SUPERIOR COURT Docket No. , ss STATE OF MAINE DISTRICT COURT Location Docket No. Plaintiff v. REQUEST FOR WITHDRAWAL (MINOR'S SETTLEMENT) M.R. Civ. P. 17A(b)(5) Defendant TO: (Justice, Superior Court) (Judge, District Court), of the State of Maine. I respectfully ask for the approval of the court to withdraw the sum of $ from Account No. in the name of now in the Financial Institution of at for the following reason(s): , Date: By: Next Friend / Petitioner ORDER The withdrawal of $ from the above account for the above described purpose is approved (on condition that ). The withdrawal of $ from the above account is not approved for the following reason: Date: CV-060, Rev. 06/14 Page 1 of 1 Judge/Justice American LegalNet, Inc. www.FormsWorkFlow.com