IN THE COURT OF COMMON PLEAS OF MONTGOMERY COUNTY, PENNSYLVANIA : : VS. : : : NO. AFFIDAVIT OF DEPOSIT OF MINOR'S FUNDS I, 1. I am employed by name of bank or authorized depository being duly sworn according to law depose and say: as . name of bank or authorized depository . 2. I am authorized to make this affidavit on behalf of 3. On No. pursuant to Order of Court dated 4. Account/Certificate No. to File No. is entitled, the sum of $ was deposited by in an insured, interest-bearing Savings Account / Certificate of Deposit 5. The express prohibition of withdrawals of income prior to FURTHER ORDER OF COURT has been noted on the depository's records and on the passbook/certificate. without Signature Print Name / Title Address Notary Public Sworn to and subscribed before me this day of , 20 . THIS AFFIDAVIT SHALL BE FIELD IN THE OFFICE OF THE PROTHONOTARY, MONTGOMERY COUNTY COURTHOUSE, SWEDE AND AIRY STREETS, NORRISTOWN, PENNSYLVANIA WITHIN THIRTY (30) DAYS OF THE DATE OF THE ORDER OF COURT. (6/02) American LegalNet, Inc. www.USCourtForms.com