Acknowledgment Of Responsibility {16.0C}

PROBATE COURT OF MONTGOMERY COUNTY, OHIO ALICE O. McCOLLUM, JUDGE IN THE MATTER OF: CASE NO.: ACKNOWLEDGEMENT OF RESPONSIBILITY [R.C. 2111.05] INSTRUCTIONS: Read the below Custodian's/Parent's Signature blank. acknowledgment. If you agree, sign on the Legal I am the parent or legal custodian of the above-named minor. I participated in the application to dispense with the appointment of a guardian of the estate of the minor child. I acknowledge that monies belonging to the minor child have been placed in a controlled account in the child's name with a depository authorized to receive fiduciary funds and that these monies are to be held for the child's benefit until he or she reaches 18 years of age. I acknowledge and agree that it is my responsibility to inform the minor child of these monies when he or she reaches 18 years of age, so that the child can contact the depository to receive the monies held for the child's benefit. Date Legal Custodian's/Parent's Signature Legal Custodian's/Parent's Printed Name Date Legal Custodian's/Parent's Signature Legal Custodian's/Parent's Printed Name American LegalNet, Inc. www.FormsWorkFlow.com M.C. FORM 16.0C ­ ACKNOWLEDGEMENT OF RESPONSIBILITY 6/1/16