Application For Appointment Of Conservator {20.0}

PROBATE COURT OF GEAUGA COUNTY, OHIO JUDGE TIMOTHY J. GRENDELL IN RE: CASE NO.: APPLICATION FOR APPOINTMENT OF CONSERVATOR NOTE: If space allotted is inadequate to respond, write "See Exhibit" in the space and add appropriate exhibit letter sequence, then attach exhibit containing information requested for that space. The undersigned petitioner states that his/her legal settlement or residence is , in County, Ohio. Petitioner states that he/she is a mentally competent adult who is physically infirm. Petitioner requests that: Name of Proposed Conservator Street City County State Zip Phone Number (include Area Code) be appointed conservator of the person and estate of the person only of the estate only and letters issued upon qualification. The petitioner states, with particularity, all real and personal property to be placed under the conservatorship is: ConservatorApplication American LegalNet, Inc. www.FormsWorkFlow.com The petitioner requests that the proposed conservator be granted the following powers: The petitioner requests that the powers of the proposed conservator or Court be limited as follows : Petitioner requests that the conservatorship: continue indefinitely continue for a definite period of time: from to , 20 , 20 Attorney for Petitioner Petitioner Typed or Printed Name Typed or Printed Name Address Address Phone Number (Include Area Code) Phone Number (Include Area Code) Registration Number Date of Birth Social Security Number www.FormsWorkFlow.com