CIRCUIT COURT OF CLAY COUNTY, MISSOURI PROBATE DIVISION No. CV Matter of , *minor, *disabled. APPLICATION TO SPEND PROTECTEE’S FUNDS As Conservator of the above named estate, I hereby state to the Court that it is reasonable, necessary, and in the best interest of the Protectee to spend up to $ . The specific facts justifying the expenditures are: . WHEREFORE, I request an order of the Court authorizing the above expenditures. Dated: Signature of Conservator THE STATEMENTS AND REPRESENTATIONS IN THIS DOCUMENT ARE MADE UNDER OATH AND ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THEY ARE MADE SUBJECT TO THE PENALTIES OF MAKING A FALSE AFFIDAVIT OR DECLARATION. ORDER ALLOWING EXPENDITURES The Court considers the above application and authorizes the expenditures up to $ . Dated: JUDGE Form 411 Revised 4/23/03 Clerk Page 1 of 1 American LegalNet, Inc. www.USCourtForms.com