Free PR-5 - California

Name, Address and Telephone No. of Attorney or Party Submitting Form

Bar No.: ATTORNEY FOR:

For Use of the Court Clerk Only

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SONOMA
Conservatorship / Guardianship / Estate of Co urt No.

Co nse rvatee/ W ard/ D ece den t/

RECEIPT AND ACKNOWL EDGEM ENTS OF O RDER RESTRICTING RELEASE OF PROPERTY Date o f Cou rt Order:

Prope rty on De posit ( For cash and cash equivalents: provide account number, type of account and account balance. For securities: provide type, issuer, number of shares or face value. For promissory notes: provide date, payor, sec urity and face value. For jewe lry and other p ersona l effec ts: specify an d de scribe):

Desig nated Dep ository (nam e an d ad dres s):

Ackno wled gem ent of D epos itory: Receipt is hereby acknowledged of the property and Court Order referenced above. Said prope rty (Strike One ) including/excluding interest, dividends, or note payments, will be held by us and will not be released exc ept upon Order o f the S ono m a Coun ty Superior C ourt.

Da ted:

By: Signature Title Name

PR-5 (Rev. January 1, 2003)

(Continued on reverse)

Cons ervatorship/Guard ianship/Estate of Conservatee, Ward, Decedent

Case Num ber

RECEIPT AND ACKNOWLEDGEMENTS OF ORDER RESTRICTING RELEASE OF PROPERTY Ackno wled gem ent of C onse rvator, Gu ardian o r Person al Repres entative: I understand that the prop erty specified above is to be held by the designated depository and may not be released to me except upon Order of the S ono m a Coun ty Superior C ourt.

Da ted:

By: Signature Title Name

Original to be filed with the Clerk of the Co urt; copies to be retained by the depository; by the conservator, guardian, or personal representative; and by the attorney for the estate.