NO._________ IN THE ESTATE OF __________________________________, DECEASED/AN INCAPACITATED PERSON } } } } } } } IN THE PROBATE COURT NUMBER ONE OF TRAVIS COUNTY, TEXAS VERIFICATION OF FUNDS ON DEPOSIT TO THE HONORABLE JUDGE OF SAID COURT: NOW COMES _________________ BANK, Austin, Texas, by and through an officer of such institution, who does hereby state under oath and whose signature is duly affixed below, that __________________, Administrator/Guardian of the above-captioned Estate, has deposited with such institution in Account No. ________, funds belonging to said Estate with a balance as of _________ [accounting period ending date] of $_________. [Add the following if funds are subject to a Safekeeping Agreement:] Further, _______________ BANK, Austin, Texas, certifies that it will not deliver to the said Administrator/Guardian or any other person, any of said funds so deposited, including any subsequent deposits to the account or any interest or dividends credited to such account, except upon the written authority of the Judge of Probate Court Number One of Travis County, Texas, in accordance with Sections 194(5)/ 703(e) of the Texas Probate Code, as amended. _______________________ BANK By_____________________________ (Signature of authorized Bank officer) _______________________________ (Printed name of officer) _______________________________ (Position) SUBSCRIBED AND SWORN TO BEFORE ME BY __________________ (name of Bank officer) this _________ day of __________________, 200_. [SEAL] _______________________________ Notary Public, State of Texas American LegalNet, Inc. www.USCourtForms.com