Form CC 16:2.13 Certificate of Proof of Possession - Nebraska

Form CC16:2.13 is a Nebraska Judicial Branch form also known as the "Certificate Of Proof Of Possession". The latest edition of the form was released in March 1, 2016 and is available for digital filing.

Download an up-to-date Form CC16:2.13 in PDF-format down below or look it up on the Nebraska Judicial Branch Forms website.

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Nebraska State Court Form
REQUIRED
CERTIFICATE OF
PROOF OF POSSESSION
CC 16:2.13 Rev. 03/16
Neb. Ct. R. §6-1442
TO THE GUARDIAN AND/OR CONSERVATOR: This form must be completed by the financial
institution. It must be filed with the court, sent to all interested persons, and will be public
information. For protection of financial information, give only the last four digits of accounts and
bond information on this form. Complete account and bond information must be provided on the
Personal and Financial Information for Guardianships and Conservatorships form (CC 16:2.23).
_____________________________________________________________________________________________________________________________________________________________________________________________________________
In the matter of the estate of _______________________________case number________________
guardian and/or
conservator: ____________________________________________
Name of
Name and address of institution _______________________________________________________
CERTIFICATE OF BALANCE ON DEPOSIT
I CERTIFY that on the ____ day of ___________ , 20___ , there was on deposit in this institution to the
benefit of the above ward, incapacitated or protected person the following:
Checking Account, No. XXXXXXX-__ __ __ __  Restricted
Balance of $
including interest of $____________________ paid
during period of statement of account.
Savings Account, No. XXXXXXX-__ __ __ __  Restricted
Balance of $____________________________including interest of $____________________ paid
during period of statement of account.
Please Note: To be considered restricted, the account shall be designated with the following notice: “NO
WITHDRAWAL WITHOUT COURT ORDER”
(*Extend above format for additional accounts as required)
NOTE TO CERTIFYING OFFICIAL: This certificate may be executed by a bank official, an authorized
official or agent of the company which is surety on your bonds.
I CERTIFY that the accounts listed above were exhibited to me by the above-named guardian and/or
conservator as being the property of the estate of the ward, protected or incapacitated person said
deposits then and there being in the custody and control of the guardian and/or conservator.
____________________________________________________________________________________
Signature and Title of Certifying Official
Date
Address of Certifying Official
State of
)
) ss.
County of
)
The foregoing instrument was acknowledged before me by
, this
Name of Official certifying above
day of
,
.
Day
Month
Year
Notary Public (signature of person taking acknowledgment)
My commission expires:
(title or rank)
(serial number, if any)
Page 1 of 2
Certificate of Proof of Possession
CC 16:2.13 Rev 03/16
Nebraska State Court Form
REQUIRED
CERTIFICATE OF
PROOF OF POSSESSION
CC 16:2.13 Rev. 03/16
Neb. Ct. R. §6-1442
TO THE GUARDIAN AND/OR CONSERVATOR: This form must be completed by the financial
institution. It must be filed with the court, sent to all interested persons, and will be public
information. For protection of financial information, give only the last four digits of accounts and
bond information on this form. Complete account and bond information must be provided on the
Personal and Financial Information for Guardianships and Conservatorships form (CC 16:2.23).
_____________________________________________________________________________________________________________________________________________________________________________________________________________
In the matter of the estate of _______________________________case number________________
guardian and/or
conservator: ____________________________________________
Name of
Name and address of institution _______________________________________________________
CERTIFICATE OF BALANCE ON DEPOSIT
I CERTIFY that on the ____ day of ___________ , 20___ , there was on deposit in this institution to the
benefit of the above ward, incapacitated or protected person the following:
Checking Account, No. XXXXXXX-__ __ __ __  Restricted
Balance of $
including interest of $____________________ paid
during period of statement of account.
Savings Account, No. XXXXXXX-__ __ __ __  Restricted
Balance of $____________________________including interest of $____________________ paid
during period of statement of account.
Please Note: To be considered restricted, the account shall be designated with the following notice: “NO
WITHDRAWAL WITHOUT COURT ORDER”
(*Extend above format for additional accounts as required)
NOTE TO CERTIFYING OFFICIAL: This certificate may be executed by a bank official, an authorized
official or agent of the company which is surety on your bonds.
I CERTIFY that the accounts listed above were exhibited to me by the above-named guardian and/or
conservator as being the property of the estate of the ward, protected or incapacitated person said
deposits then and there being in the custody and control of the guardian and/or conservator.
____________________________________________________________________________________
Signature and Title of Certifying Official
Date
Address of Certifying Official
State of
)
) ss.
County of
)
The foregoing instrument was acknowledged before me by
, this
Name of Official certifying above
day of
,
.
Day
Month
Year
Notary Public (signature of person taking acknowledgment)
My commission expires:
(title or rank)
(serial number, if any)
Page 1 of 2
Certificate of Proof of Possession
CC 16:2.13 Rev 03/16
CERTIFICATE AS TO SECURITIES (certificates of deposits, savings bonds, etc.)
DATE OF
 Restricted
KIND OF BOND OR SECURITY
COST
INTEREST RATE
PRESENT VALUE
PURCHASE
 Restricted
1.
 Restricted
2.
 Restricted
3.
 Restricted
4.
(identify U.S. Savings Bonds by series, last four digits of bond, purchase date, and cost. Identify accounts
by last four digits of account.)
Please Note: To be considered restricted, the account shall be designated with the following notice: “NO
WITHDRAWAL WITHOUT COURT ORDER”
(*extend format for additional bonds or securities as required)
I CERTIFY that the securities listed above were exhibited to me by the above-named guardian and/or
conservator as being the property of the estate of the ward, protected or incapacitated person said
securities then and there being in the custody and control of the guardian and/or conservator.
____________________________________________________________________________________
Date
Signature and Title of Certifying Official
Address of Certifying Official
State of
)
) ss.
County of
)
The foregoing instrument was acknowledged before me by
, this
Name of Official certifying above
day of
,
.
Day
Month
Notary Public (signature of person taking acknowledgment)
Year
My commission expires:
(title or rank)
(serial number, if any)
Page 2 of 2
Certificate of Proof of Possession CC
16:2.13 Rev 03/16

Download Form CC 16:2.13 Certificate of Proof of Possession - Nebraska

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