Verification Of Unrestricted Deposit
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Verification Of Unrestricted Deposit Form. This is a Missouri form and can be use in 7th Circuit (Clay County) Local Circuit Courts.
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Tags: Verification Of Unrestricted Deposit, 407, Missouri Local Circuit Courts, 7th Circuit (Clay County)
CIRCUIT COURT OF CLAY COUNTY, MISSOURI
PROBATE DIVISION
No.
Matter of
, *minor - *disabled - *deceased.
VERIFICATION OF UNRESTRICTED DEPOSIT
The undersigned hereby certifies that __he is an official of the below named depository, which had (a)
deposit(s) on this _____ day of ____________________, 20____. The following amount(s) in the name(s) of
, as *Conservator__, *Personal
Representative__, of the above named estate. THERE ARE NO OTHER NAME(S) ON THE ACCOUNT(S)
EXCEPT AS FOLLOWS:
Account
Type:
Savings,
CD, MM,
Checking
Account Number
Interest
Rate
Due Date on
CD
Total Amt in
Acct.
Date of
Last Int.
Pymt.
Current value of
account
THE STATEMENTS AND REPRESENTATIONS IN THIS DOCUMENT ARE MADE UNDER OATH
AND ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND
THEY ARE MADE SUBJECT TO THE PENALTIES OF MAKING A FALSE AFFIDAVIT OR DECLARATION.
Date:____________________
Depository:
Address:
By:
TYPE OR PRINT NAME
SIGNATURE ( REQUIRED )
Title:
INSTRUCTIONS: Any erasures or corrections must be initialed by a depository agent.
*strike if inapplicable
Form 407
Revised 9/23/2004
Page 1 of 1
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