Print Form Cause No. § § FORT BEND COUNTY, TEXAS, § VS. IN THE DISTRICT COURT OF JUDICIAL DISTRICT MOTION TO WITHDRAW FUNDS FOR HEALTH, EDUCATION, AND SUPPORT OF MINOR CHILD/BENEFICIARY NOTICE: ALL INFORMATION MUST BE COMPLETELY PROVIDED OR THIS MOTION WILL NOT BE CONSIDERED BY THE COURT NAME OF MINOR CHILD/BENEFICIARY: SOCIAL SECURITY NUMBER OF MINOR CHILD/BENEFICIARY: COMES NOW , Applicant herein, and respectfully requests the Court to allow withdrawal of invested funds on deposit in this cause of action for the use and benefit of the above-named Minor Child/Beneficiary. Applicant would show the Court that withdrawal of a portion of the funds currently in the registry of the court in this case is necessary for the following reasons: Purpose for Expenditure Amount Requested TOTAL $ Applicant hereby certifies that withdrawal of such funds is in the best interest of the Minor Child/Beneficiary and that all funds withdrawn will be used for the purpose(s) set out above. If Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Applicant is the parent or legal guardian of said Minor Child/Beneficiary, Applicant further certifies that there are no other funds available to provide for such necessities. It is therefore requested that this Court enter an order directing the District Clerk of Fort Bend County, Texas, to issue payment to Applicant for the sum requested to be used only for the health, education, and support of the Minor Child/Beneficiary, as specified above. WHEREFORE, premises considered, Applicant prays that the relief requested herein be granted. SUBMITTED on this the day of , 20 . , Pro Se (Applicant’s Signature) (Applicant’s Social Security Number) (Applicant’s Printed Name) (Area Code) (Telephone) (Street, City, State, Zip Code) Amount of Initial Deposit into the Registry of the Court: $ Amount of Funds Currently in the Registry of the Court: $ On this day personally appeared the above Applicant who, after being duly sworn, stated that the information contained in this Application is true and correct. SWORN TO AND SUBSCRIBED before me, the undersigned authority, by the above Applicant on this the , day of , 20 . (Notary Certificate, if appropriate) Deputy District Clerk / Notary Public REV. 1-15-2000 REV. 1-13-2009 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Cause No. ` § § VS. IN THE DISTRICT COURT OF FORT BEND COUNTY, TEXAS, JUDICIAL DISTRICT § ORDER TO WITHDRAW FUNDS (HEALTH, EDUCATION, AND SUPPORT OF MINOR CHILD/BENEFICIARY) On this the day of , 20 on to be heard the Motion of , came , Applicant, to withdraw certain funds from the registry of the court to provide for the health, education, and support of the above-named Minor Child/Beneficiary. The Court, having considered the evidence and the facts, finds that such Motion should be granted. It is, therefore, ORDERED that the District Clerk of Fort Bend County, Texas, issue payment to to be used solely for the purposes set out Applicant the sum of $ on the Motion to Withdraw Funds for Health, Education and Support of Minor Child/Beneficiary. Signed this the day of , 20 . Judge Presiding REV. 1-15-2000 American LegalNet, Inc. www.FormsWorkFlow.com