PROBATE COURT OF MONTGOMERY COUNTY, OHIO ALICE O. McCOLLUM, JUDGE GUARDIANSHIP OF ____________________________________________________ CASE NO. __________________________ APPLICATION FOR APPOINTMENT OF GUARDIAN OF ALLEGED INCOMPETENT [R.C. 2111.03] Applicant represents to the Court that ________________________________ aged ______ years, resides or has a legal settlement at ________________________in _____________ County, Ohio and that the prospective ward is incompetent by reason of (R.C. 2111.01(D)) _______________ ______________________________________________________________________________. A Statement of Expert Evaluation is attached. (Form 17.1) A list of Next of Kin of Proposed Ward is also attached. (Form 15.0) The whole estate of the prospective ward is estimated as follows: Personal Property…………….….$ ________________________ Real Estate……………………....$________________________ Annual Rents…………………....$ ________________________ Other annual income………….…$ ________________________ Applicant represents that the applicant is not an administrator, executor or other fiduciary of the estate wherein the alleged incompetent is interested. Applicant offers the attached bond in the amount of $ __________________. Applicant further represents that a guardian of the alleged incompetent is necessary in order that the ward the ward's property may be taken proper care of and asks that a guardian be appointed. TYPE OF GUARDIANSHIP APPLIED FOR IS [check the applicable boxes] non-limited limited person and estate estate only person only If limited guardianship is applied for, the limited powers requested are ______________________________________________________________________________ ______________________________________________________________________________. FORM 17.0 – APPLICATION FOR APPOINTMENT OF GUARDIAN (AN ALLEGED INCOMPETENT) Eff. Date March 1, 2008 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO.__________________ The time period requested is indefinite definite to ________________________________ ______________________________________________________________________________. Applicant's relationship to alleged incompetent is ______________________________________ ______________________________________________________________________________. The Applicant has (not) been charged with or convicted of a crime involving theft, physical violence, or sexual, alcohol or substance abuse except as follows (if applicable, state date and place of each charge or each conviction.) ______________________________________________________________________________ ______________________________________________________________________________. ____________________________________ Attorney for Applicant ____________________________________ Applicant ____________________________________ Type or Print Name ____________________________________ Type or Print Name ____________________________________ Address ____________________________________ Age __________________________________ City State Zip ____________________________________ Address ____________________________________ Phone number (include area code) __________________________________ City State Zip ____________________________________ Attorney Registration Number __________________________________ Phone number (include area code) FORM 17.0 – APPLICATION FOR APPOINTMENT OF GUARDIAN (AN ALLEGED INCOMPETENT) Eff. Date March 1, 2008 American LegalNet, Inc. www.FormsWorkFlow.com