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Statement Of Additional Information 17.0F - Ohio

Statement Of Additional Information Form. This is a Ohio form and can be used in Adult Guardianship Guardianship-Adult-Minor Probate Franklin County (Court Of Common Pleas) .
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PC-G-17.0F (Rev. 1-2001) PROBATE COURT OF FRANKLIN COUNTY, OHIO LAWRENCE A. BELSKIS, JUDGE ROBERT G. MONTGOMERY, JUDGE IN THE MATTER OF THE GUARDIANSHIP OF CASE NO. STATEMENT OF ADDITIONAL INFORMATION Now comes the applicant for the appointment of guardian of the person and/or estate of the above captioned person, and answers the following questions with respect to the prospective ward. 1. Is the ward eligible for or receiving any of the following benefits, and if so, where are they or their source located? TYPE NAME AMOUNT PER MONTH Social Security ...................................................................................................................... $ P.E.R.S. ................................................................................................................................. Veterans Admin. .................................................................................................................... R.R. Retirement ..................................................................................................................... Employee's Pension Insurance Benefits Other ............................... ................................ ................................... A.D.C. ..................................................................................................................................... 2. Does the prospective ward have an interest in an estate or trust? If so, give the decedent's name, Court case number, name and location of Court, or trustee, etc. 3. Does the prospective ward have an expectancy from any minor's settlement? If so, give the defendant's name or his insurer's name, and the amount expected. 4. Cash? Yes No Amount: 5. Bank, Savings and Loan, Brokerage and other financial accounts describe below: INSTITUTION ADDRESS ACCOUNT CURRENT BALANCE $ FRANKLIN COUNTY FORM 17.0F - STATEMENT OF ADDITIONAL INFORMATION American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. 6. Securities? ISSUER: .................................. .................................. .................................. 7. Land installment contracts? VENDEE & ADDRESS Yes No [if yes, describe below.] PROPERTY LOCATION AMT. PER MO. AND BALANCE / / Yes No [if yes, describe below.] CURRENT VALUE $ 8. Rental from real estate? ADDRESS OF REAL ESTATE Yes No [if yes, describe below.] AMT. PER MO. 9. Interest in real estate? Yes No [if yes, describe below.] ADDRESS OF REAL ESTATE 10. Income from any other source? Yes No [if yes, describe below.] 11. Other assets? Yes No [if yes, describe below.] Applicant American LegalNet, Inc. www.FormsWorkFlow.com
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