Affidavit {16.1}

<document>COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE:::::::Index No.Calendar No.IN THE MATTER OF THE GUARDIANSHIP OF CASE NO. JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)AFFIDAVIT (R.C. 3109.27)State of Ohio, County ofs.s.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(To be filed only when guardianship of the person of a minor is sought.)Affiant being first duly sworn, deposes and says: 1. That the child's present address, the places where the child has lived within the last five years, and the names and present addresses of the person(s) with whom the child has lived during that period are: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,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 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., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) for2. That affiant . has . has not participated as a party, witness, or in any other capacity in any litigation concerning the custody of the child(ren) in this or any other state. 3. That affiant . has . has no information of any custody proceeding concerning the child(ren) pending in a court of this or any other state. 4. That affiant . has . has no knowledge of any person not a party to the proceedings who has phycial custody of the child(ren) or claims to have custody or visitation rights with respect to the child(ren). If 2, 3, or 4 is answered in the affirmative, and the space afforded is insufficient for full explanation, please attach and incorporate herein any necessary information. Affiant realizes that he/she has a continuing duty to inform the Court of any custody proceedings concerning the child(ren) in this or any other state of which affiant obtains information during the pendency of this proceeding. Sworn to before me and subscribed in my presence thisday of, 20.Office and P.O. AddressNotary Public 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.Telephone No.: Facsimile No.: E-Mail Address:«he27/2%-Mobile Tel. No.:FORM 16.1 -AFFIDAVITAmerican LegalNet, Inc. www.USCourtForms.com</document>