JDF 869 SC R 9/18 ORDER RE: MOTION TO WITHDRAW FUNDS FROM RESTRICTED ACCOUNT District Court Denver Probate Court County, Colorado Court Address: I n the Interest of : P rotected Person /Minor COURT USE ONLY Case Number: Division: Courtroom: ORDER RE: MOTION TO W I THDRAW FUNDS FROM RESTRICTED ACCOUNT This matter comes before the c ourt on the Motion to Withdr aw Funds from Restricted Account filed on (date) . The c ourt, having reviewed the m otion and supporting documentation , and any respons es received from interested persons, enters the following o rders: T he m otion is GRANTED . The c onservator is authorized to withdraw $ from the account(s) specified in the m otion and as identified below: Name and Address of Financial Institution Account Number (last 4 - digits only) Amount to Withdraw from Account $ Total $ The c onservator is required to file a copy of the receipt (s) for the purchase with the c ourt within 10 days. No te: All c onservators are required to keep all original receipt(s). The m otion is DENIED for the following reasons: The c ourt further o rders: Date : Judge Magistrate CERTIFICATION I certify that this is a true and correct copy of the original in my custody. Date: Probate Registrar/(Deputy) Clerk of Court American LegalNet, Inc. www.FormsWorkFlow.com