IN THE PROBATE COURT OF MONTGOMERY COUNTY, OHIO ALICE O. McCOLLUM, JUDGE IN THE MATTER OF: CASE NO. __________________ ________________________ APPLICATION TO APPROVE DESIGNATION OF SUCCESSOR CUSTODIAN (R.C. 5814.07(E)) __________________________________________________________ Applicant says that _____________________________was named as a custodian under the Ohio Transfer to Minors Act (R.C. 5814.01 - 5814.09) for ________________________ _______________________________, a minor, born on _______________________ as to the following described bank account and/or brokerage account: (List name of financial institution, type of account, and account number.) Applicant further states that the custodian passed away on the _________ day of ________________________(Month), ________(Year). (Attach Copy of Death Certificate) Applicant further states that he/she is/is not (circle one) the Executor/Administrator of the custodian’s probate estate. Applicant further states that no successor custodian has been named by the application that established the above account and that the Last Will and Testament of the original custodian does not name a successor custodian to serve on the above noted account. Applicant is or is not (circle one) related to the minor child by being his/her _______________________. Applicant further states that there is or is not (circle one) a legal guardian appointed by a court for the above minor and that the minor’s natural parents are: _______________________________ and ____________________________. Applicant further states that the minor resides at: _____________________________ _____________________________________________________________________________. Applicant requests __________________________ to be appointed as successor custodian and moves this Court for an order to approve the designation of the above person as successor custodian for the above account(s) in accordance with R.C. 5814.07(E). Page 1 of 2 M.C. FORM 4A - APPLICATION TO APPROVE DESIGNATION OF SUCCESSOR CUSTODIAN 09/15/05 American LegalNet, Inc. www.FormsWorkflow.com CASE NAME______________________________CASE NO. ______________ Applicant further states that the consents of the minor’s natural parents and/or legal guardian are or are not (circle one) attached o this application. (Consents are required or application must be set for hearing with notice to the non-consenting legal guardian and/or natural parent.) _____________________________________ Sign Name _____________________________________ Print Name/Title _____________________________________ Address _____________________________________ (______) _____________________________ Telephone Number Page 2 of 2 M.C. FORM 4A - APPLICATION TO APPROVE DESIGNATION OF SUCCESSOR CUSTODIAN 09/15/05 American LegalNet, Inc. www.FormsWorkflow.com