COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGECalendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)IN THE MATTER OF THE GUARDIANSHIP OF CASE NO.: GUARDIAN'S REPORT (R.C. 2111.49). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NOTE: If allotted space is inadequate to respond, write See Exhibit in the space and add appropriate exhibit letter sequence, then attach exhibit containing information requested for that space.1. This is the (circle one): 1st, 2nd, 3rd, 4th, 5th, 6th, or , Guardian's Report. 2. Ward's present address: City State Zip Telephone ( ) 3. Ward's living arrangements at the above address are best described as: ( ) a.THE PEOPLE OF THE STATE OF NEW YORK TOGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,His or her own apartment of home (includes assisted living facilities). ( )located at County ofb.Private home or apartment of: (o'clock in the day ofnoon, and at any recessed in room, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of the) (1) the ward's guardian. ( ) (2) a relative of the ward, whose name is and relationship is ( ) (3) a non-relative whose name is ( ) c.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.( ) A foster, group or boarding home. ( ) d.( ) A nursing home. ( ) e.( ) A medical facility or state institution. ( ) f.( ) Other (describe) ( ) g. ( ) if c, d, e, or f is checked, complete the following: (1) The name of the home, facility, or institution (2) The name of an individual at the home, facility or institution who has knowledge and is authorized to give information to the Court about the ward. Name Telephone Number ( ) , one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) for4. The ward will be at the address given in Item 2: ( ) a.Indefinitely. ( ) b. Temporarily. The new address and telephone number is: ( ) (1) Unknown. I will provide this information when known. ( ) (2) City State Zip Telephone ( ) Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:«HE28/8T-American LegalNet, Inc. www.USCourtForms.comPAGE 1 OF FORM 17.7 GUARDIAN'S REPORTCOURT COUNTY OF5. Guardian's contact with the ward: a.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Approximate number of times the guardian had contact with the ward during the period covered by this report: . b.Index No.Calendar No.The nature of those contacts (phone, personal, or other): c.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)Date the ward was last seen by the guardian: .6. Have you observed any major change in the ward's physical or mental condition during the period covered by this report?( ) Yes() No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If yes is checked, briefly describe the changes. 7. The care given to the ward is ( ) Adequate() Not AdequateTHE PEOPLE OF THE STATE OF NEW YORK TOIf Not Adequate is checked, explain. 8. The guardianship should be ( ) Continued() Not ContinuedGREETINGS: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 ofIf Not Continued is checked, explain. 9. During the period covered by this report, the ward () has () has not been seen by a physician.o'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 roomYour 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.If the ward has been seen, the last date was and for the Purpose of . Attached is a statement by a licensed physician, a licensed clinical psychologist, a licensed social worker, or a mental retardation team, that has evaluated or examined the ward within three months prior to the date of this report regarding the need for continuing the guardianship. {R.C. 2111.49(A)(1)(i)} (Form 17.1) If an attorney has been consulted on this report:, one of the Justices of theCourt in Witness, Honorableday of, 20 County,Date Attorney's Name(Attorney must sign above and type name below)Guardian's Signature (Type or print Attorney's Name)(Type or print Guardian's Name)Attorney(s) for (Street)(Street) (City, State, Zip Code)Office and P.O. Address(City, State, Zip Code)() () Telephone NumberTelephone Number Sup. Ct. Regis. No.Telephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:(KNOWINGLY GIVING FALSE INFORMATION ON A PROBATE DOCUMENT IS A CRIMINAL OFFENSE.) PAGE 2 OF FORM 17.7 GUARDIAN'S REPORTAmerican LegalNet, Inc. www.USCourtForms.com
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