Lorain County Probate Court Judge James T. Walther IN THE MATTER OF THE GUARDIANSHIP OF ___________________________________ CASE NO. __________________________ APPLICATION FOR APPOINTMENT OF GUARDIAN OF MINOR [R.C. 2111.03(C)] Applicant, a resident of ___________________ County, Ohio, hereby applies for the appointment of (himself) (herself) or some suitable person as guardian of the following minor and represents that the applicant is not an administrator, executor, or other fiduciary of an estate wherein the minor is interested Name of Minor Age Date of Birth Residence or Legal Settlement Attached is a list of the next of kin of the minor. (Form 15.0) A guardian is necessary because (R.C. 2111.06), ____________________________________________ ___________________________________________________________________________________ TYPE OF GUARDIANSHIP APPLIED FOR IS _____ non-limited _____ limited _____ person and estate _____ estate only _____ person only IF THE APPLICATION IS FOR LIMITED GUARDIANSHIP, The length (time period) of the guardianship requested is: ______ indefinite ______ definite to ___________________________________, 20____ The limited powers requested are: __________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Applicant attaches affidavit pursuant to R.C. 3109.27. Applicant represents that grounds exist for the Court to exercise its jurisdiction. (Applies to guardianship of person only. R.C. 3109.22). 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.) ____________________________________________________________________________________ ____________________________________________________________________________________ 16.0 APPLICATION FOR APPOINTMENT OF GUARDIAN OF MINOR American LegalNet, Inc. www.FormsWorkFlow.com The whole estate of said minor is estimated as follows: Personal Property.................................................................................. $ _________________ Real Estate .......................................................................................... $ _________________ Annual Rents......................................................................................... $ _________________ Other annual income ............................................................................. $ _________________ Total $ _________________ Applicant offers the attached bond in the amount of $ ___________________________ I hereby certify that all the information and statements contained in this application and attached exhibits are correct to the best of my knowledge and belief. ____________________________________ Attorney for Applicant _____________________________________ Applicant ____________________________________ Typed or Printed Name _____________________________________ Typed or Printed Name ____________________________________ Address _____________________________________ Address ____________________________________ City State Zip _____________________________________ City State Zip ____________________________________ Phone Number (include area code) _____________________________________ Phone Number (include area code) _______________________________ Supreme Court Registration Number American LegalNet, Inc. www.FormsWorkFlow.com