IN THE CIRCUIT COURT FOR FLORIDA IN RE: ESTATE OF COUNTY, PROBATE DIVISION File No. Division Deceased 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 the depository agrees to hold the assets, or 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 personal representative 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 personal representative of this estate. . 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. P-4.0830 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com