PROBATE COURT OF GEAUGA COUNTY, OHIO JUDGE TIMOTHY J. GRENDELL IN THE MATTER OF CASE NO. VERIFICATION OF RECEIPT AND DEPOSIT Pursuant to Court order, the sum of $ on the day of was deposited with . 20 , as . This , . evidenced by Savings/Certificate of Deposit Account Number account is held solely in the name of a minor, whose Social Security Number is By accepting said deposit for said minor, this institution agrees that said deposit, together with accumulated interest, shall be held and no part thereof released until minor attains the age of majority or upon further order of this Court. Financial Institution By Authorized Officer Typed of Printed Name Phone Number Date 22.3 - VERIFICATION OF RECEIPT AND DEPOSIT 4/97 American LegalNet, Inc. www.FormsWorkFlow.com