PROBATE COURT OF BUTLER COUNTY, OHIO RANDY T. ROGERS, JUDGE , AN ADULT IN THE MATTER OF: CASE NO. NOTICE OF HEARING ON PETITION FOR TEMPORARY RESTRAINING ORDER TO PREVENT INTERFERENCE WITH THE PROVISION OF SERVICES [R.C. 5101.68] TO: (Name of Person interfering with the provision of services) (Address) The above captioned Adult has consented to the provision of adult protective services pursuant to Chapter 5101. of the Revised Code. You are hereby notified that a Petition for Temporary Restraining Order to Prevent Interference with the Provision of Services was filed with this Court pursuant to R.C. 5101.68. It is alleged in the Petition that you are interfering with the provision of protective services for the Adult, and that a temporary restraining order should be issued against you to prevent your interference. A copy of the Petition is attached hereto. The Petition for Temporary Restraining Order to Prevent Interference with the Provision of Services shall be heard in the Butler County Probate Court, located at the Butler County Courthouse, 101 High Street, Second Floor Hamilton, Ohio on the day of , at o’clock AM/PM. You or any interested person is permitted to attend this hearing and give testimony or present other evidence as to why the petition for restraining order should or should not be granted. WITNESS my signature and seal of said Court, this day of , Probate Judge By: Deputy Clerk FORM 23.7 - NOTICE OF HEARING ON PETITION FOR TEMPORARY RESTRAINING ORDER TO PREVENT INTERFERENCE WITH THE PROVISION OF SERVICES Eff. Date: January 1, 2010 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. The State of Ohio, Butler County Probate Court I hereby certify that I caused a copy of the within notice to be mailed, by certified mail, to the last known address of at at Randy T. Rogers, Probate Judge By: Deputy Clerk RETURN Butler County, Ohio , Received this notice on the o’clock AM/PM , and on the day of , day of , at , I served the same by delivering a true copy thereof personally to FEES Sheriff Service and return, 1 st name, $ Deputy Sheriff/Process Server Additional names, at $ Miles traveled, at $ Name $ Title Total $ FORM 23.7 - NOTICE OF HEARING ON PETITION FOR TEMPORARY RESTRAINING ORDER TO PREVENT INTERFERENCE WITH THE PROVISION OF SERVICES Eff. Date: January 1, 2010 American LegalNet, Inc. www.FormsWorkFlow.com