Daup. Cnty. Pa. 2039B
___________, Parent and Natural Guardian of ___________, a minor, | : | In the Court of Common Pleas Dauphin County, Pennsylvania |
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Plaintiff | : | |
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v. | : | No. |
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_________________, | : | |
Defendant | : |
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 "No withdrawals prior to age 18 without prior court approval" on _______. Account No. _________ is entitled: __________, a minor. Proof of deposit is attached hereto as Exhibit A.
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Counsel for Parents and Natural Guardians of ___________, a minor
Daup. Cnty. Pa. 2039B