COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE:::::::Index No.Calendar No.[] CONSERVATORSHIP OF [JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)] GUARDIANSHIP OF [ ] ESTATE OF [ ] MISCELLANEOUSINCOMPETENT [] TRUST OF , DECEASED CASE NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SWORN STATEMENT IN LIEU OF AND FOR AACCOUNTTHE PEOPLE OF THE STATE OF NEW YORK TOThe undersigned, as (Name of fiduciary)(Title)of theof (Type of case)(Names of decedent, ward, etc.)GREETINGS:being first duly sworn, deposes and says that:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomWherefore, it is requested that this statement be accepted by the Court in lieu of and for a account and thatYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.[ ] The case be closed and bondsman, if any discharged [ ] The case be continued for the filing of an account on or before, one of the Justices of theCourt in Witness, Honorableday of, 20 County,Fiduciary(Attorney must sign above and type name below)STATE OF OHIO COUNTY OF LUCAS Sworn to before me and subscribed in my presence this day of20.Attorney(s) forOffice and P.O. AddressNOTARY PUBLIC 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.Telephone No.: Facsimile No.: E-Mail Address:«24.e[- «24.e[- «24.e[- «24.e[- FORM LCPC 13-D STATEMENT IN LIEU OF ACCOUNTMobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com