STATE OF MICHIGAN PROBATE COURT GENESEE COUNTY OSM CODE: PWF/OUF FILE NO. PETITION AND ORDER FOR USE OF FUNDS ESTATE OF: __________________________________________________________________________ (Print name of Minor) I, ___________________________________________, am Conservator of the above-named minor’s estate, and I am petitioning the Court for permission to withdraw $_______________________ of the above-named minor’s money to be used as follows: ________________________________________________________ _______________________________________________________________________________________ I understand this money can only be used for the benefit of the above-named minor, that I must keep receipts and furnish copies or other proof to the Court that the money was properly used, and that I must account for the money when I file my Annual Account with the Court. At the present time, the above-named minor’s total assets are approximately $___________________________. If the Court approves this request, this money will be withdrawn from Account #______________________ at _______________________________________________ Bank. I declare that this Petition has been examined by me and it is true. ___________________ __________________________________________ Date Signature of Conservator __________________________________________ Address __________________________________________ City State Zip Code __________________________________________ Telephone Number *************************************************************************************** ORDER This Conservator is authorized to withdraw the amount of $________________________ from the account of the above-named minor. Access to any other funds is still restricted. Conservator shall file receipts with the Court. Date: __________________ __________________________________________ Allen J. Nelson, Judge of Probate *************************************************************************************** NOTICE TO BANK DO NOT ACCEPT ANYTHING OTHER THAN A CERTIFIED COPY OF THIS ORDER WHICH BEARS THE COURT SEAL. (8/03) Pet-Order Use Funds American LegalNet, Inc. www.FormsWorkflow.com DO NOT RETURN THE CERTIFIED COPY OF THIS ORDER TO THE CONSERVATOR ONCE THE FUNDS HAVE BEEN WITHDRAWN.