PROBATE COURT OF WARREN COUNTY, OHIO IN THE MATTER OF CASE NO. VERIFICATION OF RECEIPT AND DEPOSIT was deposited with Pursuant to Court order, the sum of $ day of on the , as evidenced by the Savings/Certificate of Deposit Account Number . This 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 or Printed Name Phone Number Date FORM 22.3 - VERIFICATION OF RECEIPT AND DEPOSIT 4/97 American LegalNet, Inc. www.USCourtForms.com