MC­357 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): 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 EX PARTE CASE NUMBER: 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 The person whose funds are to be withdrawn (name): a. a minor.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): is b. Father (name, address, telephone number): 5. Petitioner brings this petition as (indicate capacity): a. trustee. b. custodian. c. parent. d. guardian. e. conservator. 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, 7.954 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com MC­357 CASE NAME: CASE NUMBER: 6. e. Previous withdrawals from this account (select one): (1) (2) None. 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 Continued (provide information relating to each additional account from which funds are to be withdrawn on a separate attachment designated as Attachment 6). 7.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. Other (describe): b. 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 MC-357 [Rev. January 1, 2007] PETITION FOR WITHDRAWAL OF FUNDS FROM BLOCKED ACCOUNT Page 2 of 2