Ohio Probate Form - Notice Of Petition For Court Ordered Protective Services
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2PROBATE COURT OF ___________________________COUNTY, OHIO
_______________________________, JUDGE
IN THE MATTER OF __________________________________________, AN ADULT
CASE NO. _________________
NOTICE OF PETITION FOR COURT ORDERED PROTECTIVE SERVICES
[R.C. 5101.66]
TO: __________________________________________________________________________
Name and Address of Adult Incapacitated Person
Name
Address
Relationship of Adult
__________________________________________________________________________
Adult, Guardian, Legal Counsel, Caretaker, Spouse, if any, and if none of these to the Adult’s Children or Next
of Kin
You are hereby notified that on the _______ day of __________, 20 _____, the ________County
Department of Job and Family Services filed in this Court a Petition for Court Ordered
Protective Services for the above named Adult for the following reason(s): _________________
_____________________________________________________________________________.
This Petition for Court Ordered Protective Services shall be heard in the _____________County
Probate Court, ________________, Ohio located at ___________________________________
on the ______ day of __________, 20 ____, at ___________o’clock ______.M.
The Adult has the right to legal counsel and if indigent, legal counsel will be appointed if
requested.
Witness my signature and the seal of the Court
this _____ day of ____________, 20 _______.
______________________________________
Probate Judge
By:
______________________________________
Deputy Clerk
WAIVER OF NOTICE
We, the undersigned, whose relationship to the Adult is indicated, enter our appearance and
waive notice and consent to the hearing.
Name
Relationship to the Adult
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
FORM 23.1 – NOTICE OF PETITION FOR COURT ORDERED PROTECTIVE SERVICES
Eff. Date: January 1, 2010
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