PROBATE COURT OF WOOD COUNTY, OHIO David E. Woessner, Judge In the Matter of the CONSERVATORSHIP of:__________________________________________ Case No. _____________________________ APPLICATION FOR APPOINTMENT OF CONSERVATOR (R.C. 2111.021) I, _______________________________________________, Petitioner, hereby state that I am a competent adult but am physically infirm. I request that: 1. Name of Proposed Conservator _______________________________________________________________ Street ___________________________________________________________________________________ City ____________________________, Ohio (Zip) ______________ Telephone (_____)______________ be appointed conservator of my: Person and Estates 2. Estate Only The length (time period) of the conservatorship is: Indefinite 3. Person Only Definite – to ______________________________________ , ________ (If “Person Only” or Person and Estate” is checked), I give the following power over my PERSON to the: a. Conservator: (1) All powers that a guardian would have under the guardianship laws of Ohio. (2) Limited to the power to ____________________________________________________________ _______________________________________________________________________________ __________________________________________________________________ b. Court: (1) All powers that a Court would have under the guardianship laws of Ohio. (2) Limited to the power to ____________________________________________________________ _______________________________________________________________________________ __________________________________________________________________ 4 (If “Estate Only” or “Person and Estate” is checked), I give the following power over my ESTATE to the: a. Conservator: (1) All the powers that a guardian would have under the guardianship laws of Ohio. (2) Limited to the power to ____________________________________________________________ _______________________________________________________________________________ __________________________________________________________________ b. Court: (1) All powers that a Court would have under the guardianship laws of Ohio. (2) Limited to the power to ____________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ FORM 20.0 – APPLICATION FOR APPOINTMENT OF CONSERVATOR Crensch$\forms\20.0 8/00 American LegalNet, Inc. www.USCourtForms.com c. The following of my property is subject to the foregoing powers: (1) All property, (attach description of property) (2) Only the property listed as follows: ___________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 5. If the application is for a conservatorship of the estate: a. The estate to be placed under conservatorship is: Personal Property $__________________ Real Property $__________________ Annual Rents $__________________ Other Annual Income $__________________ TOTAL…………………..$ b. 6. A bond in the amount of $_________________ is attached. (R.C. 2109.04(A)(1)) (Form 15.3) Service of notice of the conservatorship is to be given to: None Same as Guardianship As listed on Form 15.0 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 to the best of my knowledge and belief. _______________________________ Date __________________________________ _______________________________ Attorney for Applicant Applicant __________________________________ _______________________________ Typed or Printed Name Typed or Printed Name Address: __________________________ Address: _______________________ __________________________________ _______________________________ __________________________________ _______________________________ Phone Number (Include area code) Phone Number (Include area code) __________________________________ Attorney Registration Number American LegalNet, Inc. www.USCourtForms.com