Conservatorship Credibility Application {20.0G}

PC-C-20.0G (REV. 3-2001) PROBATE COURT OF FRANKLIN COUNTY, OHIO ROBERT G. MONTGOMERY, JUDGE LAWRENCE A. BELSKIS, JUDGE IN THE MATTER OF THE CONSERVATORSHIP OF CASE NO. CONSERVATORSHIP CREDIBILITY APPLICATION Name of Conservatee Name of Conservator to be Appointed Prospective Conservators Current Address Previous Address (5 yrs. only) Previous Address (5 yrs. only) Spouses Name Address Case No. Age From What Date From What Date to What Date From What Date to What Date Years Married to This Spouse From What Date From What Date to What Date From What Date to What Date [ ] Checking [ ] Savings [ ] Safe Deposit Box [ ] Checking [ ] Savings [ ] Safe Deposit Box [ [ [ [ [ ] ] ] ] ] Yes Yes Yes Yes Yes [ [ [ [ [ ] ] ] ] ] No No No No No Prospective Conservators Employer Previous Employer (5 yrs. only) Previous Employer (5 yrs. only) Name of Prospective Conservators Bank Name of Prospective Conservators Bank Has Conservator Ever Filed Bankruptcy? Has Conservator Ever Been Garnisheed? Has Conservator Ever Been in Receivership? Has Conservator Ever Been Convicted for a Felony? Has Conservator Had Experience in Handling Investments in Marketable Securities? Set Forth that Experience This statement is made in support of my application to be appointed conservator in the above styled matter and the undersigned says that the facts stated in the foregoing application are true. Signature of Prospective Conservator FRANKLIN COUNTY FORM 20.0G - CONSERVATORSHIP CREDIBILITY APPLICATION American LegalNet, Inc. www.FormsWorkFlow.com