PROBATE COURT OF SUMMIT COUNTY, OHIO ELINORE MARSH STORMER, JUDGE IN THE MATTER OF GUARDIANSHIP OF CASE NO. ADDENDUM TO APPLICATION FOR APPOINTMENT OF GUARDIAN (Attach to Application for Appointment of Guardian for Incompetent, Form 17.0) 1. Why is Guardianship necessary? 2. Information concerning Guardian/Applicant: Name Occupation Work Address Work Phone 3. Information concerning Ward: a. Full Name and AKA b. Nickname c. Age d. Male Female e. Ward's Present Address (Location) City County Telephone f. State Zip Ward's Legal Settlement or Residence, if different than ward's present address (above): Address City State County Zip Telephone g. Ward's living arrangements at present address are best described as: (1) (2) His/her own apartment or home (includes assisted living facilities). Private home or apartment of: (a) (b) the Ward's guardian. a relative of the ward, whose name is and whose relationship is (c) a non-relative whose name is FORM GA.6 ­ ADDENDUM TO APPLICATION FOR APPOINTMENT OF GUARDIAN PAGE 1 OF 4 www.FormsWorkFlow.com Rev. 01/13/2016 American LegalNet, Inc. CASE NO. 3. g. (Continued) (3) (4) (5) (6) (7) A foster, group, or boarding home. A nursing home. A medical facility or state institution. Other (describe): If either (3), (4), (5), or (6) is checked, complete the following: (a) The name of the home, facility or institution: (b) The name of an individual at the home, facility, or institution who has knowledge, and is authorized to give information to the Court about the ward. Name Telephone Number h. The ward will be at the address given in Item 3-f: (1) (2) Indefinitely. Temporarily. The new address and telephone number is: (a) (b) Unknown. I will provide this information when known. City Telephone State Zip i. List any problems the alleged incompetent may have in communicating: j. Name of a contact person to arrange for service of notice of guardianship on the ward by court investigator: Name Home Phone Work Phone Name any agencies already involved with the proposed ward. AGENCY CONTACT PERSON k. TELEPHONE NO. FORM GA.6 ­ ADDENDUM TO APPLICATION FOR APPOINTMENT OF GUARDIAN PAGE 2 OF 4 American LegalNet, Inc. www.FormsWorkFlow.com Rev. 01/13/2016 CASE NO. l. Does the proposed ward have: (1) Power of Attorney? (2) Health Care Power of Attorney (3) Advance Directive or Living Will? (4) Last Will and Testament? Yes Yes Yes Yes No No No No (If yes, attach copy.) (If yes, attach copy.) (If yes, attach copy.) (If yes, attach copy.) (If yes, where is it located?) 4. Information concerning finances of Ward: a. Specifically, is the ward eligible for, or receiving, any of the following benefits, and, if so, what corporation or organization is the source of the funds? AMOUNT TYPE PER MONTH Social Security Public Employees Retirement System Veterans Administration Railroad Retirement (Name) Employee's Pension (Name) Insurance Benefits (Name) Other (Name) b. Does the prospective ward have an interest in an estate or trust? Yes No If so, give the decedent's name, Court case number, name and location of Court, or the trustee, etc. c. Cash? Yes Yes No No ADDRESS ACCOUNT Amount d. Bank Accounts? INSTITUTION AMOUNT e. Securities? ISSUER Yes No MARKET VALUE FORM GA.6 ­ ADDENDUM TO APPLICATION FOR APPOINTMENT OF GUARDIAN PAGE 3 OF 4 American LegalNet, Inc. www.FormsWorkFlow.com Rev. 01/13/2016 CASE NO. f. Land Installment Contracts? VENDEE and ADDRESS Yes No PROPERTY LOCATION AMT. PER MONTH AND BALANCE g. Real Estate? Yes No MARKET VALUE PROPERTY LOCATION h. Rental from Real Estate? Yes No AMT. PER MONTH ADDRESS OF REAL ESTATE i. Income from any other source? Yes No j. Titled Motor Vehicles? VEHICLE MAKE Yes No MODEL YEAR VALUE k. Pre-need Funeral/Burial? Describe: Yes No Date Applicant Signature Applicant Print or Type Name American LegalNet, Inc. www.FormsWorkFlow.com FORM GA.6 ­ ADDENDUM TO APPLICATION FOR APPOINTMENT OF GUARDIAN PAGE 4 OF 4 Rev. 01/13/2016