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              M C-3 57ATTO RNEY O R P AR TY W IT H O UT A TTO RNEY ( N am e, s ta te b ar n um ber, a nd a ddre ss):F O R C O URT U SE O NLYT E LE PH O NE N O .FA X N O . ( O ptio nal) :E -M AIL A D DR ESS ( O ptio nal) :A TTO RNEY F O R ( N am e):S U PER IO R C O URT O F C ALIF O RNIA , C O UNTY O F STR EE T A D DRESSM AIL IN G A D D RESSC IT Y A N D Z IP C O DEBR AN CH N AM EC ASE N AM E:P ETIT IO N F O R W IT H DRAW AL O F F U NDS FRO M B LO CKED A C C O UNTCASE N UM BERE X P AR TE1. P etit io ner ( n am e): re q u ests a n o rd er p erm it tin g t h e w it h dra w al o f f u nds b elo ngin g t o t h e p ers o n d escrib ed b elo w .2. T h e p ers o n w hose f u nds a re t o b e w it h dra w n ( n am e):isa .a m in or.b .a c o nserv ate e.c .a b en efic ia ry .d.o th er ( s p ecif y ):3 . T h e i n fo rm atio n a b out t h e p ers o n i d en tif ie d i n i t e m 2 i s a s f o llo w s:a . D ate o f b ir th :b. A ddre ss:c. T ele p hone n um ber: d. C urre n t s ch ool ( n am e a n d l o catio n):e . C urre n t e m plo yer ( n am e a n d a d dre ss):4 . I f t h e p ers o n i d en tif ie d i n i t e m 2 i s a m in or, t h e m in or's p are n ts a re a. M oth er ( n am e, a d dre ss, t e le p hone n um ber):b . F ath er ( n am e, a d dre ss, t e le p h one n um ber):5 . P etit io ner b rin gs t h is p etit io n a s ( in dic ate c ap acit y ):a .tr u ste e.b.c u sto dia n .C.pare n t.d .g uard ia n .e.c o nserv ato r.f.o th er ( s p ecif y ):6 . A cco unt s ta tu s:a. N am e a n d t it le o n a cco unt:b . D ep osit o ry ( n am e):(1 ) B ra nch :(2 ) A ddre ss:c . A cco unt n um be r:d . C urre nt b ala nce :Page 1 o f 2F orm A dopte d fo r M andato ry U se Ju dic ia l C ouncil o f C alif o rn ia MC -3 57 [R ev. J a nuary 1 , 2 007]P ETIT IO N F O R W IT H DRAW AL O F F U NDS FRO M B LO CKED A C C O UNTCal. R ule s o f C ourt, r u le s 3 .1 384, 7 .9 54electronic form 2001 WWW.LawCA.com Law Publishers              10. N um ber o f p ag es a tta ch ed :   CASE N AM E:CASE N UM BER6 . e . P re vio us w it h dra w als f r o m t h is a cco unt ( s e le ct o ne):(1 )N one.(2 )A s f o llo w s:(a) Amount: $(b) Date:(c ) P urp ose:A ddit io nal w it h dra w als f r o m t h is a cco unt d escrib ed i n A tta ch m en t 6 e .C ontin ued ( p ro vid e in fo rm atio n r e la tin g t o e ach a ddit io nal a cco unt f r o m w hic h f u nds a re t o b e w it h dra w n o n a s e para te atta ch m ent d esig nate d a s A tta ch m ent 6 ).7 . A m ount o f f u nds t o b e d is b urs ed u nder t h is p etit io n:a.b .B ala n ce o f a cco unt o r a cco unts . Oth er ( s p ecif ic t o ta l a m ount t o b e d is b urs e d): $8 . R easo ns f o r d is b urs em en t o f f u nds:a.b .M in or h as a tta in ed t h e a g e o f 1 8 y ears o r o ld er, a n d t h is i s a f in al d is tr ib utio n. Oth er ( d escrib e):9 . P aye e t o w hom f u nds w ill b e d is tr ib ute d :a. P aye e ( n am e):(1 ) A ddre ss:(2 ) A m ount: $( 3 ) P urp ose:b. P aye e ( n am e):(1 ) A ddre ss:(2 ) A m ount: $( 3 ) P urp ose:c. P aye e ( n am e):(1 ) A ddre ss:(2 ) A m ount: $( 3 ) P urp ose:d. P aye e ( n am e):(1 ) A ddre ss:(2 ) A m ount: $( 3 ) P urp ose:C ontin ued ( if t h ere a re a ddit io nal p a ye es, m ake a lis t a nd a tta ch it t o t h is p etit io n a s A tta ch m ent 9 ).I d ecla re u nder p en alt y o f p erju ry u nder t h e l a w s o f t h e S ta te o f C alif o rn ia t h at t h e f o re g oin g i s t r u e a n d c o rre ct.D ate :(T Y PE O R P R IN T N AM E) (S IG NATU RE O F P ETIT IO NER ) SIG NATU RE F O LLO W S L A ST A TTA C HM EN T M C-3 57 [R ev. J a nuary 1 , 2 007]P ETIT IO N F O R W IT H DRAW AL O F F U NDS FRO M B LO CKED A CCO UNTPage 2 o f 2electronic form 2001 WWW.LawCA.com Law PublishersMC-3 57