Acknowledgment of Receipt of Order and Funds for Deposit in Blocked Account

Judicial Council of California · General

Verified current as of July 16, 2026

This form confirms that a court clerk has received money and a court order that requires the funds to be deposited into a blocked account that cannot be accessed without court permission. Guardians, conservators, or parents in custody cases use this form to get written proof that the court has accepted their funds and will hold them safely for a minor or protected person.