PROBATE COURT OF MONTGOMERY COUNTY, OHIO ALICE O. McCOLLUM, JUDGE GUARDIANSHIP OF: CASE NO.: LETTERS OF GUARDIANSHIP [R.C. 2111.02] is appointed Guardian of , an Incompetent Guardian's powers are: All powers conferred by the laws of Ohio and rules of this Court over the ward's Minor. Person and Estate Limited to Person Only Estate Only Those guardianship powers, until revoked, are for an Indefinite time period Definite time period to The above-named Guardian has the power conferred by law to do and perform all the duties of Guardian as described. No expenditures shall be made without prior Court authorization. __________________________________________ DATE __________________________________________ ALICE O. McCOLLUM, PROBATE JUDGE NOTICE TO FINANCIAL INSTITUTIONS Funds being held in the name of the within-named Ward shall not be released to Guardian without a Court order directing release of a specific fund and amounts thereof. CERTIFICATE OF APPOINTMENT AND INCUMBENCY The above 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 guardian, who is qualified and acting in such capacity. (Seal) ALICE O. McCOLLUM, PROBATE JUDGE By: Deputy Clerk Date FORM 15.4 ­ LETTERS OF GUARDIANSHIP American LegalNet, Inc. www.FormsWorkFlow.com 6/1/16