[Fill in the spaces next to the instructions. Other spaces are for Court use.]SUPREME COURT OF THE STATE OF NEW YORKCOUNTY OF NASSAUPresent: Hon. Justice of the Supreme Court----------------------------------------------------------------------------x[1. Index No. & Year] ,Index No. [2. Fill in name(s)] Plaintiff(s) / PETITION FOR -against-WITHDRAWAL OF ANINFANT222S FUNDS ,[3. Fill in name(s)] Defendant(s)-----------------------------------------------------------------------------xTO THE SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF NASSAU: The petition of [4. Your name] guardian of infant [5. Insert infant name] respectfully shows tothis court: 1.Infant is [6. Insert infant age] and infant date of birth is [7. Insert infant date of birth.] 2.Infant resides at [8. Insert Infant Residence] 3.The original bank deposit was [9. Insert Amount]$ and was made on [10. Insert Date of Deposit] . 4.The petitioner received [11. Insert Amount, if none write zero] $ ,in settlement of the action for loss of services. American LegalNet, Inc. www.FormsWorkFlow.com 5.Prior withdrawals were made as follows [12. Insert prior amounts withdrawn]DateAmountReason 6.The current amount now on deposit is [13. Money on Deposit] $.7.The amount of the current withdrawal request is [14. Money requested]$. This money shall be used to pay for [15. Insert purpose, be specific.] 8. There are currently [16. Number of people] , people living in the household. They are as follows: [17. Name all people include relationship and age.]NameRelationshipAge American LegalNet, Inc. www.FormsWorkFlow.com 9. The monthly rent is [18. Insert rent amount, if petitioner owns residence, writezero] $. 10.The monthly mortgage and fixed carrying charges are [19. Insert mortgageamount, and include any utilities] $. 11.The household222s monthly income is as follows: [20. Include all income.] Father $ Mother $ Children $ Other $ 12.The family [21. Check one] does does not own any real property. 13.The family has other bank deposits in the total amount of [22. Insert all bank deposits including money market and brokerage accounts] $ 14.No prior application for the relief (the current withdrawal) have been made to thisCourt. [23. If a prior application for the current withdrawal was made state the Court,when, who made the application, the result of the application, attach a copies of theapplication and explain why you are making another application.] WHEREFORE, your petitioner respectfully asks that this court grant the reliefrequested in this petition. Petitioner Signature[24. Your signature] [25. Print Your Name] [26. Your Address] [27. City, State & Zip Code] [28. Your Phone Number] American LegalNet, Inc. www.FormsWorkFlow.com [Fill in the spaces next to the instructions.]SUPREME COURT OF THE STATE OF NEW YORKCOUNTY OF NASSAU----------------------------------------------------------------------------x[29. Index No. & Year],Index No. [30. Fill in name(s)] Plaintiff(s) / VERIFICATION-against-,[31. Fill in name(s)] Defendants(s)-----------------------------------------------------------------------------xSTATE OF NEW YORK}SS. :}COUNTY OF }[32. Insert County where papers signed and notarized][33. Insert Your Name] , being duly sworn,deposes and says: I am the [34. Insert Petitioner orRespondent] in this matter.I have read the foregoing [35. Insert the name(s) of the above documents e.g. affidavit, petition etc.] and know the contents thereof.The same are true to my knowledge, except as to matters therein stated to be alleged oninformation and belief and as to those matters I believe them to be true [36. SIGN YOUR NAME BEFORE NOTARY] [37. PRINT YOUR NAME]Sworn to before me thisday of , 20 Notary Public[38. Verification must be notarized] American LegalNet, Inc. www.FormsWorkFlow.com , Index No. / PETITION FOR [2. Fill in name(s)] -against- WITHDRAWAL OF ANINFANT222S FUNDS ,Defendant(s) Infant is Infant resides at The original bank deposit was$ 4.The petitioner received $in settlement of the action for loss ofservices. SUPREME COURT OF THE STATE OF NEW YORKCOUNTY OF NASSAUPresent:Hon. Justice of the Supreme Court----------------------------------------------------------------------------x -----------------------------------------------------------------------------xTO THE SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF NASSAU:The petition of guardianof infant respectfully shows tothis court:5.Prior withdrawals were made as followsDateAmountReason American LegalNet, Inc. www.FormsWorkFlow.com The current amount now on deposit is $.The amount of the current withdrawal request is This money shall be used to pay for 8.There are currently people living in the household. They are as follows:NameRelationshipAge 9. The monthly rent is $.10.The monthly mortgage and fixed carrying charges are $.11.The household222s monthly income is as follows: Father $ Mother $ Children $ Other $ American LegalNet, Inc. www.FormsWorkFlow.com 12.The family does does not own any real property. WHEREFORE, your petitioner respectfully asks that this court grant the reliefrequested in this petition. The family has other bank deposits in the total amount of $No prior application for the relief (the current withdrawal) ha been thisCourt. Petitioner Signature American LegalNet, Inc. www.FormsWorkFlow.com [29. Index No. & Year]Index No. / VERIFICATION SUPREME COURT OF THE STATE OF NEW YORKCOUNTY OF NASSAU----------------------------------------------------------------------------x,[30. Fill in name(s)] Plaintiff(s)-against-,[31. Fill in name(s)] Defendants(s)----------------------------------------------------------------------------x STATE OF NEW YORK} SS.:}COUNTY OF }[32. Insert County where papers signed and notarized] , being duly sworn,I am the in this matter.contents thereof.The same are true to my knowledge, except as too be alleged oninformation and belief and as to those matters I Sworn to before me thisday of , 20 Notary Public American LegalNet, Inc. www.FormsWorkFlow.com