Form 13 - Petition For Withdrawal Of An Infant'S Funds printable pdf download

Form 13 - Petition For Withdrawal Of An Infant'S Funds

Petition for Withdrawal of an Infant’s Funds (Form 13)

Petition

[1. Index No. & Year] Insert Index Number & the year it was purchased

[2. Fill in name(s)] Fill in the Plaintiff name

[3. Fill in name(s)] Fill in the Defendant name

[4. Your name(s)] Your name

[5. Insert infant name.]

[6. Insert infant age.]

[7. Insert infant date of birth.]

[8. Insert Infant address]]

[9. Insert amount] Insert the original amount deposited into the bank account

before any withdrawals.

[10. Insert the date of Deposit] State the original date the money was

deposited into the bank account.

[11. Insert amount, if none write zero] Insert the amount you received in the

settlement of the original action for loss of services, if any.

[12. Insert prior amounts withdrawn] Insert the date, amount and the reason

for the withdrawal

[13. Money on Deposit] State the current amount on deposit in the bank

account

[14. Money requested] Insert the amount of money you are requesting.

[15. Insert purpose, be specific] Explain why you are withdrawing the money,

and what it is going to be used for.

[16. Number of people] Insert the number of people living in your household.

[17. Name all people including relationship & age.] Insert names, relationship

to you, and age of all people living in your house.

[18. Insert rent amount, if petitioner owns residence, write zero]

[19. Insert mortgage amount, and include any utilities]

[20. Include all income.] State the money contributed to the household by all

people living in your household

[21. Check one] State if anyone in your household owns real property

[22. Insert all bank deposits including money market and brokerage

accounts] State any additional money in bank accounts

[23. If a prior application for the current withdrawal was made state the

Court, when, who made the application, the result of the application, attach

a copies of the application and explain why you are making another

application.] State whether you asked for the same withdrawal for the same

purpose previously

[24. Your signature]

[25. Print Your Name]

[26. Your Address]

[27. City, State & Zip Code]

[28. Your Phone Number]

Form 13 - Petition For Withdrawal Of An Infant'S Funds