Verification Of Unrestricted Deposits {10534}

IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI - PROBATE DIVISION AT IN THE ESTATE OF ESTATE NUMBER , Protectee. VERIFICATION OF UNRESTRICTED DEPOSITS This is to certify that , thefiduciary of the above captioned estate, maintains the deposits described on the reverse side of thisverification for which deposits constitute fiduciary funds. 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 penalties of making a false affidavit ordeclaration. Dated: . SIGNATURE: TITLE: DEPOSITORY: ADDRESS: TELEPHONE NUMBER: Page 1 of 2 <<<<<<<<<********>>>>>>>>>>>>> 2Savings, Account Interest Due Date on Amount Includes Total Amount inChecking, Number Rate C.D. Interest to Following AccountCert. Dep. Date Form 10534 Page 2 of 2 8/2/96