Application For Appointment Of Emergency Guardian {504}

<document>PROBATE COURT OF BUTLER COUNTY, OHIOIN THE MATTER OF GUARDIANSHIP OF Case No.APPLICATION FOR APPOINTMENT OF EMERGENCY GUARDIAN OF ALLEGED INCOMPETENT [R.C. 2111.02] Applicant represents to the Court thatagedyears, resides or has a legal settlement at, inCounty, Ohio and that the prospective wardis incompetent by reason of (R.C. 2111.01(D)).Applicant further represents that an emergency exists and that it is reasonably certain that immediate action is required to prevent significant injury to the person or estate of the proposed ward. A Statement of Expert Evaluation is attached. (Form 17.1)A List of Next of Kin of the Proposed Ward is also Attached (Form 15.0), however, applicant requests that the Court act ex parte, without notice because of the emergency existing. The whole estate of the prospective ward is estimated as follows:Personal property........................................................ $ Real estate................................................................... $Applicant represents thatis not an administrator, executor or other fiduciary of the estatewherein the alleged incompetent is interested.Applicant further represents that a guardian of the alleged incompetent is necessary in order thatthe wardward's property may be taken proper care of and asks that a guardian be appointed.PRESENT LOCATION OF WARD:StreetCityZip CodeStateTYPE OF GUARDIANSHIP APPLIED FOR IS EMERGENCYlimitedperson onlyestate onlyperson and estateThe limited powers requested areThe time period requested is from.toApplicant's relationship to alleged incompetent is.BCPC FORM 504 -APPLICATION FOR APPOINTMENT OF EMERGENCY GUARDIAN OF ALLEGED INCOMPETENT10/972001 © American LegalNet, Inc.The Applicant has (not) been charged with or convicted of a crime involving theft, physical violence, or sexual, alcohol or substance abuse except as follows (if applicable, state date and place of each charge or each conviction):.Attorney for ApplicantApplicantType or Print nameType or Print nameAddressAgeSocial Security NumberCity, State, Zip CodeAddressPhone number (include area code)City, State, Zip CodeSupreme Court Registration NumberPhone number (include area code)KNOWINGLY GIVING FALSE INFORMATION ON A PROBATE DOCUMENT IS A CRIMINAL OFFENSE. [R.C. 2921.13 (A)(11)]2001 © American LegalNet, Inc.</document>