PROBATE COURT OF SHELBY COUNTY, OHIO GUARDIANSHIP OF CASE NO. , A MINOR NOTICE TO PARENTS You, as a parent, are required by law to provide for the care, nurture, welfare, support and education of your minor child(ren). Funds and/or assets your minor receives as a result of an insurance settlement, inheritance, or other source belong to your minor child(ren). These funds and/or assets may not be used by you to provide for the care, nurture, welfare, support and education of your minor child(ren) except under extraordinary circumstances. You will be required to prove extraordinary circumstances by means of an affidavit of income and expenses and other documentation the Court may require before the Court will release any funds and/or assets belonging to your minor child(ren). Date Date Mother Father NOTICE TO NON-PARENT GUARDIAN/CUSTODIAN All funds and/or assets' a minor receives through an insurance settlement, inheritance, or other source belong to the minor. You, as a non-parent guardian/custodian, may not use the funds and/or assets without first receiving court approval. Before the Court approves any request, you must first submit an application accompanied by documentation supporting your request. Further, before the Court approves an application for expenditures, the Court will review all resources available to the minor, including parental resources, if any. Date Date Guardian Custodian American LegalNet, Inc. www.FormsWorkFlow.com H.C. FORM 116.90 - NOTICE TO PARENTS AND NON -PARENT GUARDIANS/CUSTODIANS 02/10/03