(CAPTION)
AFFIDAVIT OF DEPOSIT OF MINOR'S FUNDS
The undersigned, counsel for ________________, parents and natural guardians of _____________, a minor, hereby certifies that the net settlement amount of $_______as set forth in this Court's order dated _________was deposited by ________into a restricted, federally insured account, marked "NOT TO BE WITHDRAWN UNTIL THE MINOR REACHES THE AGE OF EIGHTEEN (18), EXCEPT FOR THE PAYMENT OF LOCAL, STATE AND FEDERAL INCOME TAXES ON INTEREST EARNED BY THE SAVINGS ACCOUNT OR CERTIFICATE, IF ANY, OR UNTIL FURTHER ORDER OF THIS COURT" on ___________. Account No. __________is entitled: _____________, a minor. Proof of deposit is attached hereto as Exhibit A.
___________________________________
Counsel for Parents and Natural Guardians of _______________, a minor
(CAPTION)
ORDER OF COURT
AND NOW, this _____day of ________, 20___, at _______.m., upon consideration of the Petition for Approval of Minor's Settlement, it is hereby ORDERED and DIRECTED that the Compromise Settlement in the sum of ____________Dollars ($_________) is APPROVED, and that the Settlement be distributed as follows:
Counsel for petitioners is ORDERED to cause the restricted account to be created and to file an affidavit of deposit of minor's funds within thirty (30) days hereof.
Jurisdiction of any further proceeding concerning the minor's estate is transferred to the Orphans' Court Division for disposition.
Pursuant to Sch. Co. O.C. Rule 12.5B(c), if no withdrawals are made from the account prior to the minor reaching his/her majority, the institution may pay over the funds when the minor attains age eighteen (18) years, upon the joint requests of the natural parent(s) and the former minor without further Order of this Court.
BY THE COURT,
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Sch. Cnty. Pa. 2039