Person Filing: Mailing Address: City, State, Zip: Phone Number: Representing Self SUPERIOR COURT OF ARIZONA, COUNTY OF COCONINO In the Matter of the Guardianship and/or Conservatorship of: Ward 1: Ward 2: Ward 3: [ ] An Adult [ ] A Minor Case Number: GC PROOF OF RESTRICTED ACCOUNT FROM DEPOSITORY OR FINANCIAL INSTITUTION Leave the rest of the form blank. This is for the depository to fill in. Depository Name: Address: This depository has opened the following accounts: "The estate of , ward, by , conservator": Account Number $ $ $ Each account is restricted. No withdrawal is allowed without a certified court order. I have received a certified copy of the court order restricting these accounts dated , and I agree, on the depository's behalf, to comply with it. Manager's Signature*: Printed Name: Title: *Must be signed by a Bank Branch Manager or a Resident Manager for an Investment Securities Dealer. State of Arizona County of Subscribed and sworn before me this date: Seal: ) ) ) by: Notary Public: Notary Expiration Date: American LegalNet, Inc. www.FormsWorkFlow.com Type Balance Revised June 2013 Coconino County Law Library and Self-Help Center Forms