Fill and Sign the Blocked Account Form

––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– –– ––––– ––––– –– –– –– –– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– –– –– –– –– –– –– ––––– ––––– ––––– ––––– ––––– ––––– ––––– MC- 357ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): FOR COURT USE ONLY TELEPHONE NO. FAX NO. (Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS MAILING ADDRESS CITY AND ZIP CODE BRANCH NAME CASE NAME: PETITION FOR WITHDRAWAL OF FUNDS FROM BLOCKED ACCOUNT CASE NUMBER EX PARTE 1. Petitioner (name): requests an order permitting the withdrawal of funds belonging to the person described below. 2. The person whose funds are to be withdrawn (name): i s a . a minor. b . a conservatee. c . a beneficiary. d . other (specify): 3. The information about the person identified in item 2 is as follows: a. Date of birth: b. Address: c. Telephone number: d. Current school (name and location): e. Current employer (name and address): 4. If the person identified in item 2 is a minor, the minor's parents are a. Mother (name, address, telephone number): b. Father (name, address, telephone number): 5. Petitioner brings this petition as (indicate capacity): a . truste e. b . custodia n. C . pare nt. d . guardia n. e . conservato r. f . other (specify): 6. Account status: a. Name and title on account: b. Depository (name): (1) Branch: (2) Address: c. Account number: d. Current balance: Page 1 of 2 Form Adopted for Mandatory Use Judicial Council of California MC-357 [Rev. January 1, 2007] PETITION FOR WITHDRAWAL OF FUNDS FROM BLOCKED ACCOUNT Cal. Rules of Court, rules 3.1384, 7.954electronic form ã 2001 WWW.LawCA.com Law Publishers ––––– ––––– –– –– ––––– ––––– ––––– –– –– –– –– ––––– –– –– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– –– 10. Number of pages attached: ––––– ––––– ––––– ––CASE NAME: CASE NUMBER 6. e. Previous withdrawals from this account (select one): ( 1 ) Non e. ( 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 Continued (provide information relating to each additional account from which funds are to be withdrawn on a separate attachment designated as Attachment 6). 7.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 . b . Balance of account or accounts. Other (specific total amount to be disbursed): $ 8. Reasons for disbursement of funds: a . b . Minor has attained the age of 18 years or older, and this is a final distribution. 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). I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Dat e: (TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER) SIGNATURE FOLLOWS LAST ATTACHMENT MC-357 [Rev. January 1, 2007] PETITION FOR WITHDRAWAL OF FUNDS FROM BLOCKED ACCOUNT Page 2 of 2electronic form ã 2001 WWW.LawCA.com Law Publishers MC- 357