Application For Appointment Of Conservator {20.0}

<document>COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGECalendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)IN THE MATTER OF THE CONSERVATORSHIP OF CASE NO. APPLICATION FOR APPOINTMENT OF CONSERVATOR (R.C. 2111.021)I,, Petitioner, hereby state that I am a competent adult but am physically Infirm. I request that:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1. Name of Proposed Conservator StreetCityTHE PEOPLE OF THE STATE OF NEW YORK TO, Ohio (Zip)Telephone () be appointed conservator of my:. Person and Estate. Person Only. Estate Only2. The length (time period) of the conservatorship is: . IndefiniteGREETINGS:. Definite to, 20WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable3. (If Person Only or Person and Estate is checked), I give the following power over my PERSON to the: a. Conservator:. (1.) All powers that a guardian would have under the guardianship laws of Ohio. . (2.) Limited to the power to,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)b. Court: . (1.) All powers that a Court would have under the guardianship laws of Ohio. . (2.) Limited to the power to 4. (If Estate Only or Person and Estate is checked), I give the following power over my ESTATE to the:Attorney(s) fora. Conservator:. (1.) All powers that a Court would have under the guardianship laws of Ohio. . (2.) Limited to the power toOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:«dpo31/1x-Mobile Tel. No.:PAGE 1 OF FORM 20.0 APPLICATION FOR APPOINTMENT OF CONSERVATORAmerican LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.CASE NO. b. Court: . (1.) All powers that a Court would have under the guardianship laws of Ohio. . (2.) Limited to the power toCalendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)c. The following of my property is subject to the foregoing powers: . (1.) All property. (Attach description of property.) . (2.)Only the property listed as follows:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TO5. If the application is for a conservatorship of the estate:a. The estate to be placed under conservatorship is: Personal Property$ Real Property$ Annual RentsGREETINGS:$ Other Annual Income$ TOTALWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable$,located at County ofb. A bond in the amount of $is attached. (R.C. 2109.04(A)(1)) (Form 15.3)o'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in room6. Service of notice of the conservatorship is to be given to:Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.. None. Same as Guardianship. As Listed on Form 15.0Based on the foregoing information, I do hereby petition the Court to appoint a Conservator for myself, and do so freely and of my own will. I certify that all information and statements contained in this application and the attached exhibits are correct to the best of my knowledge and belief., one of the Justices of theCourt in Witness, Honorableday of, 20 County,Date(Attorney must sign above and type name below)Attorney's SignatureApplicant's SignatureAttorney(s) for(Type or Print Attorney's Name)(Type or Print Applicant's Name)(Street)(Street)Office and P.O. Address(City, State, Zip Code)(City, State, Zip Code) ()) (Telephone Number-Include Area Code)(Telephone No.: Facsimile No.: E-Mail Address:(Telephone Number-Include Area Code)Supreme Court Registration NumberMobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comPAGE 2 OF FORM 20.0 APPLICATION FOR APPOINTMENT OF CONSERVATOR</document>