PROBATE COURT OF BUTLER COUNTY, OHIO IN THE MATTER OF Case No. ENTRY DISPENSING WITH APPOINTMENT OF GUARDIAN AND ORDERING DEPOSIT OR DELIVERY The Court finds upon the application to dispense with the appointment of guardian that is a minor who resides in Butler County, Ohio, the estate of said minor is twenty-five thousand or less, and a guardianship is not necessary. Therefore, the Court orders the appointment of guardian is dispensed with, and that the property of said minor, in the sum of $ dollars be delivered or deposited as follows; delivered to delivered to is maintained. delivered to , the minor. , as the person by whom the minor , as natural guardian of the minor. delivered to the executive director responsible for the administration of children's services. deposited in the name of the minor with depository authorized to receive fiduciary funds. a None of said funds, in whole or in part, shall be released by the depository without a court order until said minor attains the age of majority. Said attorney shall file the Verification of Receipt and Deposit (Form 22.3) with this Court, evidencing that said deposit has been made, within seven days after receipt of the funds. Date Probate Judge/Magistrate N O T IC E TO COUNSEL FOR INSURANCE COM PANIES DISBURSING LIFE INSURANCE PROCEEDS OF T EN THOUSAND DOLLARS OR LESS TO MINORS RESIDING IN OHIO : Pursuant to Rule 67(C) of the Rules of Superintendence for the Courts of Ohio, "The attorney shall be responsible for depositing the funds and for providing the financial institution with a copy of the entry. The attorney shall obtain a Verification of Receipt and Deposit (Standard Probate Form 22.3) from the financial institution and file the form with the court within seven days from the issuance of the entry." You are hereby put on notice that the insurance proceeds you are disbursing, if Twenty Five Thousand Dollars or less, are not to be released to a natural parent and must be deposited in a financial institution meeting the requirements of Ohio Revised Code §2109.41. The natural parent of the minor may specify the financial institution, without additional court approval, as long as the institution is in Butler County Ohio and complies with R.C. §2109.41. The Verification of Receipt and Deposit (Form 22.3) is available on the Butler County Probate Court's web site at www.butlercountyprobatecourt.org. BCPC FORM 510 ­ ENTRY DISPENSING WITH APPOINTMENT OF GUARDIAN AND ORDERING DEPOSIT OR DELIVERY American LegalNet, Inc. www.FormsWorkFlow.com