1) Person Filing (name): Mailing Address: City, State, Zip Code: Person Filing is: If Attorney, representing: If Attorney, State Bar No.: Conservator, or Attorney SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY In the Matter of the Conservatorship or the Guardianship and Conservatorship for: Case No. PB_______________________ . Name of the Protected Adult or ACKNOWLEDGEMENT OF CONSERVATOR AND LAWYER'S UNDERTAKING AND OBLIGATION Minor I, , having been appointed by (Conservator’s Name) the Superior Court of Arizona in Maricopa County as Conservator for the protected person named above, hereby authorize to (Attorney’s Name) deposit all of the net conservatorship assets, in the amount of $____________________. The assets will be deposited in a restricted account in my name as the Conservator for: (Name of the Protected Adult or Minor) This shall be a restricted account. No withdrawals of principal or interest will be permitted except by certified Order of the Superior Court of Arizona in Maricopa County. Reinvestments may be made without an order of the Court as long as each account remains restricted and at the same financial institution. If the protected person named above is a minor, the funds shall not be released when the minor turns eighteen (18) years of age until receipt of a court order. Date Conservator’s Signature Signed or Affirmed: by (Date) Printed Name of Person Who Signed Seal /My Commission Expires: © Superior Court of Arizona in Maricopa County January 23, 2008 ALL RIGHTS RESERVED Page 1 of 2 PBC16f Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com Deputy Clerk or Notary Public I, as an officer of this Court and as the attorney for (Conservator’s Name) in this person’s capacity as the conservator for , (Protected Person’s Name) hereby assume and undertake personal responsibility to the protected person and to the Court to make the above designated restricted deposit and to deliver to the Court a completed Proof of Restricted Account form evidencing the restricted deposit and the amount thereof within thirty (30) days from this date or to refund all of the funds to the Court immediately upon demand. Date: (Attorney’s Signature) (Attorney’s Printed Name) © Superior Court of Arizona in Maricopa County January 23, 2008 ALL RIGHTS RESERVED Page 1 of 2 PBC16f Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com