Fill and Sign the Petition of Mother and Natural Guardian of a Minor for Payment of Insurance Proceeds Mississippi Form

IN THE CHANCERY COURT OF THE _______ JUDICIAL DISTRICT OF _______ COUNTY, MISSISSIPPI IN THE MATTER OF _______________ , A MINOR NO. _______ PETITION OF _______________ , MOTHER AND NATURAL GUARDIAN OF _______________ , A MINOR FOR PAYMENT OF INSURANCE PROCEEDS Comes now the Petitioner, _______________ , mother and natural guardian of _______________ , a minor, pursuant to Section 93-13-211, Mississippi Code of 1972 , as amended, and would respectfully show unto the Court the following matters and facts, to-wit: 1. That Petitioner, _______________ , is an adult resident citizen of the _______ Judicial District of _______ County, Mississippi, and resides at _______ , _______ , _______ , Mississippi _______ . 2. That Petitioner is the mother and natural guardian of _______________ , a minor, who is _______ ( ___ ) years of age and resides with the Petitioner. 3. That on _______ ___ , 20 ___ , an insurance policy in the amount of _______ Dollars ($ _______ ) was issued on the life of _______________ by _______________ Life Insurance Company, being Policy No. _______ . The beneficiary of said policy was _______________ , granddaughter of _______________ . 4. That _______________ died on _______ ___ , 20 ___ . That at the time of the death of _______________ , said insurance policy was still in existence and the proceeds are payable to _______________ , a minor. 5. That Petitioner is desirous that said proceeds from said insurance policy be paid to her as custodian of said minor, _______________ , and that the proceeds be placed in a Federally insured bank with Petitioner as custodian under the Mississippi Uniform Gifts to Minors Act. The _______________ Life Insurance Company stands ready and willing to pay said insurance proceeds. WHEREFORE, PREMISES CONSIDERED, Petitioner, _______________ , prays that she, as mother and natural guardian of _______________ , a minor, be authorized to accept payment of the aforesaid life insurance proceeds from the _______________ Life Insurance Company in the amount of _______ Dollars ($ _______ ) on behalf of said minor and that Petitioner be authorized and directed to place said insurance proceeds in a Federally insured bank in the name of Petitioner as Custodian for _______________ , a minor, under the Mississippi Uniform Gifts to Minors Act, and that upon payment as aforesaid the _______________ Life Insurance Company shall be relieved of any further liability with regard to said policy in accordance with Section 93-13-211, Mississippi Code of 1972 , as amended. And Petitioner prays for general relief. Respectfully submitted, __________________________________ _______________ , Mother and Natural Guardian of _______________ , a Minor STATE OF MISSISSIPPI COUNTY OF _______ Personally appeared before me, the undersigned authority at law in and for the aforesaid jurisdiction, _______________ , who, after being first duly sworn, acknowledged herself to be the mother and natural guardian of _______________ , a minor, and further states on oath that the matters and facts set forth in the foregoing Petition are true and correct as therein stated. _________________________________ _______________ SWORN to and subscribed before me, this the ______ day of ________________,20 ___ . _________________________________ NOTARY PUBLIC My Commission Expires: ______________________ Of Counsel: _______________ - SBA # _______ _______________ _______________ _______ , MS _______ Telephone No.: ( ___ )- _______ IN THE CHANCERY COURT OF THE _______ JUDICIAL DISTRICT OF _______ COUNTY, MISSISSIPPI IN THE MATTER OF _______________ , A MINOR NO. _______ ORDER AUTHORIZING _______________ , CUSTODIAN OF _______________ , A MINOR, TO RECEIVE PAYMENT OF INSURANCE PROCEEDS This cause came on this day to be heard on the Petition of _______________ , mother and natural guardian of _______________ , a minor, pursuant to Section 93-13-211, Mississippi Code of 1972 , as amended, and the Court having considered the matter, finds the following: 1. That Petitioner, _______________ , is an adult resident citizen of the _______ Judicial District of _______ County, Mississippi, and resides at _______ , _______ , _______ , Mississippi _______ . 2. That Petitioner is the mother and natural guardian of _______________ , a minor, who is _______ ( ___ ) years of age and resides with the Petitioner. 3. That on _______ ___ , 20 ___ , an insurance policy in the amount of _______ Dollars ($ _______ ) was issued on the life of _______________ by _______________ Life Insurance Company, being Policy No. _______ . The beneficiary of said policy was _______________ , granddaughter of _______________ . 4. That _______________ died on _______ __ , 20 ___ . That at the time of the death of _______________ , said insurance policy was still in existence and the proceeds are payable to _______________ , a minor. 5. That the proceeds from said insurance policy should be paid to Petitioner as custodian of said minor, _______________ , and that the proceeds should be placed in a Federally insured bank with Petitioner as custodian under the Mississippi Uniform Gifts to Minors Act. IT IS, THEREFORE, ORDERED, ADJUSTED AND DECREED as follows: 1. That _______________ , as Custodian of _______________ , a minor, be and is hereby authorized to accept payment of the aforesaid life insurance proceeds from the _______________ Life Insurance Company with regard to Policy No. __________ . 2. That Petitioner be and is hereby authorized and directed to place said insurance proceeds in a Federally insured bank in the name of Petitioner as Custodian for _______________ , a minor, under the Mississippi Uniform Gifts to Minors Act. 3. That upon payment as aforesaid the _______________ Life Insurance Company shall be relieved of any further liability with regard to said policy in accordance with Section 93-13-211, Mississippi Code of 1972 , as amended. SO ORDERED, ADJUDGED AND DECREED this the ______ day of _______ , 20 ___ . ____________________________________ C H A N C E L L O R Of Counsel: _______________ - SBA # _______ _______________ _______________ _______ , MS _______ Telephone No.: ( ___ )- _______