Name, Address and Telephone No. of Attorney or Party Submitting Form Bar No.: ATTORNEY FOR: For Use of the Court Clerk Only SUPERIOR COURT OF CALIFORNIA, COUNTY OF SONOMA Conservatorship / Guardianship / Estate of Court No. Conservatee/ Ward/ Decedent/ RECEIPT AND ACKNOWLEDGEMENTS OF ORDER RESTRICTING RELEASE OF PROPERTY Date of Court Order: Property on Deposit ( For cash and cash equivalents: provide account number, type of account and account balance. For securities: provide type, issuer, number of shares or face value. For promissory notes: provide date, payor, security and face value. For jewelry and other personal effects: specify and describe): Designated Depository (name and address): Acknowledgement of Depository: Receipt is hereby acknowledged of the property and Court Order referenced above. Said property (Strike One) including/excluding interest, dividends, or note payments, will be held by us and will not be released except upon Order of the Sonoma County Superior Court. Dated: By: Signature Title Name Form Adopted for Optional Use Local Rule 6.6D PR-5 (Rev. 3/11; 1/19) (Continued on reverse) American LegalNet, Inc. www.FormsWorkFlow.com Conservatorship/Guardianship/Estate of Case Number Conservatee, Ward, Decedent RECEIPT AND ACKNOWLEDGEMENTS OF ORDER RESTRICTING RELEASE OF PROPERTY Acknowledgement of Conservator, Guardian or Personal Representative: I understand that the property specified above is to be held by the designated depository and may not be released to me except upon Order of the Sonoma County Superior Court. Dated: By: Signature Title Name Original to be filed with the Clerk of the Court; copies to be retained by the depository; by the conservator, guardian, or personal representative; and by the attorney for the estate. American LegalNet, Inc. www.FormsWorkFlow.com