PROBATE COURT OF SHELBY COUNTY, OHIO CONSERVATORSHIP OF CASE NO. LETTERS OF CONSERVATORSHIP is appointed Conservator of As Conservator, his/her powers are: 1. 2. All powers conferred by the Guardianship laws of Ohio and the Rules of this Court over the conservatee's: Person Only Estate Only Person and Estate Those guardianship powers, until revoked, are for an: Indefinite time period Definite time period to The Conservator's powers are limited to: . 3. 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 Probate Judge NOTE 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. Page 1 of 2 FORM 20.2 - LETTERS OF CONSERVATORSHIP 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. Probate Judge by Deputy Clerk Date (SEAL) Page 2 of 2 FORM 20.2 - LETTERS OF CONSERVATORSHIP American LegalNet, Inc. www.FormsWorkFlow.com