PROBATE COURT OF WOOD COUNTY, OHIO David E. Woessner, Judge In the Matter of the GUARDIANSHIP of:___________________________________________________ Case No. _____________________________ Date:_______________________ APPLICATION FOR APPOINTMENT OF EMERGENCY GUARDIAN OF ALLEGED INCOMPETENT (R.C. 2111.02) The applicant represents to the Court that _________________________________________ aged _____ years, 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 applicant further represents that an emergency exists and that it is reasonably certain that immediate action is required to prevent significant injury to the person or estate of the proposed ward. A Statement of Expert Evaluation is attached. (Form 17.1) A List of Next of Kin of the Proposed Ward is also Attached (Form 15.0), however, applicant requests that the Court act ex parte, without notice because of the emergency existing. The whole estate of the prospective ward is estimated as follows: Personal property $_________________ Real estate $_________________ Annual rents $_________________ Other annual income $_________________ The applicant represents that ______ is not an administrator, executor, or other fiduciary of the estate wherein the alleged incompetent is interested. The applicant further represents that a guardian of the alleged incompetent is necessary in order that ____ the ward ____ ward’s property may be taken proper care of and asks that guardian be appointed. PRESENT LOCATION OF WARD: ______________________________________________________________________ Street ___________________________________________________________________________________________________ City State Zip Code TYPE OF GUARDIANSHIP APPLIED FOR IS EMERGENCY _____ limited _____person and estate _____estate only _____person only The limited powers requested are _________________________________________________________________ ___________________________________________________________________________________________________ The time period requested is from ___________________ to ___________________. The applicant’s relationship to alleged incompetent is _____________________________. FORM 30.0 - APPLICATION FOR APPOINTMENT OF EMERGENCY GUARDIAN OF ALLEGED INCOMPETENT Crensch$\forms\30.0.doc 2/6/01 American LegalNet, Inc. www.USCourtForms.com 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.) ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ __________________________________________ Attorney for Applicant ____________________________________ Applicant __________________________________________ Typed or Printed Name ____________________________________ Typed or Printed Name Address____________________________________ Age_________________________________ ___________________________________ Address______________________________ Phone No. _________________________________ ______________________________ Attorney Registration No.______________________ Phone No.____________________________ KNOWINGLY GIVING FALSE INFORMATION ON A PROBATE DOCUMENT IS A CRIMINAL OFFENSE [R.C. 2921.13 (A)] American LegalNet, Inc. www.USCourtForms.com