PROBATE COURT OF CUYAHOGA COUNTY Anthony J. Russo, Presiding Judge Laura J. Gallagher, Judge IN THE MATTER OF THE GUARDIANSHIP OF _________________________________________ CASE NUMBER: _____________________________ APPLICATION TO PAY OR DELIVER ESTATE OF AN INCOMPETENT ADULT WITHOUT APPOINTMENT OF A GUARDIAN OF ESTATE Now comes the undersigned and represents that __he is Guardian of the Person of _________________________, aged _______years, who resides at_____________________________________________________________________, who was on the _________day of ___________________, 20______, adjudge an incompetent person by the probate Court of Cuyahoga County.The Guardian of the Person further represents that the above named person is the owner of, or entitled to receive property not exceeding in value the sum of $25,000.00, described as follows:___________________ __________________________________________________________________________________________________ _________________________________________________________________________________________________. The Guardian of the Person further represents that the above listed property constitutes the entire estate of the person and that __he has no legally appointed Guardian of Estate. The Guardian of the Person further represents that the funds or property received will be deposited or used for the benefit of the ward as follows: ______ Funds to be deposited and held in a depository authorized to receive fiduciary funds; Verification of Receipt and Deposit, Form 22.3 shall be filed with the Court within thirty days. ______Funds to be released to the Guardian of the Person and expended for the benefit of the ward asfollows: _____________________________________________________________________________________ ____________________________________________________________________________________. __________________________________________ Attorney for Guardian ____________________________________________ Guardian of Person _______________________________________ ___ Typed or printed name ____________________________________________ Typed or printed name __________________________________________ Address __________________________________________________________ City State Zip _________________________________________________________ Telephone Number (include area code) ________________________________________________________ Registration Number ____________________________________________ Address _____________________________________________________________ City State Zip _____________________________________________________________ Telephone Number (include area code) American LegalNet, Inc. www.FormsWorkFlow.com