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IN THE COURT OF COMMON PLEAS DIVISION OF PROBATE LAKE COUNTY, OHIO IN THE MATTER OF ) ) ) ) CASE NO. JUDGE MARK J. BARTOLOTTA CONSENT TO WEBCHECK CRIMINAL BACKGROUND CHECK [Loc.R. 66.05(A)] I, the undersigned, hereby authorize the Lake County Educational Service Center or alternate Lake County location to perform a criminal background check using the WEBCHECK system. The results will be sent directly to the Lake County Probate Court to become a permanent part of the Court's record. ___________________________________ Signature Date ___________________________________ Printed Name ___________________________________ Address ___________________________________ ___________________________________ Telephone Number ___________________________________ Date of Birth LCPC Form 17.11--Consent to Webcheck Criminal Background Check Rev. 12/04/15 American LegalNet, Inc. www.FormsWorkFlow.com