A4 - Petition for Depository with Investment Powers Last Revised: 04/07/2014Page 1 of 2 Case Number: PROBATE DIVISIONPetitioner, , alleges: 1. Petitioner appointed the above named 2. Petitioner the following assets (?Assets?) of the 3. Petitioner desires to deposit these Assets with a depository as provided by Section 69.031 and Section 744.351 (6), Florida Statutes, for safekeeping and prudent investment under Chapter 518, Florida Statutes. 4. Due to the substantial value of these Assets and the Internal Revenue Code's requirements, Petitioner believes it is in the best interests for these Assets to be placed in a designated financial institution that can provide investment services as well as safekeeping of funds. 5. , whose address is , is a financial institution doing business in Florida that offers both safekeeping and investment services. It is willing to act as the designated financial institution under Section 69.031 and Section 744.351 (6), Florida Statutes, for safekeeping and investment of the Ward's intangible Assets [?Depository?]. A-4 Section:PETITION FOR ORDER DESIGNATING DEPOSITORY FOR ASSETS(With Investment Powers)IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT, IN AND FOR MIAMI-DADE COUNTY, FLORIDAIN RE: GUARDIANSHIP OFWard:Ward'sWard's Guardian of the Propert y .Format Must Be YYYYNNNNNN@@02 where @@ is GD, MH or CPA4 - Petition for Depository with Investment Powers Last Revised: 04/07/2014Page 2 of 2Petitioner requests that an order be entered: (a) Designating the above institution as Depository for the Assets. (b) Directing that any person or entity having possession or control over any of the Assets shall pay and deliver such Assets to the Depository, upon its demand, and that the Depository's receipt shall relieve the person or corporation from further responsibility thereof. (c) Authorizing the Depository to hold the Assets it receives in a fiduciary account for the benefit and to invest and reinvest the Assets in accordance with the standards set forth in Section 518.11 and Section 744.444(10), Florida Statutes. (d) Authorizing the Depository to invest the Assets in one or more consolidated funds in which separate fiduciary accounts have undivided interests, provided that separate accounting is maintained for the Assets. (e) Directing the Depository to hold all Assets it receives and all interest, dividends, principal and debts collected by it on account thereof in safekeeping, subject to the Petitioner's instructions as authorized by court order. The Depository, however, shall pay any Florida taxes on the Assets to Florida's Department of Revenue as well as all federal income tax incurred to the Internal Revenue Service, without further court order. (f) Authorizing the Depository, per Section 69.031(4), Florida Statutes; to deduct, from time to time, a reasonable amount for its services and expenses from the Assets it holds. (g) Directing the Depository to file with the court its acceptance of designation as depository and its receipts for all Assets received, and to give a copy thereof to the Petitioner. Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief. Ward'sWard'sWard's SIGNED on this day of 20,Attorney for PetitionerFlorida Bar No:Address:Telephone:Name: Petitioner Email:Email: