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Petition And Declaration For Withdrawal From Blocked Financial Account Form. This is a Washington form and can be use in King Local County.
Tags: Petition And Declaration For Withdrawal From Blocked Financial Account, 42, Washington Local County, King
1 2 3 4 5 6 7 8 IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON IN AND FOR THE COUNTY OF KING 9 10 In the Guardianship of: 11 _______________________, 12 13 An Incapacitated Person. 16 Case No.: PETITION AND DECLARATION FOR WITHDRAWAL FROM BLOCKED FINANCIAL ACCOUNT (PT) COMES NOW__________________, the [ ] Guardian [ ] Guardian ad Litem [ ] 14 15 ) ) ) ) ) ) Custodian of funds in the above captioned matter and petition the Court as follows: 1. Reason For Withdrawal. At this time I am seeking a Court order authorizing a withdrawal from account number (only 17 include the last four digits of the account number)______________ held at the following 18 named financial institution: ___________________________________ in the amount of 19 $__________ for the following reason or purpose(s):_______________________________. 20 OR 21 [ ] The Incapacitated Person named above is now over 18 years of age. [ ] I am the person named above. 22 23 24 OR [ ] I am the Court-appointed Guardian or Guardian ad Litem, and [ ] I am seeking to have the blocked account funds distributed and to have the 25 Guardianship terminated. 26 OR PETITION AND DECLARATION FOR WITHDRAWAL FROM BLOCKED FINANCIAL ACCOUNT- 1 12/2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.USCourtForms.com 1 [ 2 expenses or to place the assets in a new blocked account. 3 2. 4 Reason Other than the Incapacitated Person Reaching Age 18 5 6 7 ] I am seeking to have the account unblocked for the payment of court approved Documents Required To Be Submitted with Petition for Withdrawal for Any I understand that according to RCW 11.92.040(3), I am required to provide an inventory and accounting prior to the Court’s considering this withdrawal. Attached to this application is: (A) An inventory of assets which came into my hands at the time I was appointed in this proceeding; 8 (B) An accounting of all income, receipts, and expenditures received or made from the date 9 of the Inventory or the date of the last Accounting. 10 (C) If the person requesting the withdrawal is the parent of the Incapacitated Person who is 11 a minor and the reason for the withdrawal is other than because the minor reached 18 years 12 13 14 15 16 17 18 19 of age, I have completed the attached Financial Statement of my spouse and myself, which demonstrates why we are not able to pay for the item or services for which we are seeking this withdrawal. 3. Statement Regarding Repayment. The funds withdrawn [ [ ] shall not be subject to repayment, OR ] shall be repaid according to the following terms: ___________________________. I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. Signed at ________________, Washington, ___________, ____200__. 20 21 Signature Printed Name Address Telephone/Fax Number City, State, Zip Code Email Address 22 23 24 25 26 PETITION AND DECLARATION FOR WITHDRAWAL FROM BLOCKED FINANCIAL ACCOUNT- 2 12/2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.USCourtForms.com