IN THE CIRCUIT COURT OF STATE OF OREGON FOR THE COUNTY OF MARION Probate Department In the Matter of the: Conservatorship Protective Proceeding for: , A Minor Protected Person (the "child") ) ) ) ) ) Case No.: MOTION FOR RELEASE OF RESTRICTED FUNDS , ("Parent") moves the Court for an Order approving the release of restricted funds, and respectfully represents: 1. Under the terms of the order approving the personal injury settlement, the parents of Child must obtain court approval before withdrawing any money from any account holding the personal injury proceeds. 2. Parent requests authority to withdraw from (name of financial institution) Account # for the following purposes: the sum of $ Supporting documents (such as statements, estimates, invoices, etc.) are attached. 3. This request for funds is based on the following emergency 4. Although I, as a parent, have a duty to support my child, it is appropriate for the requested expenses to be paid from my child's funds because: WHEREFORE, Parent prays for an order of this Court granting authority to withdraw the sum of $ from (name of financial institution) Account # for the purposes described above. Dated: Signature of Parent We consent to this motion and waive notice and time to object: Signature of Protected Person (if age 14 or over) Print Name MOTION FOR RELEASE OF RESTRICTED FUNDS Signature of Other Parent Print Name Page 1 of 1 FC(9/22/15) American LegalNet, Inc. www.FormsWorkFlow.com