PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE IN THE MATTER OF: CASE NO.: MOTION TO PROCEED IN FORMA PAUPERIS Now come and respectively m the undersigned petitioner and attorneyove this Court to proceed in the above-entitled ( Guardianship,  Conservatorship,  Full Administration,  Relief from Administration,  Other: ) without prepayment of Probate Court fees or costs or to give security therefore. Petitioner understands that prepayment is still necessary, and that he / she will remain obligated to pay the costs, if any, of newspaper publication, foreign sheriff service, and other actual expenses which Probate Court incurs during the pendency of this case. In support of this motion, the following circumstances apply: (Check all boxes, which are applicable)  The petitioner, because of poverty, is unable to pay the costs of said proceeding or give security therefore. (See attached affidavit).  The petitioner is an unpaid volunteer, who seeks to establish a guardianship over an individual who is believed to be in poverty. Said volunteer agrees not to accept any fees or commissions, except from the Courts Indigent Guardianship Fund, after application.  Although the petitioner is unable, because of poverty, to prepay court costs at this time, it is anticipated that same can be paid out of the decedents / wards estate after a fiduciary is appointed. (See attached affidavit).  Other: D.2+- PAGE 1 OF FORM LUCAS COUNPTY R OBATECOUR-T C-1 MODIFIED MOTION TO PROCEED IN FORMA PAUPERIS EFF: 6/05 American LegalNet, Inc.American LegalNet, Inc. www.USCourtForms.comwww.USCourtForms.com>>>> 2 CASE NO.: The following circumstances apply to counsel fees: (Check one of the following boxes)  This matter is being handled by an attorney associated with a pro bono, legal aid, or legal services program, and there will be no counsel fees charged for this matter.  This matter is being handled by a private attorney, who agrees not to accept any counsel fees for this matter except from the Indigent Guardianship Fund, or upon order of the Court. Please type: Signatures: Petitioners Name Petitioner Petitioners Address Attorney Petitioners Phone Number Attorneys Name Attorneys Address Attorneys Phone Number Attorneys Registration Number 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. PAGE 2 OF FORM LUCAS COUNPTY R OBATECOUR T - C MODIFIED-1 MOTION TO PROCEED INF ORMA PAUPERIS American LegalNet, Inc.American LegalNet, Inc. www.USCourtForms.comwww.USCourtForms.com