Petition For Withdrawal Of An Infant'S Funds - New York Supreme Court Page 3

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9. The monthly rent is [18. Insert rent amount, if petitioner owns residence, write
zero] $____________.
10. The monthly mortgage and fixed carrying charges are [19. Insert mortgage
amount, and include any utilities] $____________.
11. The household’s monthly income is as follows: [20. Include all income.]
Father $
Mother $
Children $
Other $
12. The family [21. Check one]
does
does not own any real property.
13. The family has other bank deposits in the total amount of [22. Insert all bank
deposits including money market and brokerage accounts] $
14. No prior application for the relief (the current withdrawal) have been made to this
Court. [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.]
WHEREFORE, your petitioner respectfully asks that this court grant the relief
requested in this petition.
Petitioner Signature
[24. Your signature]
[25. Print Your Name]
[26. Your Address]
[27. City, State & Zip Code]
[28. Your Phone Number]

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