Missouri > Local Circuit Courts > 7th Circuit (Clay County) > Probate > Minors And Adults
Verification Of Restricted Deposit 406 - Missouri
| Verification Of Restricted Deposit Form. This is a Missouri form and can be used in Minors And Adults Probate 7th Circuit (Clay County) Local Circuit Courts . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
CIRCUIT COURT OF CLAY COUNTY, MISSOURI PROBATE DIVISION No. Matter of , *minor - *disabled - *deceased VERIFICATION OF RESTRICTED DEPOSIT The undersigned hereby certifies that __he is an official of the below named depository, which had (a) deposit(s) on the ______ day of _____________________, 20___. The following amount(s) in the name of , as *Conservator__, *Personal Representative__, of the estate of __ ___ *minor__, *disabled__, *deceased. THERE ARE NO OTHER NAME(S) ON THE ACCOUNT(S) EXCEPT AS FOLLOWS: __ Said deposit(s) have been made and accepted with the specific contract and agreement that they are subject to the order of the Probate Division of the Circuit Court of Clay County, Missouri and no withdrawals will be permitted from such restricted accounts except on the order of the Court, however, the Conservator may change the type of account within this depository without Court order. Account Account Number Interest Due Date on Total Amt in Date of Is Interest Type: Rate CD Acct. Last Int. restricted? Savings, Pymt. YES__ or NO__ CD, MM, etc. THE STATEMENTS AND REPRESENTATIONS IN THIS DOCUMENT ARE MADE UNDER OATH AND ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THEY ARE MADE SUBJECT TO THE PENALTIES OF MAKING A FALSE AFFIDAVIT OR DECLARATION. Date:____________________ Depository Address By: REQUIRES A SIGNATURE Title: INSTRUCTIONS : Do not restrict regular checking accounts. Any erasures or corrections must be initialed by a depository agent. *strike if inapplicable Form 406 Page 1 of 1 Revised 8/22/2003
|
|||||||
