PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE [ [ [ [ [ ] ] ] ] ] CONSERVATORSHIP OF GUARDIANSHIP OF ESTATE OF MISCELLANEOUS INCOMPETENT TRUST OF __________________________________________________________, DECEASED CASE NO. __________________________ RELEASE FOR RECORD CHECK ON PROPOSED FIDUCIARY By my signature below, I hereby authorize the release of any and all records or information that your agency may have pertaining to me to the Probate Court of Lucas County, Ohio. I further understand that my social security number, driver’s license number and birthday listed on the attached sheet shall be used for conducting the record check and upon the conclusion of the record check that the attached sheet containing my social security number, driver license number and birth date shall be destroyed. _________________ Date Signature of Fiduciary/Applicant Typed Name CONCLUSION OF RECORD CHECK _________ Records checked and found to be in order. _________ Records checked and found not to be in order. _________ Record Check Information Sheet destroyed. Record Check Information Sheet returned to attorney. _________________ Date __________________________________ Deputy Clerk 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. _____________________ Attorney Ohio Supreme Court Number «ssdqgy− LCPC FORM – RRCPF – RELEASE FOR RECORD CHECK ON PROPOSED FIDUCIARY EFF. 10/01/2005 American LegalNet, Inc. www.USCourtForms.com RECORD CHECK INFORMATION SHEET Name: Address: Date of Birth: Social Security Number: Driver License Number: LCPC FORM – RRCPF – RELEASE FOR RECORD CHECK ON PROPOSED FIDUCIARY EFF. 10/01/2005 American LegalNet, Inc. www.USCourtForms.com