SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION _________ GDN _________ In re Estate of ________________________________ Minor PETITION FOR AUTHORITY TO INVEST OR FOR APPROVAL OF INVESTMENT PLAN OR PROGRAM 1. Guardian of the estate of the minor hereby requests, in accordance with [ [ 2. ] ] Permission to invest $______________________ as detailed below, or Permission for approval of an investment plan as detailed below. Superior Court, Probate Division Rule 222: In support of this request, petitioner provides the following information: a. Age of minor: ___________________________________________________________________ b. Residence of minor: ___________________________________________________________________ c. Total current assets of minor: ___________________________________________________________________ d. Annual income of minor: ___________________________________________________________________ e. Ending balance of last approved account: ___________________________________________________________________ 3. Details concerning the type of investment requested or the investment plan proposal are as follows: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 4. If approved by the Court, this investment or investment plan is expected to benefit the minor as follows: ___________________________________________________________________ March 2014 ­ 809.10.v2 American LegalNet, Inc. www.FormsWorkFlow.com ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 5. Attached are the following documents in support of this petition: ___________ ___________________________________________________________________ ___________________________________________________________________ _______________________________________ Signature of filer _______________________________________ Typed name of filer _______________________________________ Address (actual address/not Post Office Box) _______________________________________ _______________________________________ _______________________________________ Telephone number _______________________________________ Email address _______________________________________ Unified Bar number (if filer is an attorney) VERIFICATION I ____________________________, being first duly sworn, on oath, depose and say that I have read the foregoing pleading by me subscribed and that the facts therein stated are true to the best of my knowledge, information, and belief. _________________________________ Signature of petitioner Subscribed and sworn to before me this ____ day of _________________, 20__. _________________________________ Notary Public/Deputy March 2014 ­ 809.10.v2 American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF SERVICE I certify that on the ____ day of ____________________, 20____, a copy of this filing was either eServed in accordance with the provisions of Administrative Order 13-15 or served by first class mail, postage prepaid, on the following persons (list names and complete mailing addresses): ________________________ Signature March 2014 ­ 809.10.v2 American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION _________ GDN_________ In re Estate of ________________________________ Minor ORDER REGARDING PETITION FOR AUTHORITY TO INVEST OR FOR APPROVAL OF INVESTMENT PLAN OR PROGRAM Upon consideration of the Petition for Authority to Invest or for Approval of Investment Plan or Program filed on ______________________________, 20__, by _____________________________, it is hereby this _____ day of _____________, 20__, [ ] ORDERED that the petition is granted and that ___________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Provided that this order authorizing investments under Superior Court, Probate Division Rule 5 shall not constitute Court approval of the particular investments nor shall the fiduciary be relieved from any fiduciary responsibility for having made the investments. [ ] ORDERED that the petition is denied. ____________________________ JUDGE See attached list. March 2014 ­ 809.10.v2 American LegalNet, Inc. www.FormsWorkFlow.com cc: March 2014 ­ 809.10.v2 American LegalNet, Inc. www.FormsWorkFlow.com