PROBATE COURT OF WARREN COUNTY, OHIO IN THE MATTER OF GUARDIANSHIP OF ___________________________________ Case No. __________________Docket _________________Page __________________ LETTERS OF EMERGENCY GUARDIANSHIP (72 Hours) _________________________________________________________________________ is appointed Guardian of __________________________________________________________________, an ____ Incompetent ____ Minor Guardian's powers are: All powers conferred by the laws of Ohio and rules of this Court over the ward's: ____ Person and Estate Limited to: ____ Person Only ____ Estate Only consenting or withholding consent for medical treatment and personal care; authorizing hosipitalization or other residential institutionalization. __________________________________________________________________________________ _________________________________________________________________________________. Those guardianship powers, until revoked, are for an: ____ Indefinite time period ____ Definite time period to 72 hours from date of appointment The above-named Guardian has the power conferred by law to do and perform all the duties of Guardian as described. No expenditures shall be made without prior Court authorization. ________________________________ Date _____________________________________________ Probate Judge NOTICE TO FINANCIAL INSTITUTIONS Funds being held in the name of the within-named Ward shall not be released to Guardian without a Court order directing release of a specific fund and amounts thereof. CERTIFICATE OF APPOINTMENT AND INCUMBENCY The above document is a true copy of the original kept by me as custodian of this Court. It constitutes the appointment and letters of authority of the named guardian, who is qualified and acting in such capacity. ________________________________________ Probate Judge by ________________________________________ Deputy Clerk ________________________________________ Date American LegalNet, Inc. www.USCourtForms.com