Application For Appointment Of Emergency Guardian Of Alleged Incompetent - Probate Court Of Wayne County

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PROBATE COURT OF WAYNE COUNTY, OHIO
In the Matter of the Guardianship of:
Case No.
APPLICATION FOR APPOINTMENT OF EMERGENCY GUARDIAN
OF ALLEGED INCOMPETENT
(R.C. 2111.02)
The applicant represents to the Court that
age
years,
resides or has a legal settlement at
in
County, Ohio and that the
prospective ward is incompetent by reason of (R.C. 2111.01 (D))
.
The applicant further represents that an emergency exists and that it is reasonable 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 with a Supplement for Emergency Guardian of Person (Form 17.1 and Form 17.1(A)).
A List of Next of Kin of the Proposed Ward is also attached (Form 15.0).
The whole estate of the prospective ward is estimated as follows:
Personal property
$
Real estate
$
Annual rents
$
Other annual income
$
The applicant represents that
is not an administrator, executor, or other fiduciary of the estate
wherein the alleged incompetent is interested.
The applicant further represents that a guardian of the alleged incompetent is necessary in order that
the ward
the wards property
may be taken proper care of and asks that an emergency guardian be appointed. The applicant understands that the
Court can appoint emergency guardianship for a maximum period of seventy-two hours and that this Court may extend
the emergency guardianship for a period not to exceed thirty additional days only after a hearing and notice to the ward
and next of kin.
(STREET, CITY, STATE, ZIP CODE):
PRESENT LOCATION OF WARD
TYPE OF GUARDIANSHIP APPLIED FOR IS EMERGENCY
Limited
Person and estate
Estate only
Person only
The limited powers requested are
WC FORM 17.01 – APPLICATION FOR APPOINTMENT OF EMERGENCY GUARDIAN OF ALLEGED INCOMPETENT

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