Affidavit Of Supervision Administrator
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Affidavit Of Supervision Administrator Form. This is a Ohio form and can be use in Butler County (Court Of Common Pleas).
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Tags: Affidavit Of Supervision Administrator, 516, Ohio County (Court Of Common Pleas), Butler
PROBATE COURT OF BUTLER COUNTY, OHIO
IN THE MATTER OF
Case No.
AFFIDAVIT OF SUPERVISOR/ADMINISTRATOR
Affiant being first duly sworn, deposes and says:
In accordance with the order of this Court dated
,
the above named ward was
(Action Taken Regards the Ward)
Sworn to before me and subscribed in my presence this
day of
,
.
Notary Public
1.
The affidavit must be signed by a supervisor/administrator of a rest home or facility (if ward was admitted to same),
doctor or medical provider (if ward was hospitalized, medicated or surgical procedures performed), etc.
2.
This form must be RETURNED to the Butler County Probate Court NO LATER THAN FIVE (5) DAYS after the
expiration of the 72 hour order.
BCPC FORM 516 - AFFIDAVIT OF SUPERVISOR/ADMINISTRATOR - PDF
4-1-2004
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