Fill and Sign the Fillable Online Calculating Speed Time Distance Worksheet Fax Form

Page 1 of 3 PG -662 (6/18 )(cs) AS 13.26. 147 (b) PETITION TO RECEIVE FUNDS ON BEHALF OF A MINOR AS 13.26. 401 - .440 IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Protective Proceeding of ) ) ) ) ) CASE NO. Minor ) Date of Birth: ) PETITION TO RECEIVE FUNDS ON BEHALF OF A MINOR (AS 13.26. 440 ) Petitioner asks the court to authorize to receive the funds described below on behalf of the minor named above and to manage the funds as custodian under the Alaska Uniform Transfers to Minors Act (AS 13.46.010 - .999) until the minor reaches age 18. deposit the funds in the following trust: deposit or use the funds as follows : 1. Petitioner's Full Name Age Petitioner's Mailing Address (box or street number) (city) (state) (ZIP) Petitioner's Daytime Phone Relationship to Minor 2. Nominated Guardian (if not Petitioner) Age Mailing Address (box or street number) (city) (state) (ZIP) Daytime Phone Relationship to Minor 3. Minor's Full Name Age Minor’s Physical Address (box or street number) (city) (state) (ZIP) Minor 's Daytime Phone 4. Description of Funds. The funds are the proceeds of a life insurance policy on the life of (name ) who died on (date) . The d eceased person was the minor ’s (describe relationship) Name of Insurance Company: Address of Insurance Company: Policy No. Amount Owed to Minor : Page 2 of 3 PG -662 (6/18 )(cs) AS 13.26. 147 (b) PETITION TO RECEIVE FUNDS ON BEHALF OF A MINOR AS 13.26. 401 - .440 I received a letter dated from the ins urance company stating that the company cannot pay the minor ’s money to me unless I am the minor ’s legal guardian. I am attaching a copy of this letter. Other funds (provide as much detail on the type of fund s and explain why you need authorization to receive funds): 5. The minor’s mother is living . deceased . Mother’s full name Mother's Mailing Address (box or street number) (city) (state) (ZIP) Mother's Daytime Phone 6. The minor’s father is living . deceased . Father’s full name Father's Mailing Address (box or street number) (city) (state) (ZIP) Father’s Daytime Phone 7. Name of person who has physical custody of the minor Mailing Address (box or street number) (city) (state) (ZIP) Daytime Phone 8. The minor is is not married. 9. Has a guardian or conservator been appointed for the minor by any court ? No. Yes. If yes, explain (include court location and case number, if known) : Name and address of guardian/cons ervator: 10 . Are there an y other proceedings for the appointment of a guardian or conservator pending in any court? No. Yes. If yes, explain (include court location and case number, if known) : 11. Are there any other court pr oceedings involving this minor? No. Yes. If yes, explain (include court location and case number, if known) : Page 3 of 3 PG -662 (6/18 )(cs) AS 13.26. 147 (b) PETITION TO RECEIVE FUNDS ON BEHALF OF A MINOR AS 13.26. 401 - .440 12. If authorized to become the custodian of this money under the Alaska Uniform Transfers to Minors Act (UTMA) , the custodian must manage the money for the benefit of the minor in accordance with the UTMA . Petitioner understands that , among other things, the UTMA requires the custodian to: a. keep these funds separate from the custodian ’s funds and anyone else’s funds at all times, 1 b. keep records of all transactions concerning these funds ,2 c. manage and invest the funds and the funds’ earnings to benefit the minor, and in dealing with the funds , observe the standard of care that would be observed by a prudent person dealing with property of another ,3 d. when depositing the funds at financial institutions (banks, stock brokers, etc.), name the accounts as follows: “ (Custodian’s Name) as custodian for (Minor’s Name) under the Alaska Uniform Transfers to Minors Act,” 4and e. transfer the funds to the minor when the minor reaches age 18 .5 The UTMA allows the custodian to pay to the minor or spend for the minor’s benefit as much of these funds as the custodian considers advisable for the use and benefit of the minor. 6 Date Signature of Petitioner or Petitioner’s Attorney If attorney, print name and bar number: Verification I state on oath or affirm that I have read this petition and that all statements made in it are true to the best of my knowledge and belief. Date Petitioner's Signature Subscribed and sworn to or affirmed before me at , Alaska on . Date (SEAL) Clerk of Court, Notary Public, or other person authorized to administer oaths. My commission expires: 1 AS 13.46.110(d) 2 AS 13.46.110(e) 3 AS 13.46.110 4 AS 13.46.080(a)(2) 5 AS 13.46.190(2) 6 AS 13.46.130(a)