PROBATE COURT OF STARK COUNTY, OHIO DIXIE PARK, JUDGE IN THE MATTER OF THE GUARDIANSHIP OF __________________________________ CASE NO. ___________ NOTICE OF HEARING ON APPLICATION FOR APPOINTMENT GUARDIAN OF MINOR To Parent, Known Next of Kin and Person Having Custody [R.C. 2111.04] To _____________________________________________________________________________________ Address ________________________________________________________________________________ To _____________________________________________________________________________________ Address ________________________________________________________________________________ To _____________________________________________________________________________________ Address ________________________________________________________________________________ You are hereby notified that _____________________________________________________ filed in this Court an application for appointment of a (limited) guardian of the (person and estate) of the minor. The application will be for hearing before the Stark County Probate Court located at 110 Central Plaza South, Suite 501, Canton, Ohio 44702-1413 On the ___________ day of _________________________, 20____ at _______________ o'clock ______.M. Witness my signature and the seal of the Court, this ______ day of ______________, 20_____ (Seal) Probate Judge By: Deputy Clerk DIXIE PARK FORM 16.4 NOTICE OF HEARING ON APPLICATION FOR APPOINTMENT GUARDIAN OF MINOR TO PARENT, KNOWN NEXT OF KIN AND PERSON HAVING CUSTODY Amended: March 15, 2016 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com (Reverse of Form 16.4) CASE NO. ___________ RETURN __________________County, Ohio _____________________, 20_____ Received this writ on the________day of __________________________________, 20___, at _________o'clock ___.M., and on the day of __________________________________, 20___, I served the same by delivering a true copy thereof personally to ______________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ ______________________________________ ____________Fees______________________ Service and return, 1st name $______________ ________Additional names, at______________ ________Miles traveled, at ________________ ______________________________________ ______________________________________ Sheriff ______________________________________ Deputy ______________________________________ ______________________________________ ______________________________________ ______________________________________ Total $ _________________ AFFIDAVIT OF SERVICE The State of Ohio, ___________________________ County. _________________________________________________, being first duly sworn, says that on the __________ day of _____________________, 20_____, the within notice was served by delivering a true copy thereof personally to _________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Sworn to before me and signed in my presence, this _______ day of ____________________________, 20____ ______________________________________ ______________________________________ FORM 16.4 NOTICE OF HEARING ON APPLICATION FOR APPOINTMENT GUARDIAN OF MINOR TO PARENT, KNOWN NEXT OF KIN AND PERSON HAVING CUSTODY Amended: March 15, 2016 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com