[Reverse of Form 22.5]
CASE NO. ______________________
Applicant requests that:
The Court authorize the applicant to execute a release which shall be effective upon payment of the
settlement.
The Court order payment of the above expenses and order that the net amount of
$______________________ for the benefit of the ward be:
Deposited in the name of the ward with _____________________________________________,
a financial institution, in a restricted account and not be released without written order of this
Court.
Delivered to the guardian of the estate.
Structured as set forth in the attached documents.
Other: _______________________________________________________________________.
Supplemental forms required by local rule of Court are attached.
__________________________________________
__________________________________________
Attorney for Applicant
Applicant
__________________________________________
__________________________________________
Typed or Printed Name
Typed or Printed Name
__________________________________________
__________________________________________
__________________________________________
__________________________________________
Address
Address
__________________________________________
__________________________________________
Phone Number (include area code)
Phone Number (include area code)
Attorney Registration No. _____________________
ENTRY SETTING HEARING AND ORDERING NOTICE
The Court sets _________________________________________ at _____________ o’clock _____.m. as the
date and time for hearing the above application and orders notice to be given by the applicant, as provided in the
Rules of Civil Procedure, to all interested parties.
__________________________________________
JAMES A. FREDERICKA, PROBATE JUDGE
FORM 22.5 – APPLICATION TO SETTLE A CLAIM OF AN ADULT WARD
Effective date: January 1, 2015