Authorization To Release Confidential Information {15.11}

PROBATE COURT OF HAMILTON COUNTY, OHIO RALPH WINKLER, JUDGE GUARDIANSHIP OF CASE NO. AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION Name Last Date of Birth First Social Security Number Middle I hereby authorize the release of all confidential records and information concerning me to any officer or agent of the Hamilton County Probate Court for the purpose of an investigation pertaining to a proposed Guardianship. Witness Date Applicant H.C. FORM 15.11 - AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION 09/01/91 American LegalNet, Inc. www.FormsWorkFlow.com