Free ACKNOWLEDGMENT - Colorado

District Court Denver Probate Court _________________________________ County, Colorado Court Address: _________________________________________ In the Interests of:
__________________________________________________

Protected Person/Minor Attorney or Party Without Attorney (Name and Address):

COURT USE ONLY Case Number: ________________

Phone Number:_________________ E-mail: ___________________ FAX Number:__________________ Atty. Reg. #:________________

Division ______ Courtroom _______

ACKNOWLEDGMENT OF DEPOSIT OF FUNDS TO RESTRICTED ACCOUNT
__________________________________________ (name of federally insured financial institution), acknowledges that funds have been deposited by ____________________ (name of fiduciary) as the Conservator, Guardian, Next Friend, or Parent for ___________________________ (name of

Protected Person or Minor) as follows: Title of Account Account Number - last 4digits only
$

Amount

Total

$

This institution submits itself to the jurisdiction of this Court and agrees that it shall not permit any withdrawal of funds except upon being furnished a certified copy of an Order of this Court authorizing such withdrawal.
Date: _________________________________ _____________________________________________ Signature of Authorized Bank Officer _____________________________________________ Type name and title of Authorized Bank Officer
(Type or print name, address and telephone # below of Bank) ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________

Note: Return to the Court name and address as shown above.

JDF 867

11/07

ACKNOWLEDGMENT OF DEPOSIT OF FUNDS TO RESTRICTED ACCOUNT