PROBATE COURT OF HAMILTON COUNTY, OHIO RALPH WINKLER, JUDGE GUARDIANSHIP OF__________________________________________________________ CASE NO.__________________________ APPLICATION FOR APPOINTMENT OF GUARDIAN OF ALLEGED INCOMPETENT [R.C. 2111.03] Applicant represents to the Court that_______________________________________________, resides or has a legal settlement at ____________________________________________________, in Hamilton County, Ohio and that the prospective ward is incompetent by reason of [R.C.2111.01(D)] ___________________________________________________________________________________ ___________________________________________________________________________________ The proposed ward's date of birth is:______________________. 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) The whole estate of said prospective ward is estimated as follows: Personal property Real estate Annual rents ........................................................... ........................................................... ........................................................... $_________________________ $_________________________ $_________________________ $_________________________ Other annual income ........................................................... Applicant represents that the applicant is not an administrator, executor or other fiduciary of the estate wherein the alleged incompetent is interested. Applicant offers the attached bond in the amount of $___________________________________ Applicant further represents that a guardian of the alleged incompetent is necessary in order that the ward ward's property may be taken proper care of and asks that a guardian be appointed. THE TYPE OF GUARDIANSHIP APPLIED FOR IS non-limited limited person and estate estate only person only If limited guardianship is applied for, the limited powers requested are ___________________________________________________________________________________ ___________________________________________________________________________________ Page 1 of 2 FORM 17.0 ­ APPLICATION FOR APPOINT MENT OF GUARD IAN ( ALLEGED INCO MPETENT) 07/15/13 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. __________________ The time period requested is indefinite definite to ______________________________________ __________________________________________________________________________________. Applicant's relationship to alleged incompetent is ___________________________________________ __________________________________________________________________________________. 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.) ___________________________________________________________________________________ __________________________________________________________________________________. The Applicant represents that a guardian has been nominated in a writing pursuant to R.C. 1337.09(D) or R.C. 2111.121. The nominated person is______________________________________________. The nominated person's contact information is listed on Form 15.0 (Next of Kin). A copy of the document which nominates the guardian is attached. The Applicant represents that the proposed ward had military service. Military I.D.:_____________________________________________ Branch of service:________________________________________ Dates of service:_________________________________________ Applicant represents that the address provided is the applicant's permanent address and acknowledges the requirement that the court be notified of any change of address. Removal may result from a failure to comply with this requirement. ________________________________________ Attorney for Applicant ________________________________________ Type or Printed Name ________________________________________ Address ________________________________________ City State Zip ________________________________________ Telephone Number (include area code) Attorney Registration No.____________________ _______________________________________ Applicant ________________________________________ Type or Printed Name ________________________________________ Age _______________________________________ Permanent Address ________________________________________ City State Zip _______________________________________ Telephone Number (include area code) _______________________________________ E-mail Address Page 2 of 2 FORM 17.0 ­ APPLICATION FOR APPOINT MENT OF GUARD IAN ( ALLEGED INCO MPETENT) 07/15/13 American LegalNet, Inc. www.FormsWorkFlow.com