PROBATE COURT OF MONTGOMERY COUNTY, OHIO ALICE O. McCOLLUM, JUDGE GUARDIANSHIP OF: CASE NO.: APPLICATION FOR APPOINTMENT OF EMERGENCY GUARDIAN [R.C. 2111.02(B)(3)] INSTRUCTIONS: Provide the requested information and sign on the Applicant's Signature blank. I have filed an application to be appointed the guardian of the (person and estate) of the abovenamed proposed ward. An emergency exists and it is reasonably certain that immediate action is required to prevent significant injury to the person and/or estate of the proposed ward. More specifically, without immediate action, the proposed ward or the proposed ward's property will be injured as follows: M.C. FORM 17.03 ­ APPLICATION FOR APPOINTMENT OF EMERGENCY GUARDIAN 6/1/16 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. ____________________ Based on the above, I am requesting that the Court appoint me as the emergency guardian of the person and/or estate of the proposed ward, without notice to the proposed ward and next of kin. __________________________________________ Attorney's Signature __________________________________________ Attorney's Printed Name __________________________________________ Address __________________________________________ City State Zip Code __________________________________________ Telephone Number __________________________________________ Attorney Registration Number __________________________________________ Applicant's Signature __________________________________________ Applicant's Printed Name __________________________________________ Address __________________________________________ City State Zip Code __________________________________________ Telephone Number __________________________________________ Applicant's Email Address M.C. FORM 17.03 ­ APPLICATION FOR APPOINTMENT OF EMERGENCY GUARDIAN 6/1/16 American LegalNet, Inc. www.FormsWorkFlow.com