Certification Of Restricted Deposit

CERTIFICATION OF RESTRICTED DEPOSIT Name of Institution Address Depositor Certificate of Deposit Number Amount on Deposit $ Estate of Probate Division Number WE HEREBY CERTIFY 1. That the above amount is now on deposit in this institution as evidenced by the aboedescribed certificate of deposit issued on the . , 20 day of 2. That the records of this institution pertaining to said certificate have been so marked as to indicate that all interest, dividends or other income earned on, or resulting therefrom, are to be; a) deposited in savings account number of this institution and are not to be disbursed in any other manner, or, b) added to the amount deposited with this institution as a part of the certificate of deposit above-described. 3. That we have been advised that pursuant to an Order of the Probate Division, St. Louis Circuit Court, the above-described certificate of deposit and the present balance in said savings account, together with all additions thereto, may not be withdrawn , paid, redeemed or liquidated, except upon presentation of a certified copy of an Order of the Probate Division, 22nd Judicial Circuit Court, authorizing and approving such withdrawal, payment, redemption or liquidation. That the above-described certificate of deposit bears on its face, a statement of a restriction indicating that said certificate may not be sold, redeemed, liquidated, transferred, negotiated or paid except upon Order of the Probate Division, 22nd Judicial Circuit Court. 4. Dated this day of , . Name of Institution By Approved: Title Personal Representative/Conservator of the Est. of Estate No. Attorney Address City Telephone No. State Zip Code American LegalNet, Inc. www.FormsWorkflow.com