STATE OF SOUTH CAROLINA COUNTY OF RICHLAND ) ) ) RESTRICTED ACCOUNT AGREEMENT CASE NUMBER:____________________ IN THE MATTER OF: WHEREAS, ______________________ Conservator for ________________________ Order by the Richland County Probate Court; and , has Petitioned to be appointed as and will be appointed by Court WHEREAS, in order to avoid the necessity of posting a bond, the Conservator has agreed to deposit the assets of the Conservatorship with a domestic broker/dealer in a manner that prevents their unauthorized disposition, pursuant to South Carolina Code Section 62-5-411; NOW, THEREFORE, THE PARTIES HERETO (BEING THE CONSERVATOR, THE BROKER/DEALER AND THE COURT) AGREE AS FOLLOWS: 1. _______________________________(BROKER/DEALER) agrees to establish a restricted account(s) in the name of __________________________ as Conservator for _______________________ . 2. ______________________________ (BROKER/DEALER) and _________________________ as Conservator, expressly agree that any withdrawal from the accounts shall be allowed only upon certified Order of the Richland County Probate Court authorizing a specific withdrawal for a specific amount at a specific time. 3. ______________________________(BROKER/DEALER) and __________________________ understand that the original of this document will be filed with the Richland County Probate Court in order to induce the Court to appoint ________________________ as Conservator for ________________________ without the necessity of the posting of bond. 4. Notwithstanding the restrictions provided in this Agreement, the Conservator once appointed is permitted to (a) transfer funds from a money market/savings account to a Certificate of Deposit or renew an existing Certificate of Deposit, so long as the Certificate of Deposit is with (BROKER/DEALER) held in the name of _________________________ as Conservator for _____________________ and is subject to the withdrawal restrictions set forth above; (b) the Conservator is permitted to invest the funds in the following investments: Certificate of Deposit; Money Market accounts; Tripe “A” rated Municipal Bonds; US Agency Bonds; Government Bond Funds and Large Cap Mutual Funds invested primarily in S&P 500 companies. The Conservator may not sell assets in this brokerage account without Court approval. 5. The opening balance in the restricted account is $____________ as of , ____ ; or if not yet deposit, it is expected to be in the amount of $_____________ . American LegalNet, Inc. www.USCourtForms.com 6. The account shall maintain a minimum of $2,000 in liquid assets (i.e. money market, savings or certificates of deposit) in order to pay taxes or to provide for an emergency expenses without penalty. 7. The taxpayer identification number shall be the social security number of the incapacitated person or the minor. 8. Broker shall provide a duplicate statement either monthly or quarterly to the Richland County Probate Court, Post Office Box 192, Columbia, SC 29202, Attn: G/C/ Division. 9. SHOULD DISBURSEMENTS BE MADE WITHOUT A COURT ORDER, ________________ (BROKER/DEALER) MAY POTENTIALLY BE LIABLE FOR THE REIMBURSEMENT OF SUCH UNAUTHORIZED DISBURSEMENTS TO THE CONSERVATORSHIP ACCOUNT. Executed this ___ day of _________, ____ Executed this ___ day of _________, _____ _______________________________________ CONSERVATOR SIGNATURE _____________________________________ NAME (PRINTED) ADDRESS: _____________________________________ _____________________________________ TELEPHONE #: _____________________________________ ___________________________________ BROKER/DEALER SIGNATURE __________________________________ NAME (PRINTED) TITLE: ___________________________________ ADDRESS: ___________________________________ ___________________________________ TELEPHONE #:_____________________ American LegalNet, Inc. www.USCourtForms.com