PROBATE COURT OF FRANKLIN COUNTY, OHIO ROBERT G. MONTGOMERY, JUDGE LAWRENCE A. BELSKIS, JUDGE PC-C-20.0E (Rev. 4/2001) IN THE MATTER OF THE CONSERVATORSHIP OF CASE NO. CONSERVATORS BOND Amount of bond $ Amount of Additional bond $ The undersigned principal, and sureties if any, are obligated to the State of Ohio in the above amount, for payment of which we bind ourselves and our successors, heirs, executors, and administrators, jointly and severally. The principal has accepted in writing the duties of fiduciary in conservatees estate including those imposed by law and such additional duties as may be required by the Court. This obligation is void if the principal performs such duties as required. This obligation remains in force if the principal fails to perform such duties, or performs them tardily, negligently, or improperly, or if the principal misuses or misappropriates estate assets or improperly converts them to his own use or the use of another. [Check if personal sureties are involved.] [ ] The sureties certify that each of them owns real estate in this county, with a reasonable net value as stated below. Date Surety by Attorney in Fact Typed or Printed Name Address Net value of real estate owned in this county Principal Surety by Attorney in Fact Typed or Printed Name Address Net value of real estate owned in this county $ $ FRANKLIN COUNTY FORM 20.0E - CONSERVATORS BOND American LegalNet, Inc. www.FormsWorkFlow.com