IN THE CIRCUIT COURT OF THE TWENTY-SECOND JUDICIAL CIRCUIT McHENRY COUNTY, ILLINOIS Probate Division Estate of ) ) ) ) ) ) ______________________________________ Minor Case Number______________________________ CERTIFICATE OF DEPOSITORY ­ RECEIPT The undersigned hereby acknowledges that _________________________________________ (Guardian) of the Estate of ___________________________________________________ has deposited in the (Name of Ward) ________________________________________________________________________________ (Name of Institution) the sum of $________________________________ in the name of _________________________ ________________________________________________________________________________ in account number________________________________________________________________. It being understood that the same is to be held on deposit, in trust, until further order of the Twenty-Second Circuit Court of McHenry County, Illinois. Dated: _____________________________, 20_____ ______________________________________ Signature ______________________________________ Official Title PR-REC1: Revised 12/01/06 Minor Guardianship American LegalNet, Inc. www.FormsWorkflow.com