PROBATE COURT OF MONTGOMERY COUNTY, OHIO ALICE O. McCOLLUM, JUDGE CONSERVATORSHIP OF: CASE NO.: LETTERS OF CONSERVATORSHIP is appointed Conservator of As Conservator, his/her powers are: 1. All powers conferred by the Guardianship laws of Ohio and the Rules of this Court over the conservatee's: Person and Estate 2. Indefinite time period Definite time period to 3. The Conservator's powers are to limited to: Person Only Estate Only Those guardianship powers, until revoked, are for an 4. The following property of the conservatee is subject to the above power of the conservator: All property Only the property listed as follows: The above-named Conservator has the power conferred by law to do and perform all the duties of Conservator as described DATE ALICE O. McCOLLUM, PROBATE JUDGE NOTICE TO FINANCIAL INSTITUTIONS Funds being held in the name of the within-named Conservatee shall not be released to Conservator without a Court Order directing release of a specific fund and amounts thereof. FORM 20.2 ­ LETTERS OF CONSERVATORSHIP 6/1/16 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO.____________________ CERTIFICATE OF APPOINTMENT AND INCUMBENCY This document is a true copy of the original kept by me as custodian of this Court. It constitutes the appointment and letters of authority of the named Conservator, who is qualified and acting in such capacity. (Seal) ALICE O. McCOLLUM, PROBATE JUDGE By: Deputy Clerk Date FORM 20.2 ­ LETTERS OF CONSERVATORSHIP 6/1/16 American LegalNet, Inc. www.FormsWorkFlow.com