IN THE CIRCUIT COURT FOR FLORIDA IN RE: GUARDIANSHIP OF COUNTY, PROBATE DIVISION File No.________________ Division _______________ RECEIPT OF ASSETS BY DEPOSITORY (Investment Powers) (name and address of depository) hereby acknowledges receipt of the following assets: The depository acknowledges receipt of a copy of the Order Designating Depository of Assets and agrees to hold the assets received by it and all interest, dividends, principal and other indebtedness collected by it on account thereof, in safekeeping pursuant to Florida Statutes Section 69.031 and to invest, reinvest and disburse the assets in accordance with the provisions of said order of the court and of such subsequent orders of the court as are directed to it. 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-4.091 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com