Petition For Withdrawal Of An Infant'S Funds - New York Supreme Court Page 2

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5. Prior withdrawals were made as follows [12. Insert prior amounts withdrawn]
Date
Amount
Reason
6. The current amount now on deposit is [13. Money on Deposit] $____________.
7. The amount of the current withdrawal request is [14. Money requested]
$____________. This money shall be used to pay for [15. Insert purpose, be specific.]
8. There are currently [16. Number of people]
, people living in the household.
They are as follows: [17. Name all people include relationship and age.]
Name
Relationship
Age

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