IN THE COURT OF CHANCERY OF THE STATE OF DELAWARE PROOF OF COMPLIANCE IN THE MATTER OF: DATE: C.M. #: DATE OF BIRTH: THIS IS TO INFORM YOU THAT has deposited in this bank ,$ AS FOLLOWS: Account Title WITHDRAWALS BY COURT ORDER ONLY Type and Account Number _________________________________________ Ward's or Minor's current address: Guardian's signature & current address: THIS CERTIFICATE MUST BE RETURNED TO THE REGISTER IN CHANCERY WITHIN _______ DAYS AFTER YOUR APPOINTMENT AS GUARDIAN. The financial institution may be liable to the extent it permits withdrawals without Court of Chancery Order. BANK IDENTIFICATION OR SEAL BY: ____________________________ NAME OF BANK OFFICIAL BRANCH ADDRESS: American LegalNet, Inc. www.FormsWorkflow.com