Form Jdf 868 - Motion To Withdraw Funds From Restricted Account
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1District Court
Denver Probate Court
_________________________________ County, Colorado
Court Address:
___________________________________________
In the Interest of:
_________________________________________
Protected Person/Minor
COURT USE ONLY
Attorney or Party Without Attorney (Name and Address):
Case Number:__________________
Phone Number:_________________ E-mail: ___________________
Division_______ Courtroom _______
FAX Number:___________________ Atty. Reg. #:_______________
MOTION TO WITHDRAW FUNDS FROM RESTRICTED ACCOUNT
I,
(name of Conservator(s)), respectfully request authority to
withdraw $
, on deposit in the restricted account(s) listed below:
Attach current bank statement.
Name and Address of Financial Institution
Account
Current
Number (last
Balance in
4-digits only)
Account
$
$
Total
The funds are requested for the following purchase/reasons(s): Attach supporting documentation for
your request.
Signature of Conservator and/or Attorney Date
Signature of Conservator and/or Attorney Date
Address
Address
City, State and Zip Code
City, State and Zip Code
Check if new address
Check if new address
Date: _______________________
_______________________________________
Signature of Minor if 12 years of age or over
Certificate of Service
I certify that on _________________________ (date) a copy of this Motion to Withdraw Funds from Restricted
Account was served on each of the following:
Name of Person to Whom You
Relationship to
Address
Manner
of
are
Sending
this
Document
Protected
Service*
(Interested Persons)
Person
*
Insert one of the following: Hand Delivery, First-Class Mail, Certified Mail, E-Served or Faxed.
_____________________________________________
Signature
JDF 868 R4/09
MOTION TO WITHDRAW FUNDS FROM RESTRICTED ACCOUNT
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