Nebraska State Court Form REQUIRED CERTIFICATE OF MAILING APPLICATION FOR WITHDRAWAL OF FUNDS CC 16:2.27 Neb. Rev. Stat. 24730-2601(10) Neb. Ct. R. 2476-1433(B)(2) Page 1 of 2 Certificate of Mailing Application for Withdrawal of Funds CC 16:2.27 Rev IN THE COUNTY COURT OF COUNTY, NEBRASKA IN THE MATTER OF Ward/Incapacitated Person/Protected Person Case CERTIFICATE OF MAILING APPLICATION FOR WITHDRAWAL OF FUNDS I, , swear or affirm, I mailed copies of the forms marked below to all interested persons* and bonding company, if any, at the addresses set forth below: Application for Withdrawal of Funds (CC 16.2.19)Notice of Hearing (received from the court after filing the NAME(S) OF INTERESTED PERSON(S) ADDRESS(ES) See attached (more names and addresses than above) Date Signature(s) of Guardian(s) and/or Conservator(s) Print or Type Name of Bar Number and Firm Name (attorneys only) Street Address/P.O. Box of Guardian(s) and/or Conservator(s)City/State/ZIP Code of Guardian(s) and/or Conservator(s) Phone E-mail AddressAmerican LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Certificate of Mailing Application for Withdrawal of Funds CC 16:2.27 Rev *Interested persons are defined as:children and spouses;future heirs if the ward/incapacitated person/protected person would die without leaving avalid will (brothers and sisters who are adults, grandparents, etc.);a trustee of any trust executed by the ward/incapacitated person/protected person;if there are no individuals defined as 223interested persons224 above, include any person ororganization named as a 223devisee224 in the ward222s/incapacitated person222s/protected person222smost recent will;after death of the ward/incapacitated person/protected person, interested person alsoincludes the personal representative of a deceased ward222s/incapacitated person222s/protectedperson222s estate, the deceased ward222s/incapacitated person222s/protected person222s heirs in anintestate estate, and the deceased ward222s/incapacitated person222s/protected person222s deviseesin a testate estate;any governmental agency paying benefits on behalf of the ward/incapacitatedperson/protected person; andany person designated by order of the court to be an interested person. If there are no interested persons identified for a ward/incapacitated person/protected person, the court shall appoint a guardian ad litem (Nebraska Supreme Court Rule 247 6-1449(B)). The cost of the guardian ad litem may be taken from the assets of the ward/incapacitated person/protected person. American LegalNet, Inc. www.FormsWorkFlow.com