251 2018 Nevada Supreme Court Page 1 of 2 226 Proof of Blocked Account COURT CODE: Your Name: Address: City, State, Zip: Telephone: Email Address: Self-Represented DISTRICT COURT COUNTY, NEVADA In the Matter of the Guardianship of the: EstatePerson and Estateof: (name of person who has a guardian) A Protected Person. CASE NO.: DEPT: PROOF OF BLOCKED ACCOUNT The undersigned affirms that (name of guardian) , as Guardian of the above Estate, has established an account, Account No. , titled 223,224 in the cash sum of $ and/or for the securities and other personal assets listed on the attachment to this Proof. This form can be filled out by the Guardian or by an officer at the financial institution holding the account. If the Guardian completes the form, you must attach proof that the account has been blocked (usually a bank statement indicating the account is blocked). American LegalNet, Inc. www.FormsWorkFlow.com 251 2018 Nevada Supreme Court Page 2 of 2 226 Proof of Blocked Account The undersigned acknowledges that this account bears a blocked/frozen designation, and that no money, securities or personal assets may be withdrawn without first presenting an order from the Court authorizing the withdrawal. Complete one of the two signature blocks below, depending on whether the financial officer will sign. DATED , 20 NAME OF FINANCIAL ENTITY By: AUTHORIZED OFFICER Title: OR DATED , 20 NAME OF GUARDIAN SIGNATURE (attach proof that the account is blocked) Submitted by: (Your signature) (Your name) American LegalNet, Inc. www.FormsWorkFlow.com