PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE IN THE MATTER OF: CASE NO. Minor ENTRY DISPENSING WITH APPOINTMENT OF GUARDIAN AND ORDERING DEPOSIT Upon hearing on the oral application to dispense with the appointment of a guardian, the Court finds that is a minor with a date of birth of ; the estate of said minor is Thousand Dollars or less; and a guardianship is not necessary. Therefore, the Court orders the appointment of a guardian dispensed with, and further orders the estate of said minor in the possession of (Specify insurance company, attorney, or other payor) in the sum of dollars be deposited in the name of with , (Full Name of Minor) (Federally Insured Bank or Savings and Loan) a depository authorized to receive fiduciary funds. None of said funds, in whole or in part, including the interest earned thereon, shall be released by the depository until such time as said minor attains the age of majority or upon further order of this Court. Attorney shall be responsible for depositing the funds and shall file the Verification of Receipt and Deposit with this Court, evidencing that said deposit has been made, within seven days . Date Judge Jack R. Puffenberger CERTIFICATE OF AUTHENTICATION The above is a true copy of the original kept by me as custodian of the records of this Court. It constitutes the order authorizing the above designated depository to receive and deposit said funds. JACK R. PUFFENBERGER Probate Judge and Ex-Officio Clerk By Deputy Clerk Date I, , Attorney-at-law, hereby certify, that the within instrument was prepared and/or examined by me, and that the same, in my opinion, is correct and proper. 25327.B< LUCAS COUNTY PROBATE FORM 16-A ENTRY DISPENSING WITH APPOINTMENT OF GUARDIAN AND ORDERING DEPOSIT American LegalNet, Inc. www.FormsWorkFlow.com