(Gen. R. Prac. 145.05)
State of Minnesota | District Court | |
County of ___________ | __________ Judicial District | |
Case Type: _ | ||
_ | ||
Plaintiff/Petitioner | Case No. _ | |
and | RECEIPT OF MINOR SETTLEMENT | |
ORDER AND FUNDS | ||
_ | (Provided Pursuant to Rule 145 of the | |
Defendant/Respondent | Minnesota General Rules of Practice) |
1.__________ ("Financial Institution") acknowledges receipt of the sum of $__________ on behalf of __________ in this action.
2. Financial Institution acknowledges receipt of the Order Approving Settlement and For Deposit Into Restricted Account dated __________ in this action, and that the funds delivered remain subject to that order in the account specified below:
Name of Depository: | _ |
Branch Name: | _ |
Branch Address: | _ |
_ | |
Account Number: | _(Place on separate form 11.1*)_ |
Date Account Opened: | _ |
Current Balance: | $ _ |
3. This account is a federally insured, restricted account, and no withdrawal of either principal or interest shall be allowed by Financial Institution without a signed court order in this case.
Dated: ______________ | Type or Print Name | _ |
Signature: | _ | |
Title: | _ |
* = As required by Rule 11.2 of the Minnesota General Rules of Practice
(Added effective January 1, 2003; amended effective July 24, 2013.)