Verification Of Restricted Assets
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Verification Of Restricted Assets Form. This is a Missouri form and can be use in 16th Circuit (Jackson County) Local Circuit Courts.
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Tags: Verification Of Restricted Assets, 10532, Missouri Local Circuit Courts, 16th Circuit (Jackson County)
IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI - PROBATE DIVISION
AT _
_
IN THE ESTATE OF
_
ESTATE NUMBER
_,
_
_
Protectee.
VERIFICATION OF RESTRICTED DEPOSITS
This is to certify that _
_ , the fiduciary of the above captioned estate, maintains the
deposits described on the reverse side of this verification for which deposits constitute fiduciary
funds and are accepted subject to section 473.207 RSMo and the order of the court herein, and
no withdrawals of principal or interest therefrom may be made except on order of the Probate
Division of the Circuit Court of Jackson County, Missouri.
The above named fiduciary has no ownership interest in or right of survivorship to any of
the funds described herein except as follows:
_
_
The undersigned swears that the matters set forth herein are true and correct to the best
knowledge and belief of the undersigned, subject to the penalties of making a false affidavit or
declaration.
Dated _
_.
SIGNATURE: ___________________________________________________________
TITLE: _________________________________________________________________
DEPOSITORY: __________________________________________________________
ADDRESS: _____________________________________________________________
TELEPHONE NUMBER: __________________________________________________
1
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Savings,
Checking,
Cert. Dep.
Account
Number
Interest
Rate
Due Date
on C.D.
Restr. Includes or
Excludes in Payments
(Indicate below)
2
Amount
Total
Includes Int. Amount in
To Following Account
Date
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