PROBATE COURT OF MONTGOMERY COUNTY, OHIO ALICE O. McCOLLUM, JUDGE IN THE MATTER OF: CASE NO.: VERIFICATION OF RECEIPT AND DEPOSIT [Not for use in Custodial Account] Pursuant to Court order, the sum of $ on the 20 day of was deposited with , , as evidenced by Savings/Certificate of Deposit Account Number . This account is held solely in the name of , a minor/incompetent. By accepting said deposit for said minor/incompetent, this institution agrees that said deposit, together with accumulated interest, shall be held and no part thereof released until said minor attains the age of majority or upon further order of the Court. Financial Institution By Authorized Officer Typed or Printed Name Phone Number Date American LegalNet, Inc. www.FormsWorkFlow.com FORM 22.3A ­ VERIFICATION OF RECEIPT AND DEPOSIT 6/1/16