PC-G-16.0 (Rev. 2-2001) PROBATE COURT OF FRANKLIN COUNTY, OHIO ROBERT G. MONTGOMERY,JUDGE LAWRENCE A. BELSKIS, JUDGE IN THE MATTER OF THE GUARDIANSHIP OF CASE NO. APPLICATION FOR APPOINTMENT OF GUARDIAN (MINOR) is a minor and is in Applicant represents that need of a guardian (O.R.C. 2111.02), and the following: Note: If space allotted is inadequate to respond, write "See Exhibit" in the space and add appropriate exhibit letter sequence, then attach exhibit containing information requested for that space. 1. TYPE OF GUARDIANSHIP FOR WHICH APPLICATION IS MADE: A. B. Non-Limited Person and Estate Limited Estate Only Interim Person Only 2. IF THE APPLICATION IS FOR A LIMITED GUARDIANSHIP: A. The length (time period) of the guardianship requested is: (1) (2) Indefinite Definite from to 20 20 B. The limited powers granted to the guardian are: 3. IF THE APPLICATION IS FOR A GUARDIANSHIP OF THE ESTATE: A. The whole estate of the prospective ward is: Personal Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ Real Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Annual Rents (Include all income from every source) . . . . . . . . . . . . . TOTAL B. A bond in the amount of $ (O.R.C. 2109.04)(A)(1). is attached as Exhibit A. FRANKLIN COUNTY FORM 16.0 APPLICATION FOR APPOINTMENT OF GUARDIAN (MINOR) American LegalNet, Inc. www.FormsWorkFlow.com 4. LIST OF NEXT OF KIN OF THE MINOR FOR SERVICE OF NOTICE, AND WAIVER(S), IF ANY, ARE ATTACHED AS EXHIBIT B. 5. INFORMATION CONCERNING THE PROSPECTIVE GUARDIAN/APPLICANT: A. Name and AKA Home Address ZIP Relationship to Minor Occupation Work Address ZIP Telephone: D.O.B. B. Applicant (is/is not) an administrator, executor, or other fiduciary of the estate wherein the minor has an interest. (O.R.C. 2111.09). C. Applicant (has/has not) been charged with, or convicted of, a crime involving theft; physical violence; or sexual, alcohol, or substance abuse. If the Applicant has been so charged or convicted, list dates and places of the charge(s) or conviction(s), [O.R.C. 2111.03(A)]: Charge/Conviction Date Place Home Work 2 American LegalNet, Inc. www.FormsWorkFlow.com 6. INFORMATION CONCERNING THE MINOR: A. Full Name and AKA Age Date of Birth Legal settlement or residence is: City, State, Zip in Length of that residence is Male Female County, Ohio Telephone B. School Minor will attend while under guardianship School's telephone: C. If the minor is living at an address different from the residence shown in Section 6-A above, that address is: D. Name of person, other than minor, who may be contacted at the address where the minor is living: Name: Telephone: E. In the event of the death or incapacity of the applicant/guardian, the Court should contact the nearest friends or relatives whose names and addresses are: Name: Telephone: Address: Zip Name: Telephone: Address: Zip Name: Telephone: Address: Zip 3 American LegalNet, Inc. www.FormsWorkFlow.com F. Reasons for the guardianship are: (O.R.C. 2111.06) G. If the minor's age is over 14 years, he/she (does/doesnot) consent to the selection of the applicant as guardian. Consent is attached as Exhibit C. H. The person who has custody of the Minor is and the address is I. A certified copy of the minor's birth certificate is attached as Exhibit D. J. A custody affidavit pursuant to O.R.C. 3109.27 is attached as Exhibit E. K. I acknowledge that a parent of the ward can withdraw their consent to the guardianship at a later time and this Court may then terminate this guardianship or certify it to Juvenile Court for further action. I hereby petition the court to be appointed guardian of the foregoing described minor and certify that all the information and statements contained in this application and attached exhibits are correct to the best of my knowledge and belief. Attorney Signature Attorney's Printed Name Address City, State, Zip Code Applicant Signature Applicant's Printed Name Address City, State, Zip Code ( ) ( ) Telephone Telephone 4 American LegalNet, Inc. www.FormsWorkFlow.com