PC-G-16.01C (Rev. 12-2000) PROBATE COURT OF FRANKLIN COUNTY, OHIO LAWRENCE A. BELSKIS, JUDGE ROBERT G. MONTGOMERY,JUDGE IN THE MATTER OF CASE NO. , MINOR DISPENSE WITH GUARDIANSHIP ACKNOWLEDGMENT OF RESPONSIBILITY The parent(s) of the above-referenced minor hereby acknowledge that they have participated in a dispense with guardianship proceeding for their minor child. The undersigned further understand that monies belonging to the minor have been placed into a controlled account at a financial institution to be held for the benefit of the minor, and understand and acknowledge that it is their responsibility to insure that the minor is informed of this account and has the opportunity to receive all available funds upon attaining the age of eighteen (18) years. Date Parent Date Parent COPY TO PARENTS FRANKLIN COUNTY FORM 16.01C - DISPENSE WITH GUARDIANSHIP ACKNOWLEDGMENT OF RESPONSIBILITY American LegalNet, Inc. www.FormsWorkFlow.com