DALLAS COUNTY CLERK PROBATE SECTION REGISTRY FUND DEPOSIT INFORMATION SHEET DECEASED OR INCAPACITATED CASE: NO: STYLE: DECEASED OR INCAPACITATED PERSON: NAME: DATE OF DEATH/ INCAPACITATION: SS# / TAX ID: (1) TRUSTEE OR OTHER RESPONSIBLE PARTY: NAME: ADDRESS: PHONE #: ATTORNEY OF RECORD: NAME: ADDRESS: PHONE #: ARE THESE FUNDS TO BE INVESTED ? YES NO HAS AN ORDER BEEN SUBMITTED TO INVEST FUNDS? YES NO IT IS THE RESPONSIBILITY OF THE ATTORNEY OF RECORD TO SUBMIT AN ORDER TO INVEST FUNDS. (1) FORM 1099-INT WILL BE SENT TO THIS ADDRESS EVERY YEAR. IT IS THE RESPONSIBILITY OF THE ATTORNEY OF RECORD TO NOTIFY THIS OFFICE OF ANY ADDRESS CHANGES. SIGNATURE: DATE: DEPOSITOR FORM CCTRUST004 01/05/2005 American LegalNet, Inc. www.FormsWorkFlow.com