Statement Of Expert Evaluation Addendum No Known Applicant For Guardianship - Probate Court Of Coshocton County, Ohio

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PROBATE COURT OF COSHOCTON COUNTY, OHIO
VAN BLANCHARD II, JUDGE
IN THE MATTER OF THE GUARDIANSHIP OF
CASE NO.
STATEMENT OF EXPERT EVALUATION ADDENDUM
NO KNOWN APPLICANT FOR GUARDIANSHIP
[Must be submitted with any Statement of Expert Evaluation filed at Coshocton County Probate Court
where there is no known applicant for Guardianship.]
The Guardianship process begins with the filing of an Application for Appointment of Guardian
(OSC form
17.0) accompanied by a Statement of Expert Evaluation. If you have a Statement of
Expert Evaluation completed by a Physician, Psychologist, or Nurse Practitioner that indicates a
Guardianship is recommended but cannot locate, after a diligent effort, a suitable applicant, this
form must be completed and filed simultaneously with the Statement of Expert Evaluation in
Probate Court.
NOTE: Only Statements of Expert Evaluation and Affidavit containing an original
signature will be accepted for filing.
1) Please list any next of kin or other interested party and contact information that you may
know:
Name
Name
Address
Address
City/State/Zip Code
City/State/Zip Code
Phone number(include area code)
Phone number(include area code)
Other Contact Information
Other Contact Information
2) Please state what efforts have been made to locate next of kin to make an Application
For Appointment of Guardian:
3) Are you aware of any advance directives executed by the potential ward?
If so, please list below and provide a copy:

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