COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.PROBATE COURT OF STARK COUNTY, OHIOJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)IN THE MATTER OF THE CONSERVATORSHIP OF CASE NO.APPLICATION FOR APPOINTMENT OF CONSERVATOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(R.C. 2111.021), Petitioner, hereby state that I am a competentI, adult but am physically infirm. I request that:THE PEOPLE OF THE STATE OF NEW YORK TO1.Name of Proposed Conservator StreetCity, Ohio (Zip)Telephone () be appointed conservator of my:GREETINGS:Person and EstatePerson OnlyEstate OnlyWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the HonorableThe length (time period) of the conservatorship is: 2.,IndefiniteDefinite -t o20located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in room3.(If Person Only or Person and Estate is checked), I give the following power over my PERSON t o the:a. Conservator:(1) All powers that a guardian would have under the guardianship laws of Ohio. (2) Limited t o the power t oYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.b. Court:(1) All powers that a Court would have under the guardianship laws of Ohio. (2) Limited t o the power t o, one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)4.Attorney(s) for(If Estate Only or Person and Estate is checked), I give the following power over my ESTATE t o the:a. Conservator:(1) All powers that a guardian would have under the guardianship laws of Ohio. (2) Limited t o the power t oOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:20.0 APPLICATION FOR APPOINTMENT OF CONSERVATORAmerican LegalNet, Inc. www.USCourtForms.comCOUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.b. Court:(1) All powers that a Court would have under the guardianship laws of Ohio. (2) Limited to the power t oJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)c. The following of my property is subject t o the foregoing powers: (1) All property. (attach description of property) (2) Only the property listed as follows:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TO5.If the application is for a conservatorship of the estate: a. The estate t o be placed under conservatorship is:Personal Property$Real Property$GREETINGS:Annual Rents$Other Annual Income$WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,TOTAL$located at County ofis attached. (R.C. 2109.04(A)(1 ))(Form 15.3)b. A bond in the amount of $o'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomService of notice of the conservatorship is to be given to:6.NoneSame as GuardianshipAs Listed on Form 15.0Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.Based on the foregoing information, I do hereby petition the Court to appoint a Conservator for myself, and do so freely and of my own will. I certify that all information and statements contained in this application and the attached exhibits are correct t o the best of my knowledge and belief., one of the Justices of theDateCourt in Witness, Honorableday of, 20 County,Applicant's SignatureAttorney's Signature(Attorney must sign above and type name below)(Typed or Print Applicant's Name)(Typed or Print Attorney's Name)Attorney(s) for(Street)(Street)(City, State, Zip Code)(City, State, Zip Code) (Office and P.O. Address)) (Telephone Number -Include Area Code):-Telephone Number -Include Area Code) 1 (Telephone No.: Facsimile No.: E-Mail Address:Supreme Court Registration NumberMobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com