Verification Of Restricted Assets {10532}

IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI - PROBATE DIVISION AT IN THE ESTATE OF ESTATE NUMBER , Protectee. VERIFICATION OF RESTRICTED DEPOSITS This is to certify that , the fiduciary of the above captioned estate, maintains the deposits described on the reverse side of thisverification for which deposits constitute fiduciary funds and are accepted subject to section 473.207RSMo and the order of the court herein, and no withdrawals of principal or interest therefrom maybe made except on order of the Probate Division of the Circuit Court of Jackson County, Missouri. The above named fiduciary has no ownership interest in or right of survivorship to any of thefunds described herein except as follows: The undersigned swears that the matters set forth herein are true and correct to the bestknowledge and belief of the undersigned, subject to the penlties oa f making a false affidavit ordeclaration. Dated: . SIGNATURE: TITLE: DEPOSITORY: ADDRESS: TELEPHONE NUMBER: Page 1 of 2 <<<<<<<<<********>>>>>>>>>>>>> 2Savings, Account Interest Due Restr. Includes or Amount TotalChecking, Number Rate Date Excludes in Payments Includes Int. Amount inCert. Dep. on (Indicate below) To Account C.D. Following Date FORM 10532 Page 2 of 2 8/2/96