PROBATE COURT OF __________________ COUNTY, OHIO
IN THE MATTER OF THE GUARDIANSHIP OF ____________________________________________
CASE NO. ____________________
NEXT OF KIN OF PROPOSED WARD
[R.C. 2111.04]
(NOTE:
Specify age and birthdate of each minor under 16 on the line containing the minor's name. List the name and
address of the minor's parent, guardian or custodian on the name and address lines following the minor's address.)
Service
Relationship
Birthdate
Waived
Of Minor
1. [ ]
Name _______________________________________________ _________________ __________________
Address _______________________________________________________________
Zip _______________
2. [ ]
Name _______________________________________________ _________________ __________________
Address _______________________________________________________________
Zip _______________
3. [ ]
Name _______________________________________________ _________________ __________________
Address _______________________________________________________________
Zip _______________
4. [ ]
Name _______________________________________________ _________________ __________________
Address _______________________________________________________________
Zip _______________
5. [ ]
Name _______________________________________________ _________________ __________________
Address _______________________________________________________________
Zip _______________
6. [ ]
Name _______________________________________________ _________________ __________________
Address _______________________________________________________________
Zip _______________
7. [ ]
Name _______________________________________________ _________________ __________________
Address _______________________________________________________________
Zip _______________
8. [ ]
Name _______________________________________________ _________________ __________________
Address _______________________________________________________________
Zip _______________
9. [ ]
Name _______________________________________________ _________________ __________________
Address _______________________________________________________________
Zip _______________
10. [ ] Name ______________________________________________ _________________ ___________________
Address _______________________________________________________________
Zip _______________
_______________________________________
______________________________________
Date
Applicant
Print Form
15.0 NEXT OF KIN OF PROPOSED WARD