Application For Appointment Of Co-Guardian Of Incompetent {17.0B}

PC-G-17.0B (Rev. 1-2001) PROBATE COURT OF FRANKLIN COUNTY, OHIO ROBERT G. MONTGOMERY,JUDGE LAWRENCE A. BELSKIS, JUDGE IN THE MATTER OF THE GUARDIANSHIP OF CASE NO. APPLICATION FOR APPOINTMENT OF CO-GUARDIAN OF INCOMPETENT INFORMATION CONCERNING PROSPECTIVE CO-GUARDIAN / CO-APPLICANT: A. Name and AKA Home Address City, Sate, Zip Code Telephone Number: D.O.B. Home Work Relationship to Alleged Incompetent Do you currently act as any of the following for the proposed ward? Physician Creditor Occupation Work Address City, Sate, Zip Code B. Co-Applicant (is/is not) an administrator, executor, or other fiduciary of an estate wherein the prospective ward has an interest, O.R.C. 2111.09. C. Co-Applicant (has/has not) been charged with, or convicted of, a crime involving theft; physical violence; or sexual, alcohol, or substance abuse. If the Applicant has been so charged or convicted, list dates and places of the charge(s) or conviction(s), O.R.C. 2111.03(A). Charge/Conviction Date Place Attorney Power of Attorney Landlord Caregiver Custodian Durable Power of Attorney for Health Care FRANKLIN COUNTY FORM 17.0B - APPLICATION FOR APPOINTMENT OF CO-GUARDIAN OF INCOMPETENT American LegalNet, Inc. www.FormsWorkFlow.com