Form 17.0 - Application For Appointment Of Guardian An Alleged Incompetent Page 2
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1
2[Reverse of Form 17.0]
CASE NO.______________
The time period requested is
indefinite
definite to __________________________________________
__________________________________________________________________________________________.
Applicant's relationship to alleged incompetent is ____________________________________________
__________________________________________________________________________________________.
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.)
______________________________________________________________________________________________
______________________________________________________________________________________.
The Applicant represents that a guardian has been nominated in a writing pursuant to R.C. 1337.09(D) or R.C.
2111.121. The nominated person is _________________________________________________.
The nominated person’s contact information is listed on Form 15.0 (Next of Kin).
A copy of the document which nominates the guardian is attached.
The Applicant represents that the proposed ward had military service.
Military I.D.:______________________________________________
Branch of service:_________________________________________
Dates of service:__________________________________________
Applicant represents that the address provided is the applicant's permanent address and acknowledges
the requirement that the court be notified of any change of address. Removal may result from a failure to
comply with this requirement.
______________________________________
_____________________________________
Attorney for Applicant
Applicant
______________________________________
_____________________________________
Typed or Printed Name
Typed or Printed Name
______________________________________
_____________________________________
Address
Age
______________________________________
______________________________________
City
State
Zip
Permanent Address
______________________________________
_____________________________________
Telephone Number (include area code)
City
State
Zip
_____________________________________
Attorney Registration No.__________________Telephone Number (include area code)
Print Form
FORM 17.0 – APPLICATION FOR APPOINTMENT OF GUARDIAN
(AN ALLEGED INCOMPETENT)
PAGE 2
Amended: January 1, 2013
Discard all previous versions of this form
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