IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF MULTNOMAH In the Matter of the ) of ) CASE NO. ) , ) ACKNOWLEDGMENT OF ) RESTRICTION OF ASSETS Deceased Minor Incapacitated. ) We acknowledge receipt of a copy of the court order signed on , Account No. Value of Account Assets Type of Account Maturity The name of the holder of the account shown on our records is . We understand that the conservator/personal representative may do the following without court order: (1) transfer restricted assets to other accounts with us that are subject to the restrictions stated above; and (2) change the investment of assets, as long as all assets remain in an account with us subject to the restrictions American LegalNet, Inc. www.FormsWorkFlow.com