PC-C-20.02 (Rev. 10-2002) PROBATE COURT OF FRANKLIN COUNTY, OHIO ROBERT G. MONTGOMERY, JUDGE ERIC S. BROWN, JUDGE IN THE MATTER OF THE CONSERVATORSHIP OF: CASE NO. LETTERS OF CONSERVATORSHIP [R.C.2111.021] is the appointed conservator of the person and estate of The length of the conservatorship is: Indefinite Definite from to . . If the conservatorship is limited, the reasons for the limited conservatorship and the limited powers granted to the conservator are as follows: The following property of the conservatee is subject to the power of the conservator: All property Only the property listed as follows: The above named conservator has the power conferred by law to do and perform all the duties of Conservator except as limited above; however, no expenditures shall be made without prior Court authorization. Date LAWRENCE A. BELSKIS Robert G. Montgomery, Judge Judge NOTICE TO FINANCIAL INSTITUTIONS Funds being held in the name of the person for whom the conservatorship is established shall not be released to the Conservator without a Court Order directing release of a specific fund and amounts. CERTIFICATE OF APPOINTMENT AND INCUMBENCY The above document is a true copy of the original kept by me as custodian of this Court. It constitutes the appointment and letters of authority of the named Conservator, who is qualified and acting in such capacity. LAWRENCE A. BELSKIS ROBERT G. MONTGOMERY J u d Judge Probate g e Date Deputy Clerk FRANKLIN COUNTY FORM 20.02 - LETTERS OF CONSERVATORSHIP American LegalNet, Inc. www.FormsWorkFlow.com