1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 PROF DISTRICT COURT CLARK COUNTY, NEVADA In the Matter of the Estate of CASE NO. DEPT. NO. Deceased. PROOF OF BLOCKED ACCOUNTS (ESTATE) The undersigned affirms that , as Personal , Deceased, has , entitled " ," 18 19 20 21 22 23 Representative of the Estate of established an account, being Account No. in the cash sum of $ and/or for the securities and other personal assets listed on the attachment to this Proof. The undersigned acknowledges that these accounts bear a blocked/frozen 24 designation, and that no money, securities or personal asset may be withdrawn without 25 ... 26 27 28 PROF Estate32/4/18/2007 American LegalNet, Inc. www.FormsWorkflow.com 1 2 3 4 5 6 7 8 first presenting an Order from the Court authorizing the withdrawal. DATED this day of , 20 . ______________________________ Name of Financial Entity By:___________________________ Authorized Officer Title:_________________________ Submitted By: 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ____________________________________ 2 PROF Estate32/4/18/2007 American LegalNet, Inc. www.FormsWorkflow.com