Petition For Withdrawal Of Funds From Blocked Account Page 2
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2MC–357
CASE NAME:
CASE NUMBER:
6. e. Previous withdrawals from this account (select one):
(1)
None.
(2)
As follows:
(a) Amount: $
(b) Date:
(c) Purpose:
Additional withdrawals from this account described in Attachment 6e.
Continued (provide information relating to each additional account from which funds are to be withdrawn on a separate
attachment designated as Attachment 6).
7. Amount of funds to be disbursed under this petition:
a.
Balance of account or accounts.
b.
Other (specific total amount to be disbursed): $
8. Reasons for disbursement of funds:
a.
Minor has attained the age of 18 years or older, and this is a final distribution.
b.
Other (describe):
9. Payee to whom funds will be distributed:
a. Payee (name):
(1) Address:
(2) Amount: $
(3) Purpose:
b. Payee (name):
(1) Address:
(2) Amount: $
(3) Purpose:
c. Payee (name):
(1) Address:
(2) Amount: $
(3) Purpose:
d. Payee (name):
(1) Address:
(2) Amount: $
(3) Purpose:
Continued (if there are additional payees, make a list and attach it to this petition as Attachment 9).
10. Number of pages attached:
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF PETITIONER)
SIGNATURE FOLLOWS LAST ATTACHMENT
PETITION FOR WITHDRAWAL OF FUNDS
MC-357 [Rev. January 1, 2007]
Page 2 of 2
FROM BLOCKED ACCOUNT
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