COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE:::::::Index No.Calendar No.IN THE MATTER OF:CASE NO.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)Minor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .;ENTRY DISPENSING WITH APPOINTMENT OF GUARDIAN AND ORDERING DEPOSIT Upon hearing on the oral application to dispense with the appointment of a guardian, the Court finds thatis a minor with a date of birth ofthe estate of said minor is Ten Thousand Dollars ($10,000) or less; and a guardianship is not necessary.THE PEOPLE OF THE STATE OF NEW YORK TOTherefore, the Court orders the appointment of a guardian dispensed with, and further orders the estate of said minor in the possession of(Specify insurance company, attorney, or other payor) in the sum ofdollars be deposited in the name ofGREETINGS:with, (Full Name of Minor)(Federally Insured Bank or Savings and Loan) a depository authorized to receive fiduciary funds.WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomNone of said funds, in whole or in part, including the interest earned thereon, shall be released by the depository until such time as said minor attains the age of majority or upon further order of this Court. Attorneyshall be responsible for depositing the funds andshall file the Verification of Receipt and Deposit with this Court, evidencing that said deposit has been made, within seven days after receipt of the funds.Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply., one of the Justices of theDateJudge Jack R. PuffenbergerCourt in Witness, Honorableday of, 20 County,CERTIFICATE OF AUTHENTICATIONThe above is a true copy of the original kept by me as custodian of the records of this Court. It constitutes the order authorizing the above designated depository to receive and deposit said funds.(Attorney must sign above and type name below)JACK R. PUFFENBERGER Probate Judge and Ex-Officio Clerk ByAttorney(s) forDeputy ClerkDate I, , Attorney-at-law, hereby certify, that the within instrument was prepared and/or examined by me, and that the same, in my opinion, is correct and proper.Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:«27.B<-Mobile Tel. No.:LUCAS COUNTY PROBATE FORM 16-A ENTRY DISPENSING WITH APPOINTMENT OF GUARDIAN AND ORDERING DEPOSITAmerican LegalNet, Inc. www.USCourtForms.com
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