COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.PROBATE COURT OF STARK COUNTY, OHIOCalendar No.GUARDIANSHIP OF CASE NO.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)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.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4th, 1.1st, 2nd, 3rd,5th, 6th, or This is the (circle one):, Guardian's Report. Ward's present address: 2.THE PEOPLE OF THE STATE OF NEW YORK TOCityState Telephone Zip Ward's living arrangements at the above address are best described as: 3.()a.His or her own apartment or home (includes assisted living facilities). Private home or apartment of: b.GREETINGS:(1) the ward's guardian (2) a relative of the ward, whose name isWE 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 roomand relationship is (3) a non-relative whose name is A foster, group or boarding home. c.A nursing home. d.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.Other (describe)A medical facility or state institution. ef.If c, d, e or f is checked, complete the following: g., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(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(Attorney must sign above and type name below)Telephone Number 4.Attorney(s) for)(The ward will be at the address given in Item 2. Indefinitely. a.b.Temporarily. The new address and telephone number is:Office and P.O. Address(1) Unknown. I will provide this information when known. (2)Telephone No.: Facsimile No.: E-Mail Address:CityStateTelephone Zip)(Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comFORM 17.7 -GUARDIAN'S REPORT Page 1 of 2COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .CASE NO.:::::::Index No.Guardian's contact with the ward: Approximate number of times the guardian had contact with the ward during the period 5.Calendar No.a.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)covered by this report: The nature of those contacts (phone, personal, or other): b.Date the ward was last seen by the guardian: C.6.Have you observed any major change in the ward's physical or mental condition during the YesNo period covered by this report? If ''Yes'' is checked, briefly describe the changes.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TO7.The care given to the ward isAdequateNot Adequate If "Not Adequate" is checked, explain.GREETINGS:ContinuedThe guardianship should be If ''Not Continued'' is checked, explain.Not Continued 8.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 roomDuring the period covered by this report, the ward been seen by a physician. If the ward has been seen, the last date washas not 9.hasYour 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.and for the purpose ofAttached 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)] (H.C. Form 17.15), one of the Justices of theCourt in Witness, Honorableday of, 20 County,Date If an attorney has been consulted on this report:(Attorney must sign above and type name below)Guardian's Signature Attorney's SignatureAttorney(s) for(Type or print Guardian's Name) (Type or print Attorney's Name)(Street)(Street)Office and P.O. Address(City, State, Zip Code)(City, State, Zip Code)()Telephone No.: Facsimile No.: E-Mail Address:)(Telephone NumberSupreme Court Regis. No. (Telephone Number -Include Area Code)Mobile Tel. No.:(Knowingly giving false information on a Probate document is a criminal offense.) [R.C. 2921.13(A)(11)] Page 2 of 2American LegalNet, Inc. www.USCourtForms.com
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