M.C. Form 5.1 IN THE PROBATE COURT OF MAHONING COUNTY, OHIO JUDGE ROBERT N. RUSU, JR. IN THE MATTER OF THE GUARDIANSHIP CASE NO.: A PROPOSED WARD AFFIDAVIT OF INDIGENCY STATE OF COUNTY OF Now comes , the Affiant herein, who, after first being 1. That the proposed Ward is a resident of Mahoning County and resides at: and their phone number is: . The proposed Ward222s date of birth is: . 2. That Applicant222s relationship3. That a guardianship is necessary to protect the proposed Ward for the reason that: . 4. That the proposed Ward222s assets/income are as follows . (Note: Affiant must list the source of the asset/income, the amount, and frequency of which received) 5. That neither the proposed Ward, nor any person acting for him/her under any power of attorney or otherwise, has transferred or conveyed, in trust or otherwise, any American LegalNet, Inc. ww Case No. Page 2 of 2 M.C. Form 5.1 consideration. 6. I hereby certify that the information on this Affidavit is true and to the best of my knowledge and I further attest that the proposed Ward is without sufficient funds to retain legal Counsel for the establishment of a Guardian. AFFIANT FURTHER SAYETH NAUGHT. Affiant Signature Full Address (No P. O. Boxes) City, State, Zip Code Area Code/Phone SWORN TO and SUBSCRIBED in my presence by , the above Affiant, who swears and affirms that the facts contained within the foregoing Affidavit are true and based upon his/her personal knowledge, information and/or belief. Notary Public American LegalNet, Inc. www.FormsWorkFlow.com