Jackson Supp. L. R. 16 app F
IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF JACKSON
In the Matter of the ________________________ | ) |
) CASE NO. ________________ | |
of ______________________________________, | ) |
) ACKNOWLEDGMENT OF | |
___ Deceased ____ Minor ____ Incapacitated. | ) RESTRICTION OF ASSETS |
We acknowledge receipt of a copy of the court order signed on _______________, 20____ that restricts access to the assets of the above estate/conservatorship as described below. We will not allow ANY distribution or withdrawal of principal or income from these assets or use of the assets as security for any obligation without specific authority by court order, except as allowed by this Order unless modified by a subsequent Order of this Court. We will not close the account without Court Order or upon the minor reaching the age of majority. We will provide the Court with at least 30 days prior written notice with any intent to close for any other reason. The Order allows the conservator to make withdrawals from the restricted assets as follows: ____None ____ Other conditions or restrictions:
__________________________________________________________________
_________________________________________________________________.
The assets on deposit with us that are subject to the Order are identified as follows:
Account No. | Value of Account Assets | Type of Account | Maturity |
(You may list any other accounts subject to the Court's Order on the back of this form)
The name of the holder of the account shown on our records is_________________________.
We understand that the conservator/personal representative may do the following without court order:
(1) transfer restricted assets to other accounts with us that are subject to the restrictions stated above; and
(2) change the investment of assets, as long as all assets remain in an account with us subject to the restrictions stated above.
We agree to abide by the Order. We understand that if assets are removed from a restricted account without prior court order, this institution shall be required to pay the value of those assets to the estate/conservatorship.
DATE: ____________________, 20____. THIS DOCUMENT MUST BE SIGNED BY AN OFFICER OR OTHER PERSON AUTHORIZED TO BIND THE INSTITUTION. | Name & Address of Financial Institution: ____________________________ ________________________________ ________________________________ By: _____________________________ (Printed Name and Title) |
Appendix F (Per SLR 9.051)
Jackson Supp. L. R. 16 app F