IN THE CIRCUIT COURT OF CLAY COUNTY, MISSOURI SEVENTH JUDICIAL CIRCUIT DIVISION FOUR Liberty, Missouri 64068 Case No. ______________________ Matter of _____________________________________________, a minor. AGREEMENT TO ACCEPT RESTRICTED DEPOSIT The ____________________________________________________________________ hereby contracts and agrees to restrict and/or accept a transfer of funds directly from ______________________________________________________________________________ on behalf of _______________________________________, minor, and further agrees that said funds, and any subsequent deposits, will be placed in a Federally insured investment as designated by next friend; and said funds will not be released to the possession or control of the next friend except upon order of the court. THE STATEMENTS AND REPRESENTATIONS IN THIS DOCUMENT ARE MADE UNDER OATH AND ARE TRUE AND CORRECT TO MY BEST KNOWLEDGE AND BELIEF. I UNDERSTAND THEY ARE MADE SUBJECT TO THE PENALITES OF MAKING A FALSE AFFIDAVIT OR DECLARATION. Date ________________________ Depository ________________________________________________ Address ___________________________________________________ __________________________________________________________ By (signature) ______________________________________________ Title ______________________________________________________ Form DIV4-402 Revised 5/31/2011 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com