COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. PROBATE COURT OF LUCAS COUNTY, OHIO : Calendar No. JACK R. PUFFENBERGER, JUDGE Plaintiff(s) : JUDICIAL SUBPOENA IN THE MATTER OF THE GUARDIANSHIP OF:____________________________________ -againstCASE NO.: ____________________ : : GUARDIAN’S REPORT Defendant(s) 2111.49) (R.C. : ...................................................... NOTE: If allotted space is inadequate to respond, write “See Exhibit” in the space and add appropriate exhibit letter sequence, then attach exhibit containing information requested for that space. THE PEOPLE OF THE STATE OF NEW YORK TO 1. This is the (circle one): 1st, 2nd, 3rd, 4th, 5th, 6th, or ___, Guardian’s Report. 2. Ward’s present address: _______________________________________________________ City ______________________________ State ________________ GREETINGS: Zip ________________ Telephone ( ____ ) ___________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before 3. above best , the Honorable Ward’s living arrangements at the at the address areCourt described as: located at own apartment of home (includes assisted living facilities). County of ( ) a. His or her in room , day of , apartment of: o'clock in the , at noon, and at any recessed ( on) the b. Private home or 20 or adjourned date, to testify and give(evidence as a witness in this action on the part of the ) (1) the ward’s guardian. ( ) (2) a relative of the ward, whose name is ___________________ _______________________ and relationship is ___________________ ( ) (3) a non-relative whose name is of court and will make you liable to Your failure to comply with this subpoena is punishable as a contempt __________________________ ( ) ( ) A issued group or boarding home. the party on whose behalf c. subpoena was foster, for a maximum penalty of $50 and all damages sustained as a this ( ) d. ( ) A nursing home. result of your failure to comply. ( ) e. ( ) A medical facility or state institution. ) f. ( ) Other (describe) ________________________________________ Witness,(Honorable , one of the Justices of the ( ) g. ( )of if c, d, e, or,f20 checked, complete the following: is Court in County, day (1) The name of the home, facility, or institution ___________________________________________________ (2) The name of an individual at the home, facility or (Attorney must sign above and type name below) institution who has knowledge and is authorized to give information to the Court about the ward. Name ______________________________________________ Attorney(s) ) ____________________________ Telephone Number ( ____ for 4. The ward will be at the address given in Item 2: ( ) a. Indefinitely. Office and P.O. Address ( ) b. Temporarily. The new address and telephone number is: ( ) (1) Unknown. I will provide this information when known. ( ) (2) ____________________________________________________________ Telephone No.: City ______________________________ State _____________________ Facsimile ( ____ ) _______________________ Zip ________________ Telephone No.: «HE28/8T− E-Mail Address: Mobile Tel. No.: PAGE 1 OF FORM 17.7 – GUARDIAN’S REPORT American LegalNet, Inc. www.USCourtForms.com COURT COUNTY5.. . Guardian’s. contact. with . . . .ward:. . . . . . . . . . . . . OF. . . . . . . . . . . . . . . . . . . the . . . . .......... : a. Approximate number of times the guardian had contact with the ward during the Index No. b. c. period covered by this report: ______________________________________. Calendar No. The nature of those contacts (phone, :personal, or other): __________________________________________________________________ : JUDICIAL SUBPOENA __________________________________________________________________ Plaintiff(s) Date the ward was last seen by the guardian: __________________________. -against: 6. Have you observed any major change in the ward’s physical or mental condition during the : period covered by this report? ( ) Yes ( ) No : If “yes” is checked, briefly describe the changes. ___________________________________________________________________________ Defendant(s) : . . . . . . . . . . . . ___________________________________________________________________________ .......................................... ___________________________________________________________________________ 7. The care given to the ward is ( ) Adequate ( ) Not Adequate THE PEOPLE OF THE STATE OF NEW YORK TO If “Not Adequate” is checked, explain. ___________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 8. The guardianship should be ( ) Continued ( ) Not Continued GREETINGS: If “Not Continued” is checked, explain. __________________________________________ ___________________________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before the Honorable ___________________________________________________________________________ , at the Court located at County of ) has ( not been at any recessed in room 9. During the period covered by this ,report, the ward ( o'clock in the) has noon, and seen by a , on the day of 20 , at physician. and give evidence as a witness in this action on the part of the or adjourned date, to testify If the ward has been seen, the last date was ______________________________ and for the Purpose of _________________________________________________________________. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Attached is a statement by a licensed physician, a licensed clinical psychologist, a licensed social the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a worker, or comply. result of your failure to a mental retardation team, that has evaluated or examined the ward within three months prior to the date of this report regarding the need for continuing the guardianship. {R.C. 2111.49(A)(1)(i)} (Form 17.1) Witness, Honorable , one of the Justices of the Court in If an attorney has been consulted on this report: County, day of , 20 Date ___________________________ ____________________________________ Attorney’s Name (Attorney must sign above and type name below) ____________________________________ Guardian’s Signature ____________________________________ (Type or print Attorney’s Name) ____________________________________ (Type or print Guardian’s Name) Attorney(s) for ____________________________________ (Street) ____________________________________ (Street) ____________________________________ (City, State, Zip Code) ____________________________________ Office and P.O. Address (______) ____________________________ Telephone Number ____________________________________ Sup. Ct. Regis. No. (______)____________________________ (City, State, Zip Code) Telephone No.: Number Telephone Facsimile No.: E-Mail Address: (KNOWINGLY GIVING FALSE INFORMATION ON AMobile Tel. No.: PROBATE DOCUMENT IS A CRIMINAL OFFENSE.) PAGE 2 OF FORM 17.7 – GUARDIAN’S REPORT American LegalNet, Inc. www.USCourtForms.com