PROBATE COURT OF ______________________ COUNTY, OHIO IN THE MATTER OF _______________________________________________________ CASE NO. _________________ VERIFICATION OF RECEIPT AND DEPOSIT Pursuant to Court order, the sum of $______________________ was deposited with _____________________________________ on the ______ day of ________________________, ______, as evidenced by 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 Print Form FORM- 22.3 - VERIFICATION OF RECEIPT AND DEPOSIT 4/1/97 American LegalNet, Inc. www.FormsWorkFlow.com