Receipt {27.12}

PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE GUARDIANSHIP OF: ______________________________________________________________ CASE NO.: _______________________ RECEIPT [R.C. 2111.011] I hereby acknowledge receipt of the Guardian's Guidebook. _________________________________ Guardian's Printed Name _________________________________ Guardian's Signature _________________________________ Street _________________________________ City State Zip Code _________________________________ Telephone Number (including area code) FORM 27.12 - GUARDIAN RECEIPT Effective Date: March 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com