PROBATE COURT OF MONTGOMERY COUNTY, OHIO ALICE O. McCOLLUM, JUDGE GUARDIANSHIP OF: CASE NO.: NEXT OF KIN OF PROPOSED WARD [R.C. 2111.04] (NOTE: Specify the age and birthdate of each minor under 16 on the line containing the minor's name. List the name and address of the minor's parent, guardian or custodian on the name and address lines following the minor's address.) Service Waived 1. Name Address 2. Name Address 3. Name Address 4. Name Address 5. Name Address 6. Name Address 7. Name Address 8. Name Address 9. Name Address 10. Name Address Zip Zip Zip Zip Zip Zip Zip Zip Zip Zip Relationship Birthdate of minor Date Applicant's Signature FORM 15.0 ­ NEXT OF KIN OF PROPOSED WARD 6/1/16 American LegalNet, Inc. www.FormsWorkFlow.com