PROBATE COURT OF GEAUGA COUNTY, OHIO JUDGE TIMOTHY J. GRENDELL IN THE MATTER OF THE GUARDIANSHIP OF Case No. APPLICATION FOR APPOINTMENT OF EMERGENCY GUARDIAN OF ALLEGED INCOMPETENT (R.C. 2111.02) Applicant represents to the Court that resides or has a legal settlement at and that the prospective ward is incompetent by reason of (R.C. 2111.01(D)) aged years, , in GEAUGA, County, Ohio Applicant further represents that an emergency exists and that it is reasonable certain that immediate action is required to prevent significant injury to the person or estate of the proposed ward. A Statement of Expert Evaluation is attached. (Form 17.1) A List of Next of Kin of Proposed Ward is also attached. (Form 15.0), however, applicant requests that the Court act ex parte, without notice because of the emergency existing. A detailed description of the emergency is attached hereto marked as attachment "A" The whole estate of the prospective ward is estimated as follows: Personal Property Real Estate $ $ Applicant represents that he/she/they is/are not an administrator, executor or other fiduciary of the estate wherein the alleged incompetent is interested. Applicant further represents that a guardian of the alleged incompetent is necessary in order that the ward the ward's property may be taken proper care of and asks that a guardian be appointed. PRESENT LOCATION OF WARD: TYPE OF GUARDIANSHIP APPLIED FOR IS EMERGENCY limited The limited powers requested are person and estate estate only person only The time period requested is from to APPLICATION FOR APPOINTMENT OF EMERGENCY GUARDIAN (AN ALLEGED INCOMPETENT) 10/19/07 American LegalNet, Inc. www.FormsWorkFlow.com Applicant's relationship to alleged incompetent is Case No. The Applicant has (not) been charged with or convicted of a crime involving theft, physical violence, or sexual, alcohol or substance abuse except as follows (if applicable, state date and place of each charge or each conviction) Attorney for Applicant Applicant 1 Typed or printed name Typed or printed name Address Age City State Zip Street Phone Number (include area code) City State Zip Supreme Court Registration Number Phone number (include area code) Applicant 2 Typed or printed name Age Street City State Zip Phone number (include area code) American LegalNet, Inc. www.FormsWorkFlow.com Probate Court of Geauga County, Ohio Judge Timothy J. Grendell IN THE MATTER OF THE GUARDIANSHIP OF ______________________________ Case Number: _____________________________ AFFIDAVIT IN SUPPORT OF MOTION OF EMERGENCY GUARDIANSHIP Affiant ______________________________, having been first duly sworn, states the following emergency exists that requires the appointment of an emergency guardian: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Sworn to in my presence this _______ day of _______________, 20_____. ____________________________________ Notary or Deputy Clerk Attachment "A" American LegalNet, Inc. www.FormsWorkFlow.com