PROBATE COURT OF COUNTY, OHIO JAMES A. FREDERICKA JUDGE GUARDIANSHIP OF__________________________________________________ CASE NO. _______________________ APPLICATION FOR APPOINTMENT OF GUARDIAN OF ALLEGED INCOMPETENT [R.C. 2111.03] Applicant represents to the Court that __________________________________________ resides or has a legal settlement at ________________________________________ in __________________ County, Ohio and that the prospective ward is incompetent by reason of (R.C. 2111.01(D)) _____________________________________ __________________________________________________________________________________________. The proposed ward's date of birth is _____________________________________________________________. A Statement of Expert Evaluation is attached. (Form 17.1) A list of Next of Kin of Proposed Ward is also attached. (Form 15.0) The whole estate of the prospective ward is estimated as follows: Personal Property.....................$________________________ Real Estate..............................$________________________ Annual Rents............................$________________________ Other annual income.................$________________________ Applicant represents that the applicant is not an administrator, executor or other fiduciary of the estate wherein the alleged incompetent is interested. Applicant offers the attached bond in the amount of $ ________________________. Applicant further represents that a guardian of the alleged incompetent is necessary in order that the ward ward's property may be taken proper care of and asks that a guardian be appointed. TYPE OF GUARDIANSHIP APPLIED FOR IS [check the applicable boxes] non-limited limited person and estate estate only person only If limited guardianship is applied for, the limited powers requested are __________________________________________________________________________________________ __________________________________________________________________________________________. FORM 17.0 ­ APPLICATION FOR APPOINTMENT OF GUARDIAN (AN ALLEGED INCOMPETENT) Amended: January 1, 2013 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com [Reverse of Form 17.0] CASE NO.______________ The time period requested is indefinite definite to __________________________________________ __________________________________________________________________________________________. Applicant's relationship to alleged incompetent is ____________________________________________ __________________________________________________________________________________________. The Applicant has (not) been charged with or convicted of a crime involving theft, physical violence, or sexual, alcohol or substance abuse except as follows (if applicable, state date and place of each charge or each conviction.) __________________________________________________________________________________________ __________________________________________________________________________________________. The Applicant represents that a guardian has been nominated in a writing pursuant to R.C. 1337.09(D) or R.C. 2111.121. The nominated person is _________________________________________________. The nominated person's contact information is listed on Form 15.0 (Next of Kin). A copy of the document which nominates the guardian is attached. The Applicant represents that the proposed ward had military service. Military I.D.:______________________________________________ Branch of service:_________________________________________ Dates of service:__________________________________________ Applicant represents that the address provided is the applicant's permanent address and acknowledges the requirement that the court be notified of any change of address. Removal may result from a failure to comply with this requirement. Applicant is currently guardian for the following number of wards: Person & Estate Person Only Estate Only ______________________________________ Attorney for Applicant ______________________________________ Typed or Printed Name ______________________________________ Address ______________________________________ City State Zip ______________________________________ Telephone Number (include area code) Attorney Registration No.__________________ _____________________________________ Applicant _____________________________________ Typed or Printed Name _____________________________________ Age ______________________________________ Permanent Address _____________________________________ City State Zip _____________________________________ Telephone Number (include area code) FORM 17.0 ­ APPLICATION FOR APPOINTMENT OF GUARDIAN (AN ALLEGED INCOMPETENT) PAGE 2 Amended: January 1, 2013 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com