IN THE CIRCUIT COURT FOR FLORIDA IN RE: GUARDIANSHIP OF COUNTY, PROBATE DIVISION File No. Division RECEIPT OF ASSETS BY DEPOSITORY (name and address of depository) hereby acknowledges receipt of the following assets: The depository acknowledges receipt of a copy of the Order Designating Depository for Assets and agrees to hold the assets and the duly collected proceeds therefrom, and all interest, dividends, principal and other indebtedness subsequently collected by the depository on account thereof, in safekeeping pursuant to Florida Statutes Section 69.031, subject to such instructions of the guardian of the property of the Ward as are authorized by orders of the court directed to the depository. This receipt of assets is executed in the name of the depository by one of its authorized officers on , on the guardian of the property of the Ward. . The original has been filed with the Court and a copy served (Depository) By: (Title) [Print or Type Names Under All Signature Lines] Bar Form No. G-4.090 © Florida Lawyers Support Services, Inc. Revised January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com