistant CSC

Clerk Of Superior Court

 

 

 

 

 

 

 

 

 

Date My Commission Expires

 

Date My Commission Expires

 

 

Notary

 

 

 

 

 

 

 

Notary

 

 

 

 

 

 

 

 

 

 

County Where Notarized

 

County Where Notarized

 

 

 

SEAL

 

 

 

 

 

 

 

SEAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

Name Of Heir/Devisee (Type Or Print)

 

Name Of Heir/Devisee (Type Or Print)

 

 

 

 

 

 

 

 

 

 

 

Signature Of Heir/Devisee

 

 

Signature Of Heir/Devisee

 

 

 

 

 

 

 

 

SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME

SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME

 

 

 

 

 

 

 

 

 

Date

Signature

 

Date

 

Signature

 

 

 

 

 

 

 

 

 

 

 

Deputy CSC

Assistant CSC

Clerk Of Superior Court

Deputy CSC

Assistant CSC

Clerk Of Superior Court

 

 

 

 

 

 

 

 

 

 

Date My Commission Expires

 

Date My Commission Expires

 

 

Notary

 

 

 

 

 

 

 

Notary

 

 

 

 

 

 

 

 

 

 

County Where Notarized

 

County Where Notarized

 

 

 

SEAL

 

 

 

 

 

 

 

SEAL

 

 

 

 

 

 

 

 

 

AOC-E-404, Rev. 4/11

Original - File

 

© 2011 Administrative Office of the Courts

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This PDF will require specific information to be filled in, hence make sure to take the time to fill in what is required:

1. When submitting the north carolina aoc e 505, be certain to incorporate all of the needed blank fields in its associated area. It will help to speed up the process, which allows your information to be processed quickly and properly.

Filling out segment 1 of aoc e 404 estate form

2. Once your current task is complete, take the next step – fill out all of these fields - Date, Date, Name Of HeirDevisee Type Or Print, Name Of HeirDevisee Type Or Print, Signature Of HeirDevisee, Signature Of HeirDevisee, SWORNAFFIRMED AND SUBSCRIBED TO, SWORNAFFIRMED AND SUBSCRIBED TO, Date, Signature, Date, Signature, Deputy CSC Assistant CSC Clerk Of, Deputy CSC Assistant CSC Clerk Of, and Date My Commission Expires with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

The best way to fill out aoc e 404 estate form step 2

3. The following part is quite straightforward, SWORNAFFIRMED AND SUBSCRIBED TO, Date, Signature, Date, Signature, Deputy CSC Assistant CSC Clerk Of, Deputy CSC Assistant CSC Clerk Of, Date My Commission Expires, Date My Commission Expires, Notary, SEAL, County Where Notarized, County Where Notarized, Notary, and SEAL - all these fields is required to be completed here.

aoc e 404 estate form writing process explained (stage 3)

Always be very attentive while completing Date My Commission Expires and Notary, since this is where a lot of people make errors.

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