PROBATE COURT OF SHELBY COUNTY, OHIO IN THE MATTER OF CASE NO. , MINOR APPLICATION FOR DEPOSIT OF MINOR'S FUNDS WITHOUT APPOINTMENT OF GUARDIAN [R.C. 2111.05, $10,000 OR LESS] Now comes the undersigned applicant, without the appointment of a guardian, and applies to the Court for an order releasing to ,a depository authorized to receive fiduciary funds, the amount of $ , belonging to , a minor, from the following source: inheritance; insurance proceeds; wrongful death gift; proceeds (Estate No. Estate Name ); or other ( ). Attorney for applicant Address City, State, Zip Code Phone Number Applicant Address City, State, Zip Code Phone Number Applicant is hereby ordered to release to ,a depository authorized to receive fiduciary funds, in the sum of $ , being funds belonging to , a minor from the source described above. Said funds shall be held in the sole name of the minor and shall not be released until said minor attains the age of majority or until further order of the Court. Within fourteen (14) days of this order, the applicant shall file a Verification of Deposit with this Court. Probate Judge/Magistrate ORDER FOR DEPOSIT OF MINOR'S FUNDS WITHOUT APPOINTMENT OF GUARDIAN American LegalNet, Inc. www.FormsWorkFlow.com H.C. FORM 116.10 - APPLICATION AND ORDER FOR DEPOSIT OF MINOR'S FUNDS WITHOUT GUARDIAN 02/10/03