Certificate Of Cash Deposit

1 UNITED STATES DISTRICT COURT 2 DISTRICT OF NEVADA 3 ) ) 4 ) ) 5 ) CV ) 6 ) ) 7 ) ) 8 9 CERTIFICATE OF CASH DEPOSIT 10 1. I, , herewith tender to the Clerk (Name of Depositor) 11 of Court for deposit into the Registry Account of this Court cash in the amount of 12 $ . 13 2. This Cash Deposit: 14 A. Is tendered on behalf of: ; (Name of Party)15 B. Is in the nature of the following (e.g., Interpleader Deposit, Bond in Support 16 of Temporary Restraining Order, etc.) : 17 18 19 20 C. Is tendered pursuant to the following Statute, Rule or Court Order: 21 22 23 24 D. Is conditioned as follows: 25 26 27 . . . 28 1 11/99<<<<<<<<<********>>>>>>>>>>>>> 2 1 . . . 2 3 3. The name and address of the Legal Owner of the cash tendered 4 herewith to whom a refund (if applicable) shall be made is: 5 6 7 8 9 State of Nevada ) Dated: ) ss. 10 County of ) Signature of Depositor11 On , 20 , personally appeared before me, a 12 Notary Public, 13 14 (Name of Depositor) who acknowledged that (s)he 15 executed the above instrument. 16 17 NOTARY PUBLIC Dated: 18 19 Signature of Attorney for Party or Party Appearing 20 Se Pro (If different from Depositor)21 22 RECEIPT: 23 Cash as identified herein is hereby acknowledged as being 24 received this date. 25 Dated: 26 CLERK, U.S. DISTRICT COURT 27 By: Deputy Clerk28 2